Children in Need

The definition of Children in Need

The definition of Children in Need in national guidance is:

'A child in need is defined under Section 17 of the Children Act 1989 as a child who is unlikely to achieve or maintain a reasonable level of health or development, or whose health and development is likely to be significantly or further impaired, without the provision of services, or a child who is disabled.'

Children in Need can be supported by health services (such as health visitors and speech therapists), school or nursery staff and third sector organisations - in addition to the local authority’s children’s centres, specialist support services and social care teams.

The Department for Education publishes statistics annually on Children in Need. These publications are only about children in contact with social care, who are not looked after children (Read our Children in Care page.)

The Department for Education also publish details on the characteristics and educational performance of children with special educational needs, who would be covered by the overarching definition of children in need given above. These are published as LDD (Learning Difficulties or Disabilities) Special Educational Needs (SEND) statistics on children with Learning Difficulties or Disabilities and Special Educational Needs. With the introduction of the SEND 'Education, Health and Social Care' reforms in September 2014, more children with special educational needs are becoming known to social care.
 

With all the different understandings of which children are considered to be in need, care needs  should be taken into consideration to specify the cohort of children under discussion at all times.

Typically the children in need known to local authorities are aged under 18 and

• Need local authority services to achieve or maintain a reasonable standard of health or development

• Need local authority services to prevent significant  further harm to health or development (and can be in receipt of some child protection interventions)

• Are physically disabled or with learning disabilities or difficulties, wishing to access specialist support

Wokingham Borough’s health profile suggests that it is a very healthy place to live and, when compared nationally, Wokingham performs well on a lot of indicators Public Health Outcomes Framework (PHOF.) For example, Wokingham enjoys a higher than average healthy life expectancy from birth when compared with the England average, with 71.38 and 69.9 for males and females respectively, compared with the national figures of 63.27 and 63.95 for males and females respectively. 

Wokingham also achieved the lowest upper tier local authority score in the recent Indices of Multiple Deprivation update as shown on the Gov.uk website, demonstrating the relative affluence of the borough.

Most children go on to lead healthy and successful lives but it must be remembered that there are some children that do not. There are still areas of relative deprivation within the borough and children that do not achieve their full potential. 

Every child within the borough needs to be given the best start in life and be afforded the same possibilities. For this reason the following 6 key areas of concern have been identified within our Children’s Services Commissioning strategy 2015-18 and the Early Help and Innovation Strategy:

1.    Social isolation, deprivation and intergenerational poverty

2.    Increased usage of Children and Adolescents Mental Health Services (CAMHS), long waiting lists and uncertain mental health outcomes

3.    More children in need and children eligible for free schools meals with special educational needs

4.    Too many children in care entering the system in adolescence

5.    Disadvantage starts early

6.    Our system does not always effectively hold children who need support

These areas of need are very broad and have many complex and varying factors underneath them. They affect the way in which Wokingham Borough Council commissions and delivers services and prioritises need. These key areas will not only be affected by wider health factors and specific strategies targeted at Children in Need and Early Years, they will also cross over and incorporate a wide range of other factors that affect the development, health and wellbeing of all children resident within the borough.

This section of the JSNA cannot be read in isolation. Further reading needs to be carried out around adult and children’s mental health, safeguarding, children in care, special educational needs, school life, drug use, alcohol issues, and domestic abuse.

We already have a wide range of strategies that cover many areas that affect Children in Need, these include

• CAMHS (Children and Adolescents Mental Health Services) Strategy

• Substance Misuse Strategy

• Domestic Abuse Strategy

• Housing Strategy

The Wokingham Safeguarding Children Board (WSCB) have developed the following strategies to better support children in need within the borough

• Wokingham Children’s Services Commissioning Strategy 2015-2018

• Domestic Abuse Strategy

• Children and Young People’s Social and Emotional Wellbeing, Wokingham

• Early Help and Innovations Strategy

• Young People’s Housing Strategy

• Children and Young People’s Plan

• Sufficiency Strategy

• Drug and Alcohol Treatment Plan

• Corporate Parenting Strategy

• Workforce Strategy

• Engagement Strategy

• Education of Looked After Children Strategy

• Child Sexual Exploitation Strategy

• Commissioning Strategy
  

For more details visit the Wokingham Safeguarding Children Board website.

Social isolation, deprivation and intergenerational poverty

Wokingham has low levels of deprivation. This was highlighted in the 2015 indices of deprivation update, with Wokingham achieving an average score of 5.625 and placed as the lowest scoring Local Authority when compared with all upper tier local authorities. Despite Wokingham having 0 percent of its Lower Super Output Areas (LSOAs) in the 10 percent most deprived LSOAs, there are still some areas of relative deprivation and isolated pockets within the community where families struggle.

Some families struggle with intergenerational poverty and live in what could be considered as ‘hidden poverty’. This poverty largely relates to access to services and lack of aspiration for some of our families. As of October 2015, only 65 percent of the eligible, more vulnerable 2 year olds were taking up a place with an early years’ provider or child minder. This is an indication of a wider concern amongst providers that the most vulnerable families are not accessing the services which are available for them.

Factors identified in working with children in need

Table 1, below, highlights the number of children subject to a Child Protection Plan, and gives the breakdown of the category of need identified.

Note: There were 58 children subject to a Child Protection Plan as at 30 September 2015 but 6 of them had dual categories.

Table 2, below, highlights the distribution of the categories of need identified. Each child can be identified under several categories.

Whilst tables 1 and 2 above highlight the levels of need across the borough, Woodley has been identified as the area with the highest number of children with either a child protection plan, classed as children in need or in a troubled family. 

Table 3 shows the risk profile of children and young people in Wokingham Borough.

Whilst some of this data is from as early as 2011, this is the most up-to-date data from Public Health England. Table 3, identifies many risk factors that have the potential to put families and children at risk and in need of support.  Out of the many identified in table 3, 3 of these have been identified as strong risk factors for both adults and children. These risk factors include domestic abuse, drug misuse and alcohol misuse. These risks, coupled with mental health issues, are well researched.

Domestic abuse - Research suggests that a high proportion of children living with domestic violence are themselves being abused by the same perpetrator, either physically or sexually (Department of Health, 2002.) Mental Health - The Royal College of Psychiatrists (2015) have stated that many children will have a parent who at some point will have a mental illness – 68 percent of women and 57 percent of men with a mental health problem are parents. Stein, et al., (2014) showed that there is a large body of evidence that shows a small but significant association between perinatal mental health and an increased risk of poor child psychological and developmental outcomes.

Substance misuse - The Advisory Council on the Misuse of Drugs, 2011, produced a report that estimated that 2-3 percent of children in England and Wales have one or more parents that have a serious substance problem.

These 3 risk factors together are sometimes referred to as the ‘toxic trio’.  There is a well-researched relationship between substance misuse, domestic abuse and mental health, where each factor is a risk factor for the others. 

For example those experiencing domestic abuse are more at risk of mental health problems, and this is true for both adults and children. In relation to children specifically, if they are part of a family where one or more of the trio is being experienced, they too are at risk of experiencing abuse, mental health problems and substance misuse problems as they grow up. 

Within Wokingham Borough Table 3 identifies that whilst the number of parents in drug and alcohol treatment is lower than the national average, there are still children that are being exposed to these issues. Table 3 also demonstrates that domestic abuse is occurring within the Borough. These, coupled with the knowledge that children within the Borough are experiencing mental health problems (see next section), shows that this intricate and dangerous interrelationship between mental health, domestic abuse and substance misuse is something that is very real in Wokingham Borough and needs to be fully understood and addressed when any of the three risk factors are identified.

Increased usage of CAMHS (Child and Adolescent Mental Health Services), long waiting lists and uncertain mental health outcomes

We have a high and increasing usage of Child and Adolescent Mental Health Services across the children’s population, yet with a relatively low number of Children in Care being supported by CAMHS.

Using the estimates by Kurtz (1996) it is possible to estimate the number of children and young people who may experience mental health problems appropriate to a response from CAMHS at tiers 1, 2, 3 and 4.   

Source: Office for National Statistics mid-year population estimates for 2014. CCG population estimates aggregated form GP registered population (October 2014). Kurtz, Z. (1996).

The current usage of the service within Wokingham Borough is high when compared with neighbouring Clinical Commissioning Groups (CCGs.)

Table 5 displays data relating to the ADHD (Attention Deficit Hyperactivity Disorder), ASD (Autism Spectrum Disorder), Anxiety and Depression, Specialist Community, CAMHS (Child and Adolescent Mental Health Services) Common Point of Entry and Urgent Care services commissioned by the 4 Berkshire CCGs in the west between April 2014 and March 2015. The total caseload for the financial year was 4,003. Out of these, the majority of cases were for children aged between 10 and 15 years of age, 302 were aged under 5 and 10 were over the age of 18 years. Across Berkshire West (West Berkshire, Reading and Wokingham local authorities) there was a majority of males within the case load. Further scrutiny of the data identified that in 59 cases the children referred were subject to a child protection order and in 87 cases they were looked after children.  

Taking into account the current data, there is a need to reduce the length of time children and young people have to wait from their CAMHS initial assessment to receipt of service.

Mental health issues do not only include those assessed in the CAHMS service.  Using the average prevalence rate for any mental health disorder developed by (Egger, H et al. 206), it is estimated that there are 1710 children aged 2 to 5 years of age, living in Wokingham, who have a mental health disorder. 

Above the age of 5 years the prevalence estimates for mental health disorders in children aged 5 to 16 have been split into age bands and gender. It has been found that boys are more likely to have experienced, or be experiencing, a mental health problem than girls and children aged 11-16 are also more likely to have experienced, or be experiencing, a mental health disorder than 5-10 year olds.

The following table 6 displays how this is broken down for Wokingham Borough.

Source: Office for National Statistics mid-year population estimates for 2014. CCG population estimates aggregated form GP registered population (Oct 2014). Green, H. et al (2004.)

This data can also be compared against the regional and national averages. See Table 8, below. 

Emotional health has been identified as an area of high priority by a focus group working with children and young people.

A higher percentage of Wokingham’s Children in Need known to social care are children eligible for free schools meals or with special educational needs than the national average.

Disadvantaged children are eligible for free school meals. This helps with their nutrition and reduces the costs associated with school for parents. 

There are more children with Special Educational Needs among the Wokingham Children in Need population, including Children in Care than would be expected given the low numbers of children eligible for free school meals in the authority.

Table 9 displays the percentage of school-age Children in Need at 31 March 2015 by eligibility for free school meals (FSM). The percentage within Wokingham Borough is lower than our statistical neighbours and the national average, however after a decrease was observed in 2013 this has been reversed and the percentage has increased above that observed in 2012.  The background rate of local children eligible for free school meals also increased at this time. 

Source: Department for Education, 2015

Whilst there are relatively fewer Children in Need eligible for free school meals in Wokingham than seen nationally, this data is far more concerning once the background free school meal eligibility is taken into account. Nationally between 2 and 3 times as many children in need are eligible for free school meals, whilst the Wokingham ratio is over 4.

The percentage of children with statements of Special Educational Needs or an Education, Health and Care Plan (EHCP) is higher than seen elsewhere.

The following table 10 shows information on pupils with special educational needs at schools in Wokingham Borough. 

Source: Local Authority Interactive Tool (LAIT) on the Gov.uk website 

Children who have been given a statement of Special Educational Needs are not achieving as high as the National average for both Key Stage 2 and 4, see tables 11 and 12.

Source: Chimat, 2012

Source: Chimat, 2012 

Looking at information on children in need, known to social care, who have statements of Special Educational Needs (SEN) or an Education, Health and Care Plan (EHCP) we see:

The percentage of children in need with statements or EHCP is now similar to the national averages.

Given that our children in need known to social care are so similar to the national averages for SEN/EHCP needs and their eligibility for free school meals, yet typical Wokingham pupils are not, must introduce additional complexities for children in need whilst in school, especially given the low numbers of such children in most schools.

Too many Children in Care entering the system in adolescence

Wokingham has proportionally fewer Children in Care per 10,000 than seen elsewhere and the numbers of children in need are relatively small (227 per 10,000 aged under 18.) For more details about the profile of Wokingham Borough see Table 13.

Source: PHE Fingertips

However, despite the small numbers when compared with the Berkshire and England average Wokingham Borough recognises that we have a disproportionately higher number of adolescent males becoming looked after. Figure 14 shows the gender breakdown by age group for children in care. This clearly shows the higher percentage of boys in the older age groups when compared with girls.

Source: Wokingham Borough Council, 2015

Disadvantage starts early

There are some disadvantaged children who do not achieve a 'good standard of achievement', measured through school readiness (in their Early Years Foundation Stage (EYFSP) profiles). Figure 15 shows that Wokingham’s performance on school readiness has improved and increased to levels above the England average; however despite this the graph only indicates that 70 percent of children achieved a good level of development at the end of reception, indicating 30 percent did not.

Source: PHOF, (2013/14)

Those that start school disadvantaged and eligible for free school meals experience a gap in performance that does not decrease as the children progress through school. Table 16 and 17 demonstrates this trend.  The tables brings into focus the percentage of 19 year olds qualified to Level 2 and 3 and clearly demonstrates the gap between those that are eligible for a free school meal and those that do not, with those that are eligible achieving a lower percentage than for England and the South.

Source: Department for Education, 2015

Source: Department for Education, 2015 

Figures 16 and 17 demonstrate that both regionally and nationally there is a gap in the percentage of pupils that qualified to level 2 and 3 between those that are eligible for free school meals and those that are not.

Our system does not always effectively hold information on children who need additional support

During 2014 the rate of re-referrals were becoming an issue for concern, with increased numbers.  Consequently, in March 2014 Wokingham Borough Council started analysing the journey of children and young people through the Children Social Care pathways and the proportion of children at different tiers of need for that year. On completion of this analysis it was identified that

• A range of services across levels of need including children’s centres, educational psychology, family support and others were supporting up to 1398 children and young people, and that more than one service may have been supporting some of those young children

• From 4714 contacts (this include phone contacts), around 75 percent of cases were retained in tier 1 to 3 services

• There was a potential group of 1700-2600 children who after contact did not remain in contact with services

• There was a small number of Common Assessment Frameworks (CAFs) completed

As a result of these findings the importance of ensuring there was an early assessment intervention and support plan was highlighted. The importance of early multi-agency shared working in supporting families was also highlighted in order to limit the need for social care to make an intervention.

In addition to the analysis of pathways, an audit in 2014 uncovered that one of the reasons behind the inflated re-referral figures was a by-product of a process change and that ‘contacts’ and ‘referrals’ were no longer being recorded separately. During the 2014 audit it was found that the staff had been inadvertently ticking the ‘contact/referral’ option on a joint form, instead of the ‘contact’ option for many cases where it was inappropriate. This led to an exaggeration of referrals recorded as ‘No Further Action’ and subsequently an exaggeration of the re-referral rates.

On further auditing in 2014, in partnership with Wokingham Safeguarding Children Board (WSCB), this process error found that thresholds in the contacts/referrals team were being applied correctly and were in line with the agreed WSCB and statutory thresholds.

The learning from both the audits in 2014 and the subsequent pathway analysis informed the development of the multi-agency Early Help Triage process implemented during August 2014, by which most children enter the process through one common ‘front door’ and all children are able to be followed throughout their journey in both community and social care support.  The Early Help and Innovation Programme has also led the service improvement and development work.

• There is a high level of children going through the Children and Adolescence Mental Health Services (CAMHs) process that have an anxious parent (48 percent of parents with a child that has an emotional disorder also has an emotional disorder themselves (Joint Commissioning Panel for Mental Health, 2013)

• Woodley has the highest number of children subject to a Child Protection Plan, in a Troubled Family or identified as a Children in Need

• Children in Need have poorer outcomes than their peers

• Looking at the whole family rather than just the child

• Addressing the stigma attached and delving deeper into the reasons families and children are not taking up the offer of all services available to them

• Access to Children and Adolescence Mental Health Services (CAMHs) provision

• Services to support parents of teenagers who may be disaffected and on the edge of care

Recommendations for consideration by other key organisations such as: Clinical Commissioning Groups (CCGs), General Practices, Local Authority department e.g. housing and other providers.