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

1. Placing a Child in a Long Term Residential Establishment

1.1 Considerations to be taken into Account When Placing a Child

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.

1.1.1 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 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.

1.2 The Responsibilities of Authorities – Definitions

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.

Caption: Responsibility for Visits

Responsibility for Visits to Children and Young People Placed in Long-Term Residential Settings
	Placement is within the local authority area where child is ordinarily resident – the home local authority.	Placement is within the area of a local authority area where the child is not ordinarily resident – the host local authority.
Child or young person is placed in a residential setting (Under section 85 of Children Act 1989)	Home local authority is the responsible authority	Home local authority is the responsible authority
Child or young person is placed in a residential care home or independent hospital (Under Section 86 of Children Act 1989)	Home local authority is the responsible authority	Host local authority is the responsible authority

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.

1.3 Placing a Child in a Residential Establishment

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.

Where the child or family have not been resident in any local authority area prior to the placement (where they have come from abroad for example) the accommodating authority must notify the host authority – which then also becomes the Responsible Authority.

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.

1.4 Placement of a Child in a Care Home or Independent Hospital

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.

2. Visiting By The Local Authority Representative

2.1 The Local Authority Representative - Required Qualities

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.

2.2 Visits by the Local Authority Representative

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.

2.3 Structure and Framework of the Visit

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.

The local authority representative has the power to enter a care home or independent hospital to ensure they can meet their responsibilities and safeguard the well-being of the child. They should produce an authenticated document proving their identity and make clear that they have this authority.

3. Contact Arrangements for Children

Contact from family and significant others for children and young people living away from home on a long term basis is important for them in the short and long term future, (unless there are contra-indicators that this is the case). It may also indicate what status the child should be placed in the establishment (see Section 1.1.1, Considering the Child's Status: Child in Need or Looked After).

The Responsible Authority must ensure that a child's needs are met where assessments identify safeguarding and welfare needs. This includes contact with parents, carers and other significant people including outside professionals for the child or young person. These services may include:

• Advice, guidance and counselling;
• Services necessary to enable the child or young person to visit, or be visited by, members of their family, including assistance with the costs of travel; and
• Assistance to enable the child or young person and members of their family to have a holiday together.

4. Reports by the Visiting Representative

Under Regulation 5 of the Visits to Children in Long-Term Residential Care Regulations 2011, the representative of the responsible authority must provide a report of each visit. Reports must include the representative's assessment of:

• The child or young person's wishes and feelings about the accommodation provided by the residential placement, so far as the visitor has been able to ascertain them;
• Whether the child or young person's welfare is adequately safeguarded and promoted by placement in the accommodation;
• The success of the placement, including any comments made by the child or young person or those caring for the child or young person. (It would be helpful to include progress towards identified outcomes);
• Whether further visits, in addition to those specified in the Regulations, are required in order to safeguard and promote the child's or young person's welfare;
• Whether advocacy support was requested and provided;
• Any services which the visitor considers should be made available to promote contact between the child or young person and their family; and
• Any other steps that should be taken by the responsible authority to safeguard and promote the child's or young person's welfare, (these could, for example, include access to particular facilities or community activity).

The representative's reports of visits should highlight any matters of concern or difficulties so that action can be discussed with their supervisor and then, as necessary, with other agencies. It is important for action to address matters of concern or difficulties:

• Specifies agreed and appropriate timescales;
• Is clear who is responsible for taking action.

Where there are serious concerns about the child's or young person's welfare and there is dwindling contact with their family, the reasons for this should be fully explored and should consider:

• Whether these concerns require the local authority to adopt a safeguarding approach;
• Whether the placement is appropriate to meet the child's holistic needs;
• Whether a multi-agency review should be held and, if required, brought forward;
• Whether the legal status of the child or young person should be re-considered.

The Visiting Representative should ensure that an appropriate existing report format is used, or is developed, to ensure that all the issues highlighted are covered and commented on, together with an evaluation of the child or young person's progress against the aims and objectives that have been established in the child's plan. The report should also identify / describe their relationship with the child or young person; how they were able to communicate with them and reflect whether they have made previous visits to them or their family or carers.

A copy of the report must be sent to:

• The child or young person, unless inappropriate given their age and understanding;
• The parent's and/or any person with parental authority unless to do so would place the child or young person at risk of significant harm;
• Any other person with responsibility for the child or young person's welfare, (e.g. extended family);
• The local authority with responsibility for the child or young person's welfare, unless the responsible authority is also the home authority.

Where/to whom the visiting representative's report is sent to - to follow.

5. Further Information

National Minimum Standards and Quality Standards

• Mental Capacity Act Code of Practice: Protecting the Vulnerable 2007;
• The National Minimum Standards for Boarding Schools;
• The National Minimum Standards for Residential Special Schools;
• Further education residential accommodation: national minimum standards;
• The Guide to the Children's Homes Regulations and standards;
• Ofsted and CQC joint registration guidance children's homes and health care.

Useful web links

• Council for Disabled Children;
• Contact a Family;
• National Network of Parent Carer Forums;
• Children's Education Advisory Service (CEAS).