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ASF leads to CAMHS withdrawing support

Child and Adolescent Mental Health Services are withdrawing or reducing their investment or involvement with adoptive or children under Special Guardianship Orders, an Evaluation of the Adoption Support Fund has found.

Local authorities and providers reported an increase in the volume of demand for ASF support, fuelled not only by the availability of the Fund but also because other statutory services – in particular CAMHS - may have ‘stepped back’ from providing support to families.

The Institute of Public Care at Oxford Brookes University, which carried out the research, highlighted an earlier study of the Fund (Tavistock Institute, 2017) which had already identified that CAMHS often didn’t recognise ‘attachment-related difficulties’ as falling within their remit.

Local authorities frequently described demand for ASF-funded support as relating mainly to child:
• Developmental trauma and attachment-related issues.
• The effects of having experienced abuse and/or neglect.
• Sensory needs, which are sometimes described by local authorities as one of the initial areas of need for many children after which other underlying needs can be addressed ie attachment issues.
• Child emotional regulation difficulties.
• Child behaviour problems, including risk taking.
• Foetal Alcohol Syndrome Disorder.
• Child to parent aggression / violence.
• Conditions such as Autistic Spectrum Disorder, ADHD, or learning difficulties.

“Two areas that interviewees highlighted as emerging areas of growing demand were Foetal Alcohol Syndrome Disorder, described by one local authority as ‘a struggle’ (as it is not in scope for the ASF in its own right); and child to parent violence,” said the report.

However, the Adoption Support Fund has had many positive outcomes, the analysis found:

• Parents have a deeper understanding of their child’s trauma, the impact of secondary trauma on them, and how they can self-care.
• Support is bespoke and high quality.
• Children’s needs are being identified earlier.
• Providers and local authorities are working creatively to develop and deliver support that is more likely to work for families.
• It has raised awareness of Special Guardianship as a form of permanency.

There was a strongly held belief by providers was that the Fund is leading to better access to therapeutic support and better outcomes for children and families, although they acknowledge that children’s outcomes are not yet being systematically measured.

The report said that there is good and improving awareness and take up of the Adoption Support Fund particularly amongst adoptive families. Adoptive parents are reported to be more aware of ‘their entitlement’ to support and are increasingly requesting it. For these families, it appears to be more acceptable to ask for help and/or there is less stigma attached to asking for help as a result of the Fund.

There was some criticism of the process of applying for ASF funded support and the impact on families, in particular the problem for families of not being able to carry over funding from one financial year to the next.

There were contrasting views about the quality and usefulness of local authority generated adoption support assessments that inform the application for ASF funding and therapy selection. Local authority interviewees generally considered these assessments to be of good quality and useful in informing therapy selection.

However, common criticisms from providers were that the assessments do not include sufficient information to inform a therapeutic plan and/or that social workers undertaking these recommend therapies about which they are not sufficiently well-informed to make a judgement about their suitability.

The report added that the use of multi-disciplinary assessments appears to be very mixed across local authorities and, in some cases, there can be a lack of consensus amongst contributors as to what are the causes of child difficulties and what is the right treatment pathway.

The Fund was thought by many providers to have engineered an improvement of skills in the field of ‘newer’ therapies such as Eye Movement Desensitisation and Reprocessing (EMDR) and/or Sensory Integration Processing Therapy and to have acted as a ‘mandate for more specialist training’. However, provider perception was also that some of the more traditionally commissioned therapies, including those that are dyadic and systemic, such as Dyadic Developmental Practice (DDP), or Theraplay continue to be more frequently requested by local authorities because they are well established, known by social workers and families, and have a reputation amongst these parties for being effective.

The relatively swift growth in demand since the inception of the Fund was thought to continue to be challenging for the sector, for example in terms of the availability of appropriate physical space for therapy or enough high-quality staff with the right kind of experience and training.

Specific gaps in the market noticed by providers and local authorities participating in this study included:
- interventions tailored (more) to the needs of SGO families.
- support for families living in rural areas.
- specific therapies that are not yet thought to be sufficiently available (such as DDP, sensory integration assessments and therapy, therapeutic life story work, Video Interaction, Positive Parenting, and therapies to deal with child to parent violence)
- whole-system support that would enable parents and schools to respond earlier and more effectively to the needs of children.

There was a general consensus about the ongoing need for the Fund and suggestions about its future development and sustainability including:
• To develop more multi-disciplinary teams.
• To further develop the spectrum of available support across different levels of need including more preventative and broader offers of support for the whole family and their supporters.
• For the Fund to be directly accessed by Voluntary Adoption Agencies as well as local authorities.
• For more information about the availability of the Fund and specific offers for SGO families.
• For greater flexibility about how the funding can be used, for example for sibling groups and groups of children with similar or complex needs, or carrying over funding from one financial year to the next.

Evaluation of the Adoption Support Fund: local authority and provider

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