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.
Table 1: Child Protection as at 30 September 2015 Category of Needs | Number of children |
Emotional abuse | 37 |
Neglect | 21 |
Physical abuse | 6 |
Sexual abuse | 0 |
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.
Table 2: Children in Need as at 30 september 2015 Category of Needs | Number of needs |
Learning Disability Support | 5 |
Mental Health Support | 2 |
Physical Support | 1 |
Abuse or Neglect | 97 |
Child Disability | 109 |
Parental illness or disability | 11 |
Family in acute stress | 9 |
Family dysfunction | 25 |
Socially unacceptable behaviour | 2 |
Absent parenting | 1 |
Cases other than Children in Need | 1 |
Total | 263 |
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.
Table 3 - risk profile of children and young people's mental health and wellbeing in Wokingham Borough. Source: PHE Fingertips
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.
Table 4 - estimates for children aged 17 years and under in Wokingham Borough in CAMHs services | Tier 1 (2014) | Tier 2 (2014) | Tier 3 (2014) | Tier 4 (2014) |
Wokingham | 5530 | 2585 | 685 | 30 |
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.
Table 5 – Child and Adolescent Mental Health Service referrals by Clinical Commissioning Groups. Source: Berkshire Healthcare NHS Foundation Trust, 2015
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.
Table 6 – estimated number of mental health disorders for Wokingham Borough split by age group and sex | Estimated number of children aged 5-10 yrs (2014) | Estimated number of children aged 11-16 yrs (2014) | Estimated number of children aged 5-16 yrs (2014) | Estimated number of boys aged 5-10 yrs (2014) | Estimated number of boys aged 11- 16 yrs (2014) | Estimated number of boys aged 5-16 yrs (2014) | Estimated number of girls aged 5-10 yrs (2014) | Estimated number of girls aged 11-16 yrs (2014) | Estimated number of girls aged 5-16 yrs (2014) |
Wokingham | 745 | 1050 | 1795 | 510 | 605 | 1110 | 240 | 445 | 685 |
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.
Table 8 – Children and Young people's mental health profile for Wokingham Borough
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.
Table 9 – Percentage of Children in Need eligible for Free School Meals | 2012 (%) CIN | 2013 (%) CIN | 2014 (%) CIN | 2014 (%) All Primary pupils |
Wokingham | 39.5 | 35.10 | 41.9 | 9.3 |
Statistical Neighbour | 44.19 | 45.57 | 44.08 | 15.3 |
England | 55.60 | 55.60 | 54.5 | 26.9 |
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.
Table 10 - Percentage of pupils with a statement of special educational needs or EHCP | Primary – Pupils with statements (%) (2014) | Primary – Pupils with statements (%) (2015) | Secondary – Pupils with statements (%) (2014) | Secondary – Pupils with statements (%) (2015) | All (incl Special)– Pupils with statements (%) (2014) | All (incl Special)– Pupils with statements (%) (2015) |
Wokingham | 1.60 | 1.40 | 2.50 | 2.40 | 3.00 | 2.90 |
England | 1.40 | 1.40 | 1.90 | 1.80 | 2.80 | 2.80 |
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.
Table 11 – Key stage 2 attainment in English and Mathematics | Pupils with no identified SEN: % achieving at level 4 or above in Key Stage 2 (2012) | Pupils at School Action: % achieving at level 4 or above in Key Stage 2 (2012) | Pupils at School Action Plus: % achieving at level 4 or above in Key Stage 2 (2012) | Pupils with a statement of SEN: % achieving at level 4 or above in Key Stage 2 (2012) | Pupils with SEN but without a statement: % achieving at level 4 or above in Key Stage 2 (2012) | All pupils: % achieving at level 4 or above in Key Stage 2 (2012) |
Wokingham | 92 | 52 | 42 | 16 | 49 | 82 |
England | 92 | 52 | 38 | 17 | 47 | 80 |
Source: Chimat, 2012
Table 12 – Key stage 4 attainment | Pupils with no identified SEN: % achieving 5+ A*-C grades inc. English and Maths GCSEs (2012) | Pupils at School Action: % achieving 5+ A*-C grades inc. English and Maths GCSEs (2012) | Pupils at School Action Plus: % achieving 5+ A*-C grades inc. English and Maths GCSEs (2012) | Pupils with a statement of SEN: % achieving 5+ A*-C grades inc. English and Maths GCSEs (2012) | Pupils with SEN but without a statement: % achieving 5+ A*-C grades inc. English and Maths GCSEs (2012) | All pupils: % achieving 5+ A*-C grades inc. English and Maths GCSEs (2012) |
Wokingham | 73.80 | 28.00 | 31.30 | 6.10 | 29.60 | 65.60 |
England | 69.50 | 27.80 | 20.50 | 8.40 | 25.30 | 59.00 |
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:
| 2012 | 2013 | 2014 |
| Wokingham | 77.10 | 62.50 | 53.90 |
| Statistical Neighbours | 61.87 | 61.09 | 58.10 |
| England | 61.00 | 57.90 | 54.70 |
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.
Table 13 – Area profile of Wokingham Borough for children's and young people's mental health and wellbeing, Social Care
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.
Figure 14 – percentage split of age groups between boys and 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.
Figure 15 – School readiness, as measured in the EYFSP | 2013 | 2014 | 2015 |
| Wokingham | 47.30 | 60.60 | 70.00 |
| South East | 54.30 | 64.10 | 70.10 |
| Statistical Neighbours | 56.24 | 63.89 | 71.01 |
| England | 51.70 | 60.40 | 66.30 |
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.
Table 16 – percentage of 19 year olds qualified to Level 2 by Free School Meal | Not eligible for FSM (%) | Eligible for FSM (%) | All (%) |
England | 88 | 71 | 86 |
South | 88 | 66 | 86 |
Source: Department for Education, 2015
Table 17 – percentage of 19 year olds qualified to Level 3 by Free School Meal | Not eligible for FSM (%) | Eligible for FSM (%) | All (%) |
England | 60 | 36 | 57 |
South | 61 | 29 | 58 |
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
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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
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From 4714 contacts (this include phone contacts), around 75 percent of cases were retained in tier 1 to 3 services
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There was a potential group of 1700-2600 children who after contact did not remain in contact with services
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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.