Written evidence submitted by the Office of the Children’s Commissioner (EYI0063)

About the Office of the Children’s Commissioner

The Children’s Commissioner has a statutory duty to promote and protect the rights of all children in England with special responsibility for the rights of children who are in or leaving care, living away from home or receiving social care services.

Independent of Government, the Commissioner has unique powers of inspection and discovery to help bring about long-term change and improvements for vulnerable children. She is the ‘eyes and ears’ of children in the system and the country as a whole and champions children’s rights across a range of policy areas. 

Introduction

The Commissioner’s unique powers have provided her with the opportunity to gain a thorough understanding of the complex issues that impact the lives of vulnerable children. The Children’s Commissioner’s Office has undertaken extensive work identifying the ‘adverse experiences’ that may significantly impact children’s lives.

1. The Children’s Commissioner has recently published a major piece of work analysing childhood vulnerability[1]. This vulnerability framework is the first of its kind to bring together information from government departments, agencies and others, in order to define and classify the numbers of vulnerable children in England. This framework forms the basis of many CCO projects, including the ‘Voices of Children’ series of reports and the Stability Index, which look more closely at specific areas of vulnerability.
2. Focusing on children in the care system, the Commissioner has developed the ‘Stability Index’[2] in order to highlight the volatility and insecurity experienced by young people whose care arrangements undergo frequent alterations. This important piece of work identifies a range of factors that can significantly affect outcomes for this group of children.
3. The Children’s Commissioner’s Office has carried out important work on access to, and experiences of, child mental health services.[3]

The Stability Index and Vulnerability Framework provide an evidence base for the link between adverse childhood experiences and long-term negative outcomes.

Vulnerability framework

‘Invisible’ children

In July 2017, the Children’s Commissioner published a major review of childhood. New analysis revealed, for the first time, the scale of vulnerability among children in England. ‘Vulnerability’ is defined as the additional needs or barriers children face that may make them less likely to live healthy, happy, safe lives, or less likely to make successful transitions to adulthood.[4] Vulnerability can take a wide range of different forms, including physical and mental health difficulties, family problems, and risks of abuse of harm. The framework identifies an initial set of 32 groups of children that in public discourse and policy have come to be associated with forms of vulnerability or risk (see CCO Technical Paper 2 for more detail on the choice of approach and selection of groups).[5]  The Vulnerability Framework is a starting point from which we can further explore the impact that adverse experiences can have on children’s lives.

Importantly, our work on vulnerability is also intended to shed light on children who are ‘invisible’ to the system or whose needs are hidden in some way. This can mean a number of things, such as children who are missing, or who are part of a group for which there are no official statistics.

Our initial publication measuring the number of vulnerable children in England, brings together a range of information held by various government departments, agencies and others. Primary analysis revealed a host of statistics about the number of children living in vulnerable situations. The Children’s Commissioner plans to update the framework annually.

Headline figures for vulnerability

•Over half a million (580,000) children so vulnerable that the state has to step in

•670,000 children in England growing up in ‘high risk’ family situations

•Over 15,000 children living with adults in treatment for alcohol problems

•800,000 children suffering from mental health difficulties

•Over 46,000 children involved with gangs

•Many more children under the radar, not being seen

Falling through gaps in Education

The Children’s Commissioner’s report on vulnerable children identified 121,000 16-18 year olds not in education, employment or training (NEET), 154,060 pupils who received a fixed period exclusion from school in 2014/15, and 5,800 pupils who were permanently excluded in 2014/15. On this basis, the Children’s Commissioner conducted the ‘Falling through the Gaps in education’ report.[6] This report builds on these groups by adding what is known about some of the more ‘invisible’ vulnerable groups who end up not participating in, or being removed from, mainstream education and potentially education altogether – even if they are not formally recorded as such.

After accounting for children enrolled in special schools, the review estimates that 37,000 5-15-year-old children, and 224,000 5-17-year-olds, are not enrolled in mainstream (or special) education. A significant proportion of these children are educated within the alternative provision (AP) sector.

We estimate that around:

• 3,000 children are in unregistered schools
• Over 36,000 are in elective home education
• Over 25,000 are in alternative provision
• Over 1,000 are in secure settings

This report also highlights the practice of unfair or illegal exclusions taking place in schools. The practice of ‘off-rolling’, managed moves and unofficial exclusion are identified as methods used to ‘clean up’ GCSE results, or relocate difficult children without recording a permanent exclusion. The report underlines the difficultly involved in accurately identifying those children whose exclusion from education is ‘hidden’ or ‘unrecorded’. It is important to note, therefore, that the evidence base for vulnerable groups of children and young people is generally stronger where there has been a long-term focus and interest from government, policy makers and researchers on the group, e.g. looked after children, NEET, children from minority ethnic populations, and children from “troubled families”. There appears to be less strong evidence where groups or issues involve low numbers in the population (e.g. unaccompanied asylum seeking children, undocumented children and children without legal identity/regular immigration status) or unclear and inconsistent definitions.

It is important, therefore, that throughout the ‘Inquiry into adverse childhood experiences’, the Select Committee recognise the large number of children whose childhood experiences leave no record or mark on public databases.

Voices of Children reports

To further understand the experiences of children identified in the vulnerability framework, the Children’s Commissioner’s Office have produced a series of ‘Voices of Children’ [7] reports bringing the lived experience of children themselves to the fore. Currently these reports include; voices of children educated in alternative provision; voices of children involved in gangs; voices of refugee and asylum seeking children and voices of children with mental health needs.  Each report offers a review of major research into the area, highlighting the ways in which children experience these particular difficulties. The reports clearly demonstrate the unique problems children face in relation to their vulnerable circumstance, for example, the lack of control and understanding felt by children attempting to navigate the immigration system, or the frustration of children who are unable to access particular GCSE topics in alternative provision. In giving voice to these groups of children, the reports identify what it is really like to be a child facing some of the most ‘adverse’ of childhood experiences.

Stability Index

Help at Hand

Help at Hand is the Children’s Commissioner’s national advice line for children and young people who are in care, leaving care, living away from home or working with children’s services. The advice line is independent of the Government and exists to make sure that young people’s rights and entitlements are upheld and that their views are taken seriously. One of the major concerns the Commissioner regularly hears about through Help at Hand is the stability of placement, of school, of social worker, for children in care.

In light of concerns around stability for children in care, the Stability Index [8] has been developed by the Children’s Commissioner to shine a light on the children ‘pinged’ between placements and services. By monitoring a combined measure of stability for the first time, the Stability Index enables the assessment of annual trends, and will allow the Commissioner to more effectively work with local authorities and others to support improvements to the lives of looked after children.

The Stability Index measures three aspects of children’s experiences of care - placement moves, school moves, and changes in social worker. To measure placement moves and school moves, we analysed data from the Children Looked After Census and School Census on children who were looked after on 31 March 2016. To measure social worker changes, we carried out a pilot data collection involving 22 Local Authorities across nine regions.

Stability Index - Headline findings

Research indicates that instability reduces the opportunity for children to form and maintain secure relationships.[9] When children in care have to change their placement, it can lead to relationships with trusted adults being broken and when they have to move schools, they can lose ties with friendship groups. Staff turnover in residential units and changes of allocated social worker can further unsettle children and young people.  Identifying the extent to which children are exposed to such instability is a vital step in attempts to minimise the impact.

As is clear from 2015/16 main findings,[10] the Stability Index allows for a complex and detailed analysis of the lives of children in the care system.

• We estimate that around 50,000 children in care on the 31st March 2016 (71% of all children in care in England) experienced a change in their placement, school, or their social worker over a 12-month period.
• Of the children for whom data was available, 2 in 3 (69%) experienced a change in at least one measure. 1 in 20 (5%) experienced a change in all three. Nationally, this would be equivalent to around 2,000 children in care attending school experiencing a change in their placement, school and social worker all within the same year.  
• We found that 1 in 10 children in care (10%) moved school in the middle of the academic year (high school instability). This is significantly higher than the proportion for all schoolchildren, which is 1 in 35 (3%). 
• Children who experienced a mid-year school move were also more likely to have experienced a placement move, and vice versa. However, more than half (56%) of those who moved school during the academic year had not experienced a placement move – suggesting that other factors (such as exclusions) play a role as well. 

The Stability Index allows for a more nuanced understanding of what is happening to children in the care system. Through its development, we are able to identify specific incidents that create instability in the care system, as well as the degree of instability experienced by children in care. For 2015/16 the Children’s Commissioner defined high instability as the experience of multiple placement moves in a year, or a mid-year school move, or multiple social worker changes in a year. In our analysis, 1 in 3 children in care attending school (35%) had experienced at least one type of high instability over a 12-month period. This includes 1 in 16 children (6%) who experienced high instability across multiple measures. Finally, we estimate that across England as a whole around 220 children experienced high instability across all three measures in the same 12-month period. That means they experienced multiple placement moves and a mid-year school move and multiple social worker changes, all within in the same 12-month period. 

Child and Adolescent Mental Health Services

The Children’s Commissioner’s ‘Briefing on Child Mental Healthcare in England’[11] provided an overview of the services available to children suffering from mental ill health. Our analysis revealed that just over 200,000 children received CAMHS treatment last year, 2.6% of the age 5-17 population. Comparing this to recent research on the number of children with a mental health condition, we estimate that between 1 in 4 and 1 in 5 children with a mental health condition received helped last year.

The report also highlighted the large proportion of NHS funding allocated to helping those children with the most severe need, with 38% of NHS spending on children’s mental health used to provide in-patient mental-health care - this is accessed by 0.001% of children aged 5-17. The investment in crisis provision, and consequent lack of funding for early intervention services, was identified in the report as a significant problem. With early intervention much cheaper to deliver (£229 per child – the cost of delivering six counselling or group CBT sessions in a school Vs £2,338 – the average cost of a referral to a community CAMHS service) many children could be unnecessarily delayed in addressing problems with their mental health. 

In addition, the mental health briefing was successful in identifying groups of children whose experience of mental health support is ‘hidden’ or ‘invisible’. Our research revealed that the NHS fails to identify the number of children who are successfully referred to Child and Adolescent Mental Health Service (CAMHS) but do not go on to receive treatment.  It also fails to record how many children drop out of treatment, or measure whether the treatment is effective at improving children’s mental health.

A particularly powerful finding that emerged from our research concerns the discrepancy between child and adult mental health services. Our analysis shows local areas spend an average of 6% of their mental health budget on children, despite children making up around 20% of the population. Moreover, our report identified that NHS England monitor 39 local measures for adult mental health, but only nine for children’s mental health. The differing priority levels assigned to adult and child mental health services are clear.

On the basis of this work, the Children’s Commissioner is carrying out a piece of research looking closely at the funding arrangements for early intervention child mental health services. Through this research the Commissioner hopes to gain a clear picture of the mental health services that are available to children when professionals first identify a need for support.

Our work on child mental health contributes to a more detailed understanding of the hidden challenges facing children with mental health issues and highlights the inequalities they may face in accessing treatment.

Conclusion

The Commissioner’s Vulnerability Framework and Stability Index are designed to capture a detailed and reliable picture of ‘adverse childhood experiences’ over time. Along with our Voices of Children reports and ongoing policy research, the Children’s Commissioner continues to build an important evidence base in understanding the lives of vulnerable children.

December 2017