Children in residential homes are not always able to access the specialist mental health services they need during the Coronavirus pandemic, Ofsted has said.

In a briefing on children’s social care providers based on evidence from assurance visits to children’s homes between 1 and 11 September, Ofsted said children didn’t always get the help they needed because sometimes because staff did not understand or prioritise their complex needs, and appointments were missed or delayed.

In some areas, a child and adolescent mental health services (CAMHS) policy of no face-to-face contact meant that psychologists and therapists were unable to visit children’s homes. But some staff did not know how to respond to incidents of self-harm.

“Although therapists often held sessions on video so that support was not interrupted, this method of engagement is not accessible or appropriate for all children. In one home, further support was provided by an on-site therapist, who monitored the impact of COVID-19 on the children’s emotional health,” said the report.

While some children experienced an improvement in their mental health during this period and had good engagement with mental health professionals, which may have been due to better relationships with staff and children in the home or reduced anxiety about school or other outside pressures, for many children in care, COVID-19 restrictions meant an increase in low mood, phobias and anxiety.

Ofsted’s inspector survey results highlighted mental health as being in children’s homes’ top three concerns.

Ofsted is carrying out a series of ‘assurance visits’ to children’s social care providers as part of a phased return to routine inspection. The visits follow existing principles for inspection and result in a report that gives no graded judgement but does include requirements or recommendations for improvement and highlights any serious or widespread concerns.

Overall, inspectors found:

• Inspectors were generally confident that children were safe and well cared for.
• Homes reported an increase in anxiety and frustration in children around COVID19.
• Staff worked hard to make homes fun and provided activities to support learning.
• Staff helped children to maintain relationships with friends and families through messaging and video technology and worked with partners to ensure that specialist services continued.
• There was some evidence of less oversight in many homes, but much more evidence of strong leaders managing the challenges of the pandemic well.

Leaders generally understood the risks associated with the pandemic well and were helping children to keep safe. Staff provided good support to children so that they understood that they needed to stay healthy by following social distancing rules and guidance. However, in some homes, staff did not always know what risks children might be exposed to. Poor record-keeping and communication between staff sometimes meant that workers did not have access to, or knowledge of, the most up-to-date information about the children in their care. In a minority of homes, a higher turnover of staff and less access to training during the pandemic exacerbated these problems.

Relationships between children in some homes during this period have been difficult, with occasional reports of bullying and conflict between children. Some children have also been struggling with restrictions and going missing which tended to be linked to children not having their usual routines or being able to visit family and friends, or a lack of consistency in staffing levels as a result of self-isolation. Despite the restrictions, most homes continued to maintain contact with children during missing episodes, to go out and look for them and to discuss with them their reasons for going missing.

Staff in children’s homes generally cared well for the children and ensured that their social, physical, emotional and mental health needs were met. Staff had developed activities to keep children busy and happy, and children were encouraged to follow their individual interests and talents. Activities such as a ‘prom party’ to celebrate children’s achievements and a ‘Bake Off’ competition helped children create happy memories during extended periods of isolation.

Relationships between children and staff in homes tended to be positive. In some cases, these had even improved during this period. Some staff commented that they had enjoyed the period as it had enabled them to spend more time with the children in the home. Staff helped children to remain in touch with their families and friends through messaging and video apps. In many cases, children had been able to see their families face to face, and staff helped children do this in a socially distanced way.

However, there have been instances when children have expressed their views to staff, but these were not seriously considered nor acted on effectively. In one case, a child went missing to avoid school, despite consistently voicing their concerns about returning to school.

Many children remained in education, some remained full-time at school, and others received a mix of online tutoring and education at home. Children’s homes encouraged children to continue to engage in learning, such as by supporting them with learning or taking them to and collecting them from school so that they could continue formal education.

Inspectors saw evidence of homes working well with schools to help children with their education, and had developed bespoke approaches for children who struggle. For example, when children did not engage in the work sent by the school, some homes used other activities, such as weighing out ingredients in baking or budgeting, in an attempt to link to the educational themes. Staff also helped the children prepare for returning fully to school in September. However, in some homes, a lack of structure during restrictions, especially in engaging children in formal and informal education, has made it harder to do this.

Staff struggled with managing a children’s home during the pandemic and found it challenging due to working under the restrictions, staff shortages due to illness and self-isolation and an increase in staff turnover and difficulties recruiting. Despite these challenges, children generally received consistency and continuity in their care. Inspectors generally found that COVID-19 had not negatively impacted the ability of homes and their staff to put children at the centre of practice.

Many managers had retained good oversight, meaning that staff were motivated, had regular supervision, felt supported and had good morale. Inspectors saw evidence of safeguarding training being kept up to date and, in several homes, a range of online training resources and/or conference calls were provided to ensure continuity and development.

In some homes, leadership and management were weak. This was sometimes linked to a history of poor practice, but also related to homes having new managers, being understaffed or experiencing significant staff changes, with staff or managers leaving or being suspended/dismissed. There was evidence though that, even during the pandemic, positive changes and improvements were possible if there was effective leadership.

Homes had clear steps in place to manage infection risks including PPE, taking children’s and visitors’ temperatures on arrival and reducing face-to-face contact by using virtual and telephone communications. However, inspectors did note some instances of COVID-19 guidance not being followed and the need for assessments to be updated to reflect current government advice.

There was very limited evidence of homes using the temporary flexibilities in the regulations permitted by the Adoption and Children (Coronavirus) (Amendment) Regulations 2020. Homes that have used these have done so to adapt family contact arrangements and to arrange independent visitors to visit virtually or less frequently. In some cases, reports based on virtual visits were of variable quality or lacked consultation with children.

Children’s homes are working well with partner agencies to meet children’s needs and train staff, and this has continued despite COVID-19 restrictions. Most homes have maintained good levels of communication with partner agencies such as police, CAMHS, social care and virtual schools. However, some visits highlighted the need for homes to improve communication with other professionals, such as social workers.

Based on the survey of inspectors, most children’s homes were not concerned about their long-term sustainability due to finances.

Of the 125 assurance visits that started between 1 and 11 September 2020, 18 identified serious or widespread concerns.

“For many homes, the pandemic has not had a detrimental effect on their ability to keep children safe and well cared for. However, for a number of homes, improvements that could have been made despite the pandemic were not. In some cases, the virus has exacerbated poor practice,” the report concluded.

COVID-19 series: briefing on children’s social care providers, September 2020 Evidence from assurance visits to children’s homes between 1 and 11 September