Background to the Research

• Although systems are in place to promote the physical health needs of LAC, the mental health of LAC in NI is not routinely assessed either upon entering the care system or during their period in care. Many children only receive help when difficulties become entrenched and more intensive treatment is required. The Department of Health, Social Services and Public Safety has recommended ''systematic assessment of the psychological and emotional needs of children on the edge and LAC''.
• The SDQ is a tool which can be used in everyday practice by social workers and has been utilised in a small-scale study of mental health need with LAC in another Trust in NI.
  

Research Approach

• A focus group approach was used to ascertain the views of frontline social workers, senior practitioners, senior social workers and principal officers involved directly with LAC as to the usefulness of the SDQ in informing Care Plans for these children. Prior to the focus groups, SDQ screening was undertaken with 76 carers, 64 teachers and 31 children aged 11+. The findings were provided for consideration at each child's LAC review.
• A file audit conducted pre and post-SDQ assessment was also undertaken to ascertain whether SDQ assessment had informed the child's LAC Review and identified further service need.
  

Main Findings

• Multi-informant SDQ assessments found that 56% of carers, 39% of teachers and 30% of children aged 11+ considered that the child had some or significant difficulties in all the domains. 40% of carers, 37% of teachers and 9% of children indicated that these difficulties were definite or severe, with 63% of carers, 35% of teachers and 45% of children stating these difficulties had been present for over a year.
• Impact scores were also high, with 33% of carers, 30% of teachers and 14% of children indicating that these difficulties were having a significant impact on the child's life. Of the 5-10 year olds assessed, 81% may have a psychiatric disorder that is probable in 45%. Of the 11-15 year olds assessed, 61% may have a psychiatric disorder that is probable in 39%.
• Participants spoke freely about their experiences of receiving SDQ Screening Reports for consideration at LAC Reviews. All commented positively on the benefits arising out of these assessments.
• Case examples were shared relating to children who were placed with parents as part of a rehabilitation plan and how the SDQ assessments from all showed clearly that they were not experiencing any significant difficulties. This demonstrable progress contributed to the LAC Review decision to seek revocation of the Care Orders for two of these children.
• Further examples were shared concerning a child becoming involved in the Leaving and After Care Service, and while the SDQ accurately identified known difficulties, it also highlighted particular strengths, hitherto not so evident, that would really help this young person in the future if further promoted/developed.
• Practitioners shared how completing SDQs had enabled carers, teachers and young people to say how things really were for them and to reveal often previously hidden problems. Practitioners agreed that SDQs, in focusing on specific issues relating to a child's difficulties and strengths, enabled/required respondents to give a realistic response.
• Practitioners working with Children with Special Needs spoke of the usefulness of the SDQs for their client group.
• There was a consensus regarding the usefulness of teacher-completed SDQs, which, in a number of cases, highlighted some children who were experiencing few difficulties in school but significant difficulties at home, thus enabling support to be targeted there. Other comments related to the usefulness of the tick-box SDQ form that asks specific questions.
• Participants highlighted the usefulness of foster carer SDQs, including giving a more holistic picture of a child's functioning.
• Participants, in considering the way ahead, highlighted the difficulties they experienced when they received SDQ Assessment Reports immediately prior to the LAC Review. Almost everyone would like to have more time to reflect on the assessment, consult informally with the SDQ Assessor, and plan the way ahead involving children, parents, carers, teachers and others before the LAC Review. Some suggested that the SDQ Assessor could attend LAC reviews. The involvement of Link Social Workers in promoting the mental health needs of LAC with carers was also highlighted as essential.
• Almost all participants highlighted their training needs in understanding LAC mental health as well as SDQ scores, particularly in relation to indicators of psychiatric disorder. It was suggested that such training would need to become part of the annual training programme if SDQ screening is adopted as part of services for all LAC.
• Participants also highlighted concerns regarding: further assessment needs; a need for help from Tier 3 Specialist Child and Adolescent Mental Health Services; addressing attachment difficulties; promoting resilience; evidenced-based training for carers; a dedicated Child and Adult Mental Health Service for LAC; and further SDQ screening.
  

Conclusions

• The response from participants concerning the usefulness of SDQ screening for Care Planning at LAC Reviews was extremely positive, as SDQs identified both mental health and ill-health in the sample of children screened, with Care Plans made to address these needs in the majority of cases. SDQ screening was useful in assisting LAC review Care Plans as it identified the most appropriate service based on each child's identified mental health needs, preventing multiple referrals.
• Recommendations include that the SDQ be adopted as the screening tool to identify unmet mental health needs in LAC; that a single route for all referrals of LAC is established; that, in any service development for LAC, consideration should be given to enhancing inter-professional working relationships; that the expertise of Family Centre practitioners should be utilised in any service development to LAC and those who care for them; and that training in relation to child mental health be provided for all childcare managers, social workers, link social workers and carers.