Mental health assessments of looked after children “need more focus on the child”

Mental health assessments of looked after children need more focus on the child and more resources, according to the report of a pilot study published by the Department for Education.

The study was conducted following Education Select Committee concerns, in 2016, that assessment of the emotional and mental health needs of looked after children were often inadequate and ineffective.

A key element of the pilot study was to add mentalisation to assessments – described as “a set of principles to take a wider perspective, focussing on empathy, and making [the assessment] validating, attentive and curious.”

Positive results of this approach include:
• giving the child space, permission and an invitation to articulate their own perspective, leading to better conversations, and new and more valuable information about the child,
• facilitating better conversations with the child’s network,
• supporting delivery of a more child-centred assessment process,
• improving the confidence of social workers in having conversations about a child’s mental health,
• offering a therapeutic intervention in and of itself.

All sites taking part in the pilot employed a Virtual Mental Health Lead (VHML) -- a professional with a mental health background, and most were social workers.

Overall, the Virtual Mental Health Lead (VHML) was the most positive single aspect of the study. Frontline assessors said that they valued the role for the immediate access it gave to expertise in mental health, and for the improved links to child and adolescent mental health services (CAMHS). ‘It’s definitely been the key to success,’ wrote one social work manager.

However, the report says, there were only a few examples of tangible results in terms of referrals or other concrete supportive action. ‘This, in combination with the lower than hoped for quality of the written outputs, means a note of caution should be sounded about the value added by the VMHL,’ the report says.

The written outputs were the most contested aspect of the model, as the majority of sites said that the template provided was not child-centred enough.

Another, and more successful element, was to bring the child’s network into the assessment.

A foster carer said, “[the child] enjoyed the focused attention…I think it's not like if you normally have an adult come to visit and they chat to the other adults. This adult was interested in them as individuals and wasn't just interested in taking notes and ticking boxes because they didn't see any of that. [The assessor] was interested in them as people. And I think they picked up on that.”

One VMHL commented: “They [the child’s network] have that feeling that it’s really connected them to the child. It’s an emotive experience. They are in touch with something about the child that most assessments do not provide you with.”

Sites recognised the drawbacks of the Strengths and Difficulties Questionnaire (SDQ) as the single way of assessing a child’s mental health. There was consensus too that the additional tools provided to supplement the SDQs were still insufficient to give the full picture.

Furthermore, the package of tools was intimidating for practitioners without a clinical background, and some tools were not child-friendly.

All sites reported that the pilot approach was more resource intensive than standard assessment process. The additional costs were generated by each element of the pilot approach, including consultation with the child and their network, contact between professionals and producing the written output.

The report comments: “The experience from the pilot suggests that given the many pressures on local authorities at the moment they are unlikely to find the resources to invest in the new approach.”

The project involved 116 children – slow throughput, the impact of the pandemic and other factors meant that this was far fewer than the initial estimate of 350 children taking part.

As a result, the project was scaled back and findings “should be taken as being indicative of the potential impact of the programme and the pilot approach,” the report says.