Placing and Visiting Children with Special Educational Needs and Disabilities or Health Conditions in Long-Term Residential Settings

Children and young people who spend long periods of time living away from home in residential settings are a vulnerable group. They can be vulnerable to abuse, experience a range of poor outcomes and dwindling contact with their families.

The UK Social Work Practice in Safeguarding Disabled Children and Young People report reasons why disabled children and young people are at greater risk and the reasons why, including where gaps in provision exist.

The likely impact of a placement in long term residential care away from home on children and young people and their families should be an important consideration when making a placement. The local authority or health body making the placement should look to make the placement close to home where possible.

The Children and Families Act 2014 built on measures provided in the Children Act 2004 by requiring local authorities and health commissioning bodies to make joint commissioning arrangements for education, health and social care provision for children and young people with special educational needs and disabilities. Local authorities are also required to integrate education, health care and social care provision where they consider it would promote the wellbeing of such children and young people.

Local authority staff responsible for services for children in need under the Children Act 1989, should be involved in making decisions about residential placements which are being considered by education and/or health colleagues.

When arranging a residential placement, the accommodating authority should have regard to:

• The views, wishes and feelings of the child or young person and their family. This should have regard to the child's maturity and their capacity to consent and the nature of the decision being sought;
• Ensuring the child or young person and their family are provided with impartial information and support so that they can be as fully involved as possible in making decisions about the child or young person's future accommodation;
• Recognising that some disabled children and young people, such as those who have learning disabilities and/or are on the autism spectrum, may need support to help them understand the issues involved in relation to placements;
• Identify children and young people who may need support in communicating their wishes and feelings. This will depend on their individual needs and could include use of alternative and augmentative communication, British Sign Language Interpreters, and advocates, etc.

Many children who are likely to require residential placements for consecutive periods of more than 3 months will have had a holistic, multi-agency assessment or review of their needs – such as an Education, Health and Care Plan (EHCP) (for those who have special educational needs), or a Care and Treatment Review.

There may be exceptions to this where, for example, children or young people are admitted to learning disability hospitals or Assessment and Treatment Units quickly because of urgent mental health needs.

Where this is the case, such a multi-agency assessment must be undertaken as a matter of urgency.

Considering the Child's Status: Child in Need or Looked After

The statutory guidance identifies that where a child is placed away from their parents for longer than 3 months it should be considered whether the child should become looked after within the meaning of the Children Act 1989, particularly Section 20 of the Act.

This decision is a judgment that can only be made after a Single Assessment has been undertaken by a social worker which has included the views of the parents, and others who have parental responsibility, together with the wishes of the child. The full facts and implications of consent should be fully discussed with the parents, and those with parental responsibility (see Decision to Look After Procedure and Care Planning Procedure).

'The Short breaks' chapter in DfE, Children Act 1989 Guidance and Regulations - Volume 2: Care Planning, Placement and Case Review, 'Deciding which provision is most appropriate for the child' may provide a useful framework for making such a decision.

Accommodating authority: The health body or local authority which is arranging the placement for a child or young person.

Host authority: The local authority in which the institution providing the placement is situated.

Home authority: The local authority in whose area the child or young person is ordinarily resident.

Responsible authority: The local authority that is responsible for monitoring and reviewing the progress and well-being of a child or young person who is placed in long-term residential care, and for arranging visits in order to safeguard and promote their welfare.

^{From: DfE/DoH, Statutory visits to children with special educational needs and disabilities or health conditions in long-term residential settings - Statutory guidance for local authorities, health bodies and health or educational establishments (2017)}

If the placement is in the area of another local authority, the responsible local authority will depend on whether the placement is in an educational or a health setting.

Where the host authority is the responsible authority as set out in the table above, it is considered good practice for the accommodating authority to ensure that the home local authority is also made aware of the placement without delay. The home local authority should consider whether any duties are owed to the child living in their area including providing services under Section 17 Children Act 1989. It is also essential  to check if any concerns or issues have been identified by the Host local authority before any placement is made. 

Discussions should normally take place between the accommodating authority, the responsible local authority, education, social care and health professionals, and the child or young person and family, before a child or young person is placed in a residential setting. It is recognised that this may not be possible when an admission is as a result of a child's urgent health needs.

Formal notification of all placements should be made without delay so that the responsible authority can fulfil its statutory duty to visit the child or young person living in their area to ensure their welfare is safeguarded and promoted:

• Where a placement has been pre-planned, the responsible authority should be notified before the child or young person takes up the placement;
• In other circumstances the notification should be made on the day of the placement.

When a child or young person is placed in an educational establishment, the accommodating authority must ensure that the Director of Children's Services of the local authority where the child or young person is ordinarily resident (the 'home' authority) is notified of the placement.

Where it is not the accommodating authority, it is important for the relevant Integrated Care Board (ICB) also to be made aware of the placement so that it is prepared for any subsequent financial responsibilities for a health care element of the placement.

Parents or carers with parental responsibility who have children and young people with learning disabilities and/or autism who are in a 52-week residential school, should be offered the opportunity to have their child's name on the ICB Dynamic Support  Register (see Dynamic Support Register and Care (Education) and Treatment Review Policy and Guide) to assist with strategic planning and commissioning.

Advocacy

The responsible local authority should ensure that all children and young people in long-term residential placements have accessible means of requesting a visit.

Children and young people in long-term residential placements who have communication needs may require the support of an advocacy service which is skilled in methods of non-verbal communication.

In Shropshire, the advocacy service is provided by Coram Voice.

When a child is provided with accommodation in a care home or independent hospital/hospice the Responsible Manager of the establishment must notify the local authority's Director of Children's Services where it is located.

The local authority then becomes the responsible authority for the child – irrespective of where the child or young person are ordinarily resident.

When notified of the placement, the local authority, (as the responsible authority), should inform the local authority where the child/young person is ordinarily resident, so that there is general awareness and can be properly involved in any element of the educational aspects of the placement.

Advocacy

Children detained under the Mental Health Act 1983 have the right to an independent advocate.

The responsible local authority must provide a representative who has the skills and experience to fulfil the statutory requirements and has the capacity to visit the child or young person on successive visits, in order to build and maintain a relationship with the child or young person and their family and develop a comprehensive understanding of their needs.

Nevertheless, whenever possible, the Responsible Local Authority should ascertain and take into account the views of the child or young person who they would prefer to carry out the visits.

In most cases this will be a social worker with whom the child has developed a positive relationship.

Where this is not possible, the skills and experience should include:

• An ability to communicate with the child or young person and their parents – this may include competence in, or access to, different forms of non-verbal communication;
• An understanding of any specific disabilities and behaviours the child or young person has (including behaviours that challenge) and their impact on the child or young person and on family life;
• An understanding of child development and the impact of separation on a child or young person's attachments;
• The ability to identify any safeguarding concerns; and
• An understanding of how to promote contact between the child or young person and their family.

Visits to children must be in accordance with Long-Term Residential Care Regulations 2011.

The identified visiting local authority representative must be sensitive to the particular care circumstances of each child and care setting.

• If the child or young person has not had their needs assessed for the purposes of Section 17 of the Children Act 1989 in the preceding 12 months, the responsible authority must ensure that an appropriate representative visits the child within 7 working days of receiving notification of the placement;
• If the child or young person has had their needs assessed for the purposes of Section 17 of the Children Act 1989 within the last 12 months, and the responsible authority has full access to all the relevant assessments and data, it must ensure that an appropriate representative visits the child within 3 months of receiving notification of the placement;
• Subsequently, the representative must visit at least every 6 months; or
• Whenever reasonably requested to do so, if the representative believes that a visit is required in order to safeguard and promote the child's or young person's welfare as a result of views expressed by:
  • The child or young person;
  • Their family or carers;
  • Their advocate; or
  • By the establishment caring for the child or young person.
• Whenever a Regulatory Authority reports a concern or publishes an adverse report about the Residential Home or establishment.
  
  Note: consideration should be given as to whether a Child Protection Enquiry (Section 47 Children Act 1989) may be appropriate.

Before each visit:

• The representative should consult with the parents/carers to establish their views about their child's progress and well-being. (There may be good reasons to conduct the visit jointly with the parents/carers);
• The representative should read and make themselves aware of actions set out in any previous visit and expected outcomes;
• Ensure they have authenticated documents proving their identity for the purpose of entering the care home or residential hospital (see note below);
• Liaise with other outside professionals who work with the child or young person such as Community Nurse, Speech and Language therapist, Psychologist so any issues are identified before the visit.

During the visit:

• The local authority representative must speak to the child or young person in private, unless the child or young person refuses, or it is inappropriate due to the child's or young person's age or levels of understanding. If the child or young person does not want a private meeting, the representative should ensure they know the reasons for this and record it;
• Where children and young people have significant communication issues, the representative should speak directly to those working most closely with the child or young person (for example, their key worker and/or Speech and Language Therapist), so they can ascertain their views. Children's Communication Passports [1] will also help the representative in doing this;
• Seek to ensure the child is safeguarded and protected;
• Confirm their health and well-being is promoted (or checking with relevant medical professionals around medication usage, medical appointments having been completed, etc. and they have access to the right support from the right professional);
• The child has their positive behaviour acknowledged and their relationships are promoted;
• Ensure the child has their views heard, listened to and acted upon;
• Where the child or young person does not have an advocate, whether such a person should be appointed;
• Access the Residential Home or establishment's policies and practices, particularly with regard to safeguarding;
• Ensure there is the required support by staff and whether staff deployment enables and promotes this;
• That the child could make a complaint or have their differences of opinion, difficulties and issues responded to and resolved;
• Should review how any plans are being implemented and whether the intended outcomes for the child or young person are being achieved;
• Assess and identify whether there are further steps the responsible authority should take to:
  • Promote the welfare of the child or young person; and
  • Promote contact with their family (as long as this is in the child's best interests).

^{[1] Communication Passports are a practical and person-centred way of supporting children, young people and adults who cannot easily speak for themselves and pull together complex information in an easy-to-follow format}

From Year 9 onwards, (i.e. when the child is 14 years), the visiting representative should consider what preparation for adulthood is being made, including employment, independent living and participation in society.

The visit should also seek to ensure there are clear systems that are available to staff to for recording welfare and contact information and ensuring key issues are addressed and reviewed regularly during the placement.