1. Implementing NICE/SCIE guidance
Looked after children and young people – actions for local multi-agency partnerships
Implementing NICE/SCIE guidance
ABOUT THIS PRESENTATION
This presentation has been written to help you raise awareness of the NICE and SCIE public health guidance on promoting the quality of life of looked-after children and young people.
This presentation outlines the actions that local multi-agency partnerships should take to implement the guidance. The actions are drawn from the full recommendations in the guidance. This presentation does not include the actions that national organisations should take. For the recommendations in full, see the guidance.
The guidance is available from NICE and SCIE.
All the actions for local multi-agency partnerships are outlined in the notes for presenters in this presentation. They are also shown in the slide set hand-out. We recommend that you give copies of the slide set hand-out to your audience so that they have more information about the key points covered on each slide.
We have included notes for presenters, broken down into ‘key points to raise’, which you can highlight in your presentation, and ‘additional information’ that you may want to draw on, such as rationale or an explanation of the evidence for a recommendation.
DISCLAIMER
This slide set is an implementation tool and should be used alongside the published guidance. This information does not supersede or replace the guidance itself.
PROMOTING EQUALITY
Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.
2010
NICE public health guidance 28

2. What this presentation covers
Background
Scope
Areas for action by local multi-agency partnerships
Costs and savings
Discussion
Find out more
NOTES FOR PRESENTERS:
In this presentation we will start by providing some background to the guidance and why it is important.
We will then present the actions for local multi-agency partnerships.
Next, we will summarise the costs and savings that are likely to be incurred in implementing the guidance.
Then we will open up the meeting with a list of questions to help prompt discussion on local issues for incorporating the guidance into practice.
Finally, we will end the presentation with further information about the support provided by NICE.

3. Background
More than 60,000 children and young people are looked after in England at any time. The main reasons for becoming looked after are abuse, neglect and family dysfunction
About 60% of looked-after children and young people have mental health and emotional problems
In adulthood, a high proportion experience poor health, educational and social outcomes
NOTES FOR PRESENTERS:
Key points to raise:
Bullet 1
More than 60,000 children, roughly 40% of whom are younger than 10, are looked after by local authorities in England at any one time. Of these, 73% are in foster care, and about 13% are in residential care. The great majority of children become looked after as a result of abuse, neglect or family dysfunction .
Entering care is strongly associated with poverty and deprivation (for example, low income, parental unemployment, relationship breakdown).
Bullet 2
About 60% of looked-after children and young people have mental health and emotional problems. Frequent placement changes can severely lessen the sense of identity and self-esteem of a child or young person, and can also adversely affect their experience of, and access to, education and health services.
Bullet 3
Being looked after is an important predictor of social exclusion in adulthood. Higher than average rates of poor mental health, drug use, behaviour problems and poor educational attainment reduce prospects of employment, with significant cost to the individual and the state.
Nationally, the quality of services for looked-after children and young people is uneven .
Additional information:
The term ‘looked after children and young people’ is used in this guidance to mean those looked after by the State where the Children Act 1989 applies, including those who are subject to a care order or temporarily classed as looked after on a planned basis for short breaks or respite care.

4. Scope
The guidance covers children and young people from birth to age 25, wherever they are looked after
The recommendations cover strategy and policy, commissioning and delivery of services, and inspection
NOTES FOR PRESENTERS
Key points to raise:
Bullet 1
This guidance covers children and young people from birth to age 25, wherever they are looked after – in residential care, foster care, young offender or other secure institutions or boarding schools, or with birth parents, other family or carers, and including placements out of the area.
Bullet 2
The recommendations cover strategy and policy development, commissioning and delivery and inspection of services. The guidance includes recommendations for national and local organisations. This slide set just outlines the actions for local organisations.
The guidance does not cover healthcare or treatments for specific illnesses and conditions, or health promotion.
The guidance is for all those who have a direct or indirect role in, and responsibility for, promoting the quality of life of looked-after children and young people. This includes directors of children’s services, commissioners and providers of health (including mental health) and social care services, directors of public health, social workers and social work managers, carers (including foster carers), local authorities, schools, voluntary and independent agencies, organisations responsible for the training and development of professionals, universities and colleges, regulatory bodies and inspectorates. The guidance may also be of interest to looked-after children and young people, their families, prospective adopters and other members of the public.
Additional information:
The guidance should be implemented alongside other guidance and regulations including:
‘Statutory guidance on promoting the health and wellbeing of looked after children’ (Department for Children, Schools and Families and the Department of Health 2009)
‘The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review’ (HM Government 2010).

5. Areas for action Strategic planning of services
Care planning, case review and placements
Supporting babies and young children, and siblings
Assuring the quality of foster and residential care
Personal preferences, identity and diversity
Health records and information
Improving educational outcomes
Preparing for independence
Training
We have divided the actions for local multi-agency partnerships into these general areas.

6. Strategic planning of services
Assess needs during the joint strategic needs assessment and show how these will be met in local plans
Provide dedicated multi-agency services for looked- after children and young people on one site
Publish a directory of local services and resources
Reflect issues raised by the children-in-care council in the yearly ‘pledge’ to looked-after children and young people
NOTES FOR PRESENTERS:
Actions:
Bullet 1 – recommendation 1
Local multi-agency partnerships should ensure that the needs of looked-after children and young people as a group are assessed during the joint strategic needs assessment.
Local plans and strategies for children and young people’s health and wellbeing should show how the needs of looked-after children and young people and care leavers will be met, and how to provide services to meet needs for emotional health and wellbeing, and improve stability of placements and education.
Provide an annual report to the children-in-care council, the overview and scrutiny committee, the NHS commissioner and the leader of the council.
Bullet 2 – recommendations 2 and 8
Commissioners of healthcare services and local authority services should use information from the joint strategic needs assessment to decide what services to commission.
Commission services to meet physical and emotional health needs, preferably on the same site. Services should be easily accessible to children and young people, and have good links with universal services. The team should include children’s services professionals, CAMHS and education specialists.
The team should also include a specialist mental health practitioner to support young people who may not meet the threshold for adult mental health services, and to link to leaving care teams and adult mental health services.
The service should provide outreach support to carers, schools, residential homes, secure accommodation and leaving-care services.
Bullets 3 and 4 – recommendation 1
Local multi-agency partnerships should publish a map that identifies all agencies that are involved with looked-after children. They should also publish a directory of resources for social workers and a resource guide for looked-after children and care leavers.
Local authorities should reflect issues raised by the children-in-care council in their yearly ‘pledge’ to looked-after children.

7. Care planning and case review
The multi-agency team should have access to a consultancy service to support collaboration on complex casework
Any concerned professional should be able to request a review of the care plan
The looked-after child or young person should also be able to request a review
Develop an information-sharing protocol
NOTES FOR PRESENTERS:
Actions:
Bullet 1 – recommendation 6
The multi-agency ‘team around the child’ should have access to a consultancy service to help them manage conflicting views about what is in the best interests of each looked-after child or young person, and help them resolve difficult situations (like repeated placement breakdown or exclusion from education).
This service could be provided in-house, by an external consultancy or by child and adolescent mental health services, and should participate in support networks.
Bullets 2 and 3 – recommendation 7
Ensure that any professional who considers that the needs of a child or young person are not being met can request a review of the care plan before the date of the next statutory review.
A looked-after child or young person should also be able to request a review. It is important that they are consistently reminded about this.
Bullet 4 – recommendation 21
Consider introducing an information-sharing protocol, addressing legal and confidentiality issues, to assist information flow between health and social care.

8. Planning placements Develop a placement strategy
Placements with family and friends should be promoted as a positive choice
Ensure there are pooled budgets for specialised care placements
NOTES FOR PRESENTERS:
Actions:
Bullet 1 – recommendations 12, 15, 29 and 30
Develop a strategy to identify suitable placements for looked-after children and young people, covering foster care, residential care, care provided by family and friends and secure accommodation, and how placements will be made if they are not available in the local authority area.
The strategy also needs to cover sibling co-placement and contact and show how any shortage of placements for sibling groups will be addressed – for example through specifically recruiting foster families for sibling groups, meeting the additional financial and housing needs of foster carers, and commissioning homes for small family groups.
Develop a diversity profile and use it to ensure that a sufficiently diverse choice of placements is available.
Bullet 2 – recommendation 40
Placements with family and friends should have equal status to other placement choices.
Train social workers to support care provided by family and friends.
Identify family and friends who could be carers, and assess their suitability.
Give financial and emotional support to carers who are family and friends, including opportunities for short breaks.
Bullet 3 – recommendation 12
Ensure there are pooled budgets for looked-after children who are likely to require highly specialised care placements for a significant period.
Develop a protocol for sharing payment for placements that have a healthcare component.

9. Placement changes
Base decisions on changing placements on an assessment of the current needs of the child or young person, and consider their wishes and feelings
Monitor the number of decisions where placement moves are made against the wishes of the child or young person, including the reasons
Monitor the number of emergency placements to understand why they happen and how they can be reduced
NOTES FOR PRESENTERS:
Actions – recommendation 13:
Bullet 1
Decisions on changing placements should be based on an assessment of the needs of the child or young person, and not because of poor planning and resource shortfalls.
Take into account the wishes and feelings of the child or young person, record the reasons for decisions that are not in accord with their wishes and feelings, and fully explain them to the child or young person. Ensure the child or young person is aware of their right to access advocacy services when a review decision is likely to overrule their wishes and feelings, and given enough notice to arrange for an advocate to support them in the review meeting.
Ensure the child or young person gets to know their new carers and placement through prior visits and wherever possible overnight stays.
Bullet 2
Monitor the number of decisions where placement moves are made against the wishes of the child or young person, including the reasons for these moves.
Bullet 3
Monitor the number of emergency placements with the aim of understanding why they happen and reducing their frequency, as they can lead to placement instability.

10. Supporting babies and young children
Carry out a comprehensive assessment
Specialist services should: – provide support and training to carers and frontline practitioners – work with the child and carer to support secure attachments
Put the impact of loss of attachment at the centre of the decision when deciding on placement change
Use ‘twin tracking’ when appropriate
NOTES FOR PRESENTERS:
Actions:
Bullet 1 – recommendation 16
Ensure there are comprehensive assessment processes to identify needs early. Ensure assessments are conducted by appropriately trained healthcare professionals (such as health visitors, paediatricians, psychologists and nurses for looked-after children), and include the views of people who have day-to-day contact with the baby or young child.
Ensure that interventions recommended by assessments are included in the healthcare plan and continue to be delivered if babies or young children move to different placements.
Bullet 2 – recommendations 17 and 18
Ensure front-line practitioners have access to specialist services (including dedicated CAMHS teams) that have practitioners with a good understanding of the emotional, physical and development needs of babies and young children, provide consultation and training to carers and frontline practitioners, and work directly with the child and carer.
Ensure that all carers and practitioners who work with babies and young children receive training from specialist providers on issues such as attachment, and the needs of babies and young children with prenatal substance exposure or development problems.
Bullets 3 and 4 – recommendations 5 and19
Ensure assessment of emotional welfare and the impact of loss of attachment are primary considerations in a decision to make a placement change, including a move to permanent carers. Take into account previous placement instability.
Give serious consideration to a foster carer’s desire to adopt a child.
Consider returning the child to a previous stable placement if an adoption breaks down.
Ensure alternative placements are available (‘twin tracking’) if assessments of current carers are unsatisfactory and there is uncertainty about reunification with birth parents. This might include approving carers as both foster carers and prospective adopters.
When deciding whether rehabilitation with birth parents is a possibility, give particular attention to the reasons why any siblings have been placed in care or been adopted.

11. Siblings Siblings should have the same social worker if possible
Place siblings together unless assessments or the wishes of the child or young person suggest otherwise
When decisions are made to separate siblings: – record the reasons and explain them to the children – plan for ongoing contact if appropriate
NOTES FOR PRESENTERS:
Actions – recommendation 15:
Bullet 1
Siblings should have the same social worker. Establish a clear communication plan if they have different social workers.
Bullet 2
Ensure contact orders made by a court are followed, and place siblings together unless assessments or the wishes of the child or young person suggest otherwise.
Bullet 3
When decisions are made to separate sibling family groups: – record the reasons and explain them to the child or young person – make plans for and manage ongoing sibling contact according to the wishes of the child or young person.
Additional information:
Siblings include siblings who are adopted, those who share one birth parent, and step-brothers and stepsisters. Siblings may also include those who are not looked after, and ‘sibling-like’ relationships that develop in a care setting.

12. Assuring the quality of foster and residential care – 1
Training should cover:
Parenting skills, child development and attachment
Transitions, stability and how to manage change
Meeting needs for physical affection
Educational stability and achievement
Good health and healthy relationships
Joint working with all agencies
Extracurricular activities
NOTES FOR PRESENTERS
Actions – recommendation 36:
Ensure foster and residential carers receive training that:
covers parenting skills
includes psychological theories of infant, child and adolescent development
develops understanding of how to develop secure attachment (according to attachment theory) for babies and young children (see also recommendations 16–19)
develops understanding of the impact of transitions and stability on a child or young person, and how best to manage change and plan age-appropriate transitions, including preparation to leave care
develops knowledge and awareness of how to safely meet the child or young person’s needs for physical affection and intimacy within the context of the care relationship
develops knowledge and understanding of the education system, educational stability and encouraging achievement
develops knowledge and awareness of how to promote, improve or maintain good health and healthy relationships
promotes joint working practices with people from all agencies involved in the care of looked-after children and young people
develops understanding and awareness of the role of extra-curricular activities for looked-after children and young people
provides a good understanding of how the absence of appropriate physical and emotional affection, or different forms of emotional and physical abuse, affect a child or young person’s psychological development and behaviour.

13. Assuring the quality of foster and residential care – 2
Support for foster carers should include:
emotional support and parenting guidance
advice as part of the team ‘around the child’
child care to help them attend training
additional support until training is complete, and when there are additional challenges
their own children in all support
help with stress and for emergencies
health promotion advice
information about leisure activities
NOTES FOR PRESENTERS:
Actions – recommendation 37:
Ensure foster carers and their families receive support that includes:
emotional support and parenting guidance
ensuring foster carers are included in the ‘team around the child’ that is receiving advice to support collaborative, multi-agency working on complex casework (see recommendation 6 on multi-agency working)
ensuring that childcare arrangements are in place to enable foster carers to attend training
ensuring that foster carers receive additional supervision, support and monitoring until foster care training is completed
ensuring children of foster carers are included when support is offered to foster care families
enabling foster carers to recognise and manage stress within their family (in its broadest sense, for example, everyday pressures on family life) to avoid placement breakdown
providing out-of-hours emergency advice and help in calming and understanding emotions and handling challenging behaviours to support stability
giving ongoing health promotion advice and help such as how to provide a healthy diet
providing information about the role and availability of creative and leisure activities for looked-after children and young people.

14. Individual preferences and personal identity
Promote continued contact with people important to the child
Ensure access to hobbies and interests
Offer assertiveness training to promote esteem and safety
Promote life-story work
NOTES FOR PRESENTERS:
Actions:
Bullets1 to 3 – recommendation 24
Promote continued contact with people important to the child (for example former carers, siblings, family members, friends and professionals).
When this is not possible acknowledge the significance of losing these relationships.
Allow contact with family members to diminish when this is in the best interests of the child.
Ensure access to hobbies and interests to encourage overall wellbeing and self-esteem.
Offer assertiveness training to promote esteem and safety and help to combat bullying.
Bullet 4 – recommendation 25
Ensure that policies and activities are in place to allow each child and young person to explore their personal identity, including their life story.
Life-story information should be delivered to the child or young person by an individual that the child trusts. Carers should be supported to answer questions about the child or young person’s personal history.
Take account of the developmental stage and emotional needs of the child when planning the timing and the extent of information that is given at any one time.
Life-story work should be viewed as an ongoing process.
Life-story information should include written information such as ‘later in life’ letters (usually written by a social worker, setting out the child’s early history and why they became looked after), letters from former carers, life-story books and visual records of celebrations, achievements and other events (such as birthdays, cultural events and holidays).
Life-story discussion should include the child’s personal journey before and through care, information about family members, personal and family health history, culture and faith and sexual identity and orientation.

15. Diversity – strategic actions
Produce a local diversity profile, and use this to commission services
Consider setting up a multi-agency panel
Ensure the children-in-care council discuss children and young people with particular needs regularly
Consult looked-after children and young people
Share good practice with similar areas
Appoint a local diversity champion
NOTES FOR PRESENTERS:
The actions in this section aim to help looked-after children and young people who are from black and minority ethnic communities, have physical or learning disabilities, are lesbian, gay, bisexual or transgender, are an unaccompanied asylum seeker with looked-after status, are from travelling communities, or belong to a faith group.
Actions:
Bullet 1 – recommendations 29 and 30
Produce a diversity profile of the local population of looked-after children and young people.
Use this when commissioning services and when planning training and development for the workforce.
Ensure there is a sufficiently diverse range of placements available.
Understand the issues affecting the children and young people listed above, including the impact of discrimination, and any health, culture, identity, education and placement needs.
Bullets 2 to 5 – recommendation 27
Consider setting up a multi-agency panel tailored to local needs to discuss particular requirements and placement choices for these groups of looked-after children and young people.
Ensure children-in-care councils include discussion of children and young people with particular needs as a standing agenda item.
Ensure that children and young people with particular needs are consulted about their experiences of services.
Network and share good practice with other local authorities with a similar profile of children and young people. Consider secondments of key staff to local authorities where good practice is recognised.
Bullet 6 – recommendation 28
Appoint a local diversity champion with strategic and leadership responsibilities to increase awareness of the children and young people with particular needs, and act as an advocate.
This person should report to and be accountable to the director of children’s services, and report to and engage with the children-in-care council.

16. Diversity – actions for service delivery
Consider cultural, religious, ethnic and language issues in core assessments and care plan reviews
Create links with community and peer support
For unaccompanied asylum-seeking children and young people, ensure access to specialist psychological services
Provide support and training to professionals and carers about diversity issues
NOTES FOR PRESENTERS:
Actions:
Bullet 1 – recommendation 31
Ensure core assessments include a picture of the child or young person’s cultural, religious and ethnic identity and needs and pay particular attention to race, language, faith and diet. Care plan reviews should reflect how these might change as the child grows and matures.
Bullet 2 – recommendations 33 and 34
Ensure that unaccompanied asylum-seeking children who are looked after have access to peer group support, religious and community groups, and to interpreters if needed.
Create links with community support groups for black and minority ethnic children and young people, and access to interpreters if needed.
Bullet 3 – recommendation 10
Ensure that unaccompanied asylum-seeking children and young people have access to specialist psychological services (including CAMHS) that have the skills and expertise to address their particular health and wellbeing needs, including post-traumatic stress, dislocation from country, family, culture language and religion, risk of sexual exploitation, lack of parental support and advocacy in a foreign country, stress related to the immigration process, physical and emotional trauma from war and disruption at home such as torture, beatings, rape and death of family members, and an increased risk for suicide and serious mental illness.
Bullet 4 – recommendations 26, 33, 34
Provide all professionals and managers with training and access to expertise in diversity issues.
Provide support and training to foster carers and residential staff on issues affecting unaccompanied asylum-seeking children and young people. Ensure all professionals who work with this group understand cultural differences in attitudes to health and wellbeing.
Provide practitioners and managers with training and resources to understand the complexity of racism for black and minority ethnic looked-after children and young people.

17. Health records and information
Collect data on the child’s and parents’ health using forms such as those provided by the British Association of Fostering and Adoption
Share health information about the child as appropriate and ensure that the personal health record follows the child up to the age of 18
Obtain appropriate consent for all healthcare interventions
Obtain appropriate permission to access healthcare information
Put a system in place to monitor, and address failure to obtain, permission or consent for health matters
NOTES FOR PRESENTERS:
Actions:
Bullet 1 – recommendation 25
When a child or young person first becomes looked after, consider using forms such as those provided by the British Association of Fostering and Adoption to collect data on the child’s and parents’ health.
Bullet 2 – recommendations 21 and 22
Ensure health information about the child or young person is shared, as appropriate.
Ensure that the personal health record (red book) follows the child or young person up to the age of 18.
Ensure that if a personal health record is lost, it is replaced and that the issuer incorporates historic information.
Ensure that a contact person is identified to manage the administration of the personal health record.
Bullet 3 – recommendation 21
Ensure that there is a process for social workers to obtain consent for statutory health assessments, routine screenings and immunisations.
Ensure that parental or delegated consent is given to health professionals if they are scheduled to carry out a medical or surgical procedure on a looked-after child or young person.
Bullet 4 – recommendation 21
Ensure social workers obtain permission to access information on the child or young person’s health history or that of their birth parents.
Bullet 5 – recommendation 21
Ensure that a system is in place to monitor, and address failure to obtain, permission or consent for health matters.

18. Improving educational outcomes
Appoint a virtual school head to work with schools to maximise the educational potential of looked-after children and young people
Ensure designated teachers are involved in preparing and monitoring PEPs, IEPs and PSPs
Support young people to apply for and attend college and university. In particular provide: – help finding accommodation, including holidays – advice on financial support
NOTES FOR PRESENTERS:
Actions:
Bullet 1 – recommendation 43
Appoint a virtual school head to work with schools to maximise education potential for looked-after children and young people, maintain a record of all looked-after children and young people educated out of the area and the adequacy of their education, and maintain a record of all pupils on part-time timetables and monitor their appropriateness.
Bullet 2 – recommendation 42
Designated teachers for looked-after children should be involved in preparing and monitoring personal education plans (PEPs), individual education plans (IEPs) and pastoral support plans (PSPs) which set out children and young person’s education needs.
They should also engage with the child or young person’s social worker and carer.
Bullet 3 – recommendation 44
Provide support to young people during the application process for college or university and throughout their time there.
Ensure they have access to financial support including the bursary currently available for looked-after young people who go to university.
Ensure good quality accommodation, including return to carers, is guaranteed for the duration of the course, including holidays.
Continue to provide practical and emotional support after the young person has left education until they are ready to be independent.
Additional information – recommendation 45
Universities and colleges should work to attain the Frank Buttle Trust quality mark, which recognises higher education institutions that provide additional targeted support to students who have been looked after.

19. Preparing for independence
Ensure there is an effective and responsive leaving-care service. Consider a one-stop shop
Establish protocols with housing, health and adult social care to identify care leavers as a priority group
Enable young people to remain in their foster or residential home beyond the age of 18
Ensure young people are not moved from a secure or custodial placement into independence too soon
NOTES FOR PRESENTERS:
Actions:
Bullet 1 – recommendation 47
Ensure that there is a leaving care service that meets care leavers’ needs, covering accommodation, education, employment, cultural, leisure, and community activities, emotional and mental health support, personal relationships, money management, sexual health, substance misuse, advice on general health issues, support to maintain contact with people important to the young person.
Consider a one-stop shop approach to providing services to care leavers.
Bullet 2 – recommendations 46 and 49
Establish protocols with housing, health and adult social care so that young people leaving care are a priority group for accessing adult services. Ensure the young person’s pathway plan identifies the support that should be in place when they do not meet the thresholds for adult social care or mental health services.
Bullet 3 – recommendation 46
Give young people the option to remain in their foster or residential home after age 18.
Allow those who experience difficulty moving to independent living to return to the care of the local authority, including to the previous placement if available.
Enable care leavers to stay in supported housing until they are ready to leave. They should not have to leave after a set period of time or at a predetermined age.
Bullet 4 – recommendation 14
Ensure that a child or young person is not moved from a secure or custodial placement into independence or semi-independence any sooner than if they had another type of placement.
Additional information – recommendation 48
Ensure that all available details of the young person’s medical history are discussed at their final statutory health assessment. If a young person does not attend their final health assessment, they should be offered a written copy of their medical history.

20. Training for supervisors
Ensure social workers and managers who supervise carers have training on:
identifying support needs
how to support carers
recognising stress or secondary trauma
when to refer a child for professional assessment or intervention
the additional needs of carers of children with vulnerabilities
NOTES FOR PRESENTERS:
Actions – recommendation 38:
Ensure all social workers and managers who undertake direct supervision of carers receive training that includes:
identifying support needs
how to support carers and develop their self-awareness and self-care skills
recognising signs of stress or secondary trauma
an understanding of when a child or young person needs to be referred for professional assessment or intervention (see recommendation on promoting mental health and wellbeing)
awareness of any additional support and information needed for carers of children and young people with particular vulnerabilities such as unaccompanied asylum seekers and those with special needs.
Additional points from recommendation 38
Ensure that social workers and managers provide support for cross-cultural placements (see recommendations 26–34).
Ensure that social workers and managers support sibling placements and contact between siblings and family members (see recommendation 15).

21. Independent reviewing officers
Provide independent reviewing officers with training on: – the education system and the importance of a stable education – evaluating health assessments and education plans – holding professionals accountable – how to motivate other professionals – the importance of creative and leisure activities
Monitor the quality of independent reviewing officer service
NOTES FOR PRESENTERS:
Actions:
Bullet 1 – recommendation 52
Ensure all independent reviewing officers undertake a core training module which includes all issues identified in recommendation 50 and which also covers:
– the educational system (including the special needs process) and its structure, and the impact of moving schools and part-time timetables on confidence and attainment
– the importance of a stable education and how to provide it
– monitoring and evaluating the quality of health assessments, personal education plans (PEPs), personal education allowances (PEAs), individual education plans (IEPs) and pastoral support plans (PSPs)
– holding professionals accountable for decisions taken at a case review and ensuring all relevant recording is of sufficient quality to describe the interventions required
– understanding the implications of policy and legislation about looked-after children and young people
– motivating and influencing others within care agencies and schools to develop effective support for looked-after children and young people
– understanding the importance and impact of extra-curricular creative and leisure activities for looked-after children and young people.
Monitor the quality of training content and its delivery, and evaluate its impact on the quality of education and care of looked-after children and young people. Feed the outcomes into future planning and delivery of courses.
Bullet 2 – recommendation 52
Ensure the independent reviewing officers service is monitored for quality.

22. Costs and savings
Likely immediate costs to the NHS, arising from: – delivery of and providing earlier access to services to promote emotional wellbeing and mental health
Possible cost savings in the short and long term, arising from: – avoiding placement breakdown – reduced risk of mental health problems – reduced rates of offending – increased employment opportunities
NOTES FOR PRESENTERS:
Bullet 1
It has not been possible to produce a national estimate of costs and saving associated with implementing this guidance, because each locality’s needs for looked-after children and young people will differ. However, organisations may incur additional costs at local level when implementing changes in the way services are delivered, particularly in these areas:
Supporting mental health and wellbeing (recommendations 35 to 38 and 49)
Physical health (recommendations 20 to 23)
Supporting education (recommendations 41 to 45)
Preparing for independence (recommendations 46 to 49)
Bullet 2
However, investing in early intervention, prevention, training and taking a collaborative, multi-agency approach could lead to a significant reduction in costs in both the short term and the longer term, as described in the slide.

23. Discussion
How can we ensure access to a consultancy service for complex casework?
How comprehensive is our placement strategy?
How effective are we at managing placement moves?
What support and training do we need to provide for professionals and carers?
How can we improve education services for looked after children?
NOTES FOR PRESENTERS:
These questions are suggestions that have been developed to help provide a prompt for a discussion at the end of your presentation – please edit and adapt these to suit your local situation.
Bullet 1
How can we ensure access to a consultancy service for complex casework? (see slide 7).
Bullet 2
How comprehensive is our placement strategy? Does it cover care provided by family and friends and sibling co-placement, does it promote residential care as a positive choice, will it lead to sufficient diverse placements? (see slide 8)
Bullet 3
How effective are we at managing placement moves? Are we monitoring the number of emergency placement moves and those that were made against the wishes of the child so that they can be reduced in the future? (see slide 9)
Is primary consideration given to the impact of loss of attachment in a decision about placement changes to babies and young children? (see slide10)
Do we allow young people to remain in their residential, foster or supported housing placement until they are ready to leave and move on to independence? (see slide 19)
Bullet 4
What support and training do we need to provide for foster and residential carers (see slides 12 and 13), supervisors (see slide 20) and independent reviewing officers (see slide 21)?
Bullet 5
How can we improve education services? Do we have a virtual school head to monitor the quality of education? Do designated teachers for looked-after children help to prepare and monitor PEPs, IEPs and PSPs? (see slide 18)

24. Find out more Visit www.nice.org.uk/PH28 for: the guidance
the quick reference guide
costing report
self assessment tool
guide to resources
Visit for Social Care TV films about looked-after children and young people
NOTES FOR PRESENTERS:
You can download the guidance documents from the NICE and SCIE websites.
The guidance itself, which includes all the recommendations in full plus considerations and evidence statements.
A quick reference guide, which gives an overview of the areas covered in the guidance.
For printed copies of the quick reference guide, phone NICE publications on or and quote reference number N2317.
NICE has developed tools to help organisations implement this guidance, which can be found on the NICE website:
Costing report – details of the likely costs and savings.
Self assessment tool – for monitoring local practice.
Guide to resources – to signpost to practical resources that will help organisations to implement the guidance.
The SCIE website has Social Care TV films about looked-after children and young people, and other tools to help implementation .