What does best practice look like for children’s homes supporting those with complex needs?
While the majority of children looked after live in foster placements, around one in 12 of them live in children’s homes. Too often, children’s homes don’t get the recognition they deserve for the significant role they play in children’s lives. Around 82 per cent of children’s homes are rated good or outstanding by Ofsted. This might not grab the headlines, but it’s a real achievement by the sector.
Each child has a unique set of circumstances, and there is no one-size-fits-all approach to caring for them. Some children will struggle to be understood by others, understand their own feelings or needs, manage relationships and situations well, or achieve independence as they get older. This may be due to physical or learning needs, or difficulties associated with autism or other complex conditions.
In this article, I want to discuss what the very best children’s homes are doing to help and support children with the most complex needs. These are homes that have staff with the knowledge, skills and determination to help children. And their Ofsted judgements reflect that.
What issues are faced by children with complex needs in residential children’s homes, and those whocare for them?
Many disabled children and/or those with SEN are dependent on a wide network of carers and other adults to ensure their social, medical and intimate care needs are met. Some children may need support carers to take them out. They also may not have the same network of relationships with their peers as other children. So maintaining the right support networks for these children when in residential care can be difficult, but it is essential.
Communication barriers can also pose a problem. At the most basic level, some carers will have difficulty understanding children’s wishes and feelings about the support they need, or concerns they might have. This can be incredibly difficult when children are placed in new situations, among people they don’t know.
Added to that are issues regarding the protection of disabled children and those with SEN. Research shows that disabled children are more at risk of being abused than non-disabled children. In fact, it is estimated that disabled children are over three times more likely to be abused or neglected than non-disabled children1. This analysis of the risk covered a wide range of disability, including physical and sensory impairments, mental illness, mental or intellectual impairments and long-term health problems.
Ensuring children with SEN and disabilities understand healthy relationships, and how to keep safe, is vital. This in itself can be challenging. Research also shows that children who have SEN often have a poorer understanding of bullying and inappropriate touching, meaning that they are less able to recognise unsafe relationships or unsafe situations.
What are the best residential children’s homes doing?
Ofsted inspectors see many homes that specialise in caring for children with autistic spectrum disorders or other complex needs, and who do so very well. These children have unique needs, so specialist training and expertise are essential to ensure that children achieve the very best outcomes.
Managers ensure that they use knowledgeable trainers and work with them to create a bespoke package for their particular setting and their children. This is how it should be. In this way, staff are better equipped to do the right thing in the right way.
First and foremost, those homes doing particularly well ensure that placements are stable. Staff in the best homes:
- have an in-depth understanding of children’s needs
- are nurturing
- show emotional warmth towards children
- help children to develop independence
- help children to influence decisions made about them.
Children come to trust staff and have a strong sense of belonging. These placements are usually long-lasting, which can help children to make good progress across all aspects of their development.
Bespoke care plans that involve the child
Care plans that are bespoke, detailed and influenced by children prove most effective. These allow for clear strategies to manage any barriers to development, such as dangerous or isolating behaviour. Working closely with occupational therapists and therapeutic services, staff in the best homes are able to identify and plan each child’s unique support, sensory or communication strategies. This approach helps to lessen the frustration and anxiety that children experience. In turn, this reduces physical interventions and avoidable incidents.
Excellent multi-agency assessments ensure that children’s complex needs are understood and met. In one North-West home, inspectors saw truly comprehensive multi-professional assessments that produce individual strategies to help children regulate their emotional health. They are closely followed in practice. For example, staff use individual sensory stimuli such as water play or beanbags to act as a calming measure and to increase children’s feelings of security.
Proactive healthcare arrangements help children to access the right kind of support. Another home provided a “healthcare passport” for each child, detailing their communicative abilities and likes and dislikes. This means that health professionals can get the right information from children during appointments and offer appropriate treatment or advice in a way they understand.
Good and outstanding homes also understand the value of maintaining relationships with families. When it is in the child’s best interests, they seek to involve them in children’s care at every opportunity. Staff at the best homes facilitate regular contact with families, irrespective of the distance to travel.
Supporting understanding of disabled children’s communication
Outstanding residential providers share common characteristics in their approach to how children with physical and learning needs communicate their choices and preferences. The best providers use innovative approaches to make sure children take part in planning their own lives and the way the services are delivered. This helps children to be assertive, to make choices, exercise control over their bodies and lives, and be safer.
In the North-West there is a residential school for blind and partially sighted children who have complex health needs. The school uses a “total communication” approach to support children. Staff know that listening and responding to children, however they express themselves, is vital to promoting their rights and protecting them from harm. The multi-disciplinary team around the child places children and their families at the centre of their practice. Staff focus on the children in the room and communicate in the most effective way with each child so that they are included.
The environment is specially adapted to support clear communication and independence; areas are identified through sensory landmarks and smells. Staff are trained in augmentative communication strategies (the use of forms of communication other than speech) and know their children so well that they can pick up on the smallest of signals to help understand and address their needs.
Good and outstanding residential providers make it a priority for children to have experiences that build their sense of self-confidence and self-esteem. Children are empowered by learning new skills, being supported to communicate their wishes, and being involved in decisions about their daily lives.
For example, at a short breaks service in the East Midlands staff have supported young people to undertake work experience in a hotel. Young people have taken part in several fund-raising events for local and national charitable organisations. They have also taken part in consultations on national issues for disabled children.
At a children’s home in the West Midlands, children’s physical and learning needs are not seen as barriers to independence. Staff assess their skills and abilities and devise programmes that assist them to be as independent as possible. The home’s children’s guide has recently been updated following feedback from young people. It is personalised to meet their individual communication needs.
Helping disabled children to develop personal safety
It is essential to help children learn about what helps to keep them safe. They must see and experience safe and effective care. Access to appropriate learning about relationships, sexuality and personal care helps them to develop an awareness of risky and harmful behaviour. In the better providers, we see elements of this work being threaded through the practical support that staff give to disabled children. For example:
- effective role modelling of safe relationships
protecting personal space
- teaching children about safe relationships
- teaching children to keep themselves safe online
- ensuring high-quality assessment and review of children’s needs.
Staff should be knowledgeable about the range of physical and emotional signs and symptoms that a child may demonstrate as a direct result of their complex needs. This helps them to identify any signs that may need further consideration, including potential child protection concerns.
Access to advocacy is important for disabled children. Good and outstanding residential schools have independent visitors and listeners who spend time with children, and then make clear evaluations about how well they are cared for and kept safe. They share this information directly with governors and leaders so that any concern is dealt with promptly.
Preparing for independence
Preparing children for independence and the next stage in their lives is key. The best places don’t allow physical or learning needs to be a barrier to accessing opportunities and broadening experiences. Many homes forge excellent links with the community, allowing children to develop their social and life skills. In one home in the South-East, staff make good use of local resources to meet children’s specific needs:
- a nearby hairdresser allows extra time to cut the hair of children who are anxious
- the charity shop saves dresses for a child who likes to dress up
- the supermarket offers support for young people who are learning to shop independently.
These may seem simple steps, but they make a huge and positive difference to children’s experiences.
The role of inspection
Ofsted expects all children, however complex their needs, to make progress and have positive experiences that contribute to that progress. This can take many forms, and is individual to each child – whether it is learning to manage emotions, developing self-care skills, achieving well in their education and preparation for adulthood, or taking steps towards greater independence.
Recognising each small step of progress a child makes is a skill that is evident in the best practitioners. They recognise progress, celebrate it and build on it. This process is complex, and certainly not always linear – something inspectors take into account.
Of course not all challenges can be overcome, but we do want to see residential homes and schools doing all they can to make a difference and improve children’s lives. There are so many places that are doing this brilliantly. I hope others will learn from their example.
Eleanor Schooling is National Director for Social Care at the Office for Standards in Education, Children’s Services and Skills (Ofsted), the Government body which inspects and regulates services that care for children and young people, and services providing education and skills for learners of all ages:
1: Jones, L. and Bellis, M.A., et al., Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies, The Lancet (accessed February 2018).