12. Developing effective care plans

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Topic 12: Developing Effective Care Plans PDF final 06/05/14Download these notes as a PDF:
Child Development Final PDF 06.05.14

 

Topic 12: Developing Effective Care Plans

  • The circumstances that lead to children becoming looked after vary greatly and so give rise to a wide range of needs. But while every plan must be tailored to meet the needs of the individual child, all plans should include a common focus on some key issues. Plans should provide a sense of permanence, be built around relationships, involve birth families and incorporate the child’s perspective.
  • In order to achieve the quality of thinking that is essential for formulating and delivering effective plans, social workers need time and space to establish positive relationships with children and their birth families. Toolkits and frameworks can support the thinking needed for the accurate assessment of needs but are not a substitute for professional judgement.
  • Good-quality supervision within a positive team culture supports the type of analytical thinking needed to produce accurate assessments and care plans that are effective, needs-led and focused on outcomes.
  • Ongoing support for foster carers is crucial to ensure placement quality and continuity. Outcomes are more likely to be positive when carers are given sufficient information about the child’s background and understand the need for care, the plan for the child and their role in it, including any work with birth parents.
  • A ‘framework for thinking’ based on the linked concepts of ‘need’, ‘outcome’ and ‘plan’ can help everyone involved in the child’s life work together to formulate, deliver and review plans that start with needs and focus on outcomes. Only when there is clarity about need and desired outcomes is it possible to spell out the work most likely to address those needs and achieve those outcomes.

This briefing will help members of the ‘team around the child’ work together to formulate and deliver effective plans for looked after children. It covers key research messages relevant to planning for all looked after children, a brief summary of the role of different members of the team and some research messages, and a useful ‘framework for thinking’ that can be used and understood by everyone involved in planning for looked after children.

Research messages relevant to all care plans

‘There is very little that is true of all the children who are looked after by the state.’ (Sinclair et al, 2007)

The circumstances that lead to children becoming looked after vary greatly and give rise to a wide range of needs. One size does not fit all. An effective plan will be based on the specific needs of an individual child and not determined by the child’s legal status or limited to decisions about the child’s placement. It should be possible to read a care plan and gain an outline picture of the child’s story and the way that story has been used as the basis for the analysis of the child’s needs.

However, while each plan should always be tailored to meet the needs of an individual child, there are key issues that must be the focus of all plans for children. Plans should:

  • provide a sense of permanence for children who cannot live at home with their birth family – in other words, ‘security, stability, love and a strong sense of identity and belonging’ (The Care Inquiry, 2013):
    • How have adverse circumstances undermined the child’s sense of self and what will be done to rebuild this for the child?
  • emphasise the overriding importance of relationships in children’s lives (The Care Inquiry, 2013):
    • How has the child been affected by past relationships?
    • What steps will be taken to preserve and sustain positive relationships or to replace or improve less positive ones so that the child can be assured of good-quality relationships that will endure into adulthood?
  • involve birth families, regardless of whether or not a return home is anticipated (Boddy, 2013):
    • How are parental problems that led to the child becoming looked after being addressed?
    • How is the child’s connection to their birth family – parents, siblings and other family members – being nurtured and preserved?
  • include the child’s perspective in plans being made for them
    • Who is having ongoing conversations with the child to ascertain their wishes and feelings?
    • How is the meaning of the child’s behaviour being understood?
    • Who is trying to imagine how the world looks from the child’s perspective?

These key messages about permanence have influenced the development of policy and legislative changes. For example:

  • under the single inspection framework, Ofsted scrutinises the ability of local authorities to ensure that the development and maintenance of safe and secure relationships with adults is central to planning for a child’s long-term future
  • ways of reducing delay for children and ensuring that all possible options for securing permanence have been considered are fundamental to current legal changes, including those introduced by the Children and Families Act 2014
  • the legal definition of long-term foster care is to be amended to give it legal status as a permanency option, and under changes introduced by the Children and Families Act 2014 young people will also now be able to stay with their foster family up to the age of 21
  • local authorities are being encouraged to support children in adoptive homes through the provision of post-adoption services.

Messages for members of the Team around the Child

Child’s social worker

The child’s social worker is responsible for gathering and evaluating information from birth parents, the child and others involved in the child’s life. The social worker is responsible also for making sure that information is analysed accurately and for ensuring the analysis forms the basis for well-planned interventions that can lead to the best outcomes possible for the child and their parents, and for then facilitating implementation of the plan.

  • Social workers need time and space to establish positive relationships with children and their birth families and to achieve the quality of thinking that is essential for formulating and delivering effective plans (Turney, 2009).
  • Toolkits and frameworks can support the thinking that is needed for the accurate assessment of needs. However, they are not a substitute for professional judgement (Brown et al, 2012).

Social work manager

The social work manager is responsible for quality assuring the work of the social work team and for ensuring that the contribution of all those involved in the team around the child is considered. The social work manager has to manage workloads and negotiate bureaucratic processes to enable social workers to prioritise good-quality practice and effective service delivery.

  • Good-quality supervision provided within a positive team culture supports good practice and the type of analytical thinking that is needed to produce accurate assessments, which in turn lead to plans that are effective, needs-led and outcome-focused (Brown et al, 2012).

Independent reviewing officer (IRO)

The IRO chairs looked after children reviews, facilitates the attendance of children and parents and makes sure their views are heard and responded to. Throughout the care planning process, the IRO protects the child’s interests and monitors their progress on an ongoing basis, challenging the local authority (including health and education) whenever plans are not responding to children’s needs.

  • Good training opportunities and supportive management increase the confidence of IROs and their ability to challenge poor practice (Jelicic et al, 2013).
  • IROs are able to monitor and quality assure plans when all decisions are made in review meetings, when they are updated regularly by social work and Cafcass colleagues and when manageable workloads enable them to visit children between meetings (Jelicic et al, 2013).

Foster carer

The foster carer’s role isto provide good-quality care for children who are not able to live with their birth families.

  • The quality of the relationship the foster carer can offer the child is crucial (Boddy, 2013),
  • Outcomes are more likely to be positive where carers have been given enough information about the child’s background, understand the need for care, the plan for the child and their role in it, including any work they will do with birth parents (Sinclair, 2005).
  • The capacity to reflect, to put themselves in the child’s shoes and to accept the child in their care are all essential attributes for foster carers (Schofield and Beek, 2005)
  • The ‘chemistry’ and fit’ between children and carers is important – where this seems positive, children are more likely to report a sense of belonging and show signs of reduced anxiety that could otherwise impede progress in other aspects of their lives (Schofield and Beek, 2005)
  • Some carers – especially kinship carers – will have financial, housing and health difficulties. These need to be addressed as part of the plan for the child (Farmer, 2010).

Supervising social worker (ie the carer’s social worker)

The supervising social worker supports the carer to provide the best quality of care possible for the child on a day-to-day basis.

  • Ongoing support for foster carers is known to be crucial in ensuring quality and continuity in placement (Boddy, 2013).
  • The kinds of support that foster carers will need are likely to include developing an appreciation of the ways in which their own personal experiences have affected them, how those experiences might affect their relationship with a child in their care, how to sustain positive relationships and effective functioning through times of stress (including with the child’s parents), and being able to let the child go.

Adoptive parent

The adoptive parent’s role is to provide a permanent family and lifetime commitment to children whose legal ties to their birth family have been terminated.

  • It is important for adoptive parents to accept that being an adoptive parent is not the same as being a birth parent.
  • Adopters need to welcome the child wholeheartedly as a lifetime member of their family, while at the same time accepting and nurturing the connections the child has to their birth family and others who care about them, including previous foster carers, for example (Cossar and Neil, 2013).
  • For children who have experienced adversity, forming positive and constructive relationships can be a slow process (Howe, 2005).

A framework for thinking

A simple ‘framework for thinking’ based on the linked concepts of need, outcome and plan found in many assessment templates can help everyone involved in the child’s life work together to formulate, deliver and review plans that start with needs and have a clear focus on desired outcomes.

The practical needs-led and outcome-focused Analytical Framework for Thinking builds on the Matching Needs and Services planning tool (designed originally by the Dartington Social Research Unit). The framework has been developed over 14 years and implemented in practice across various English and Welsh local authorities.

Need

The framework helps practitioners to use the concept of need in a very particular way. Here the Rosie case study is used to show how the framework encourages practitioners to move away from describing need:

  • in universal terms – for example: ‘Rosie needs to be safe’, or
  • in service terms – for example: ‘Rosie needs family therapy’, or
  • in terms of need for assessment – for example: ‘Rosie needs a psychiatric assessment.’

Instead, needs are described in more specific terms, as in:

  • ‘Rosie needs well-managed contact with her mother.’
  • ‘Rosie needs Lena (grandmother) and Andrea (foster carer) to understand why contact is important.’

This precision in describing need increases the chances of developing interventions that will address the specific needs of each child and relevant family members.

Outcomes

Desired outcomes should conform to the SMART standard – that is they need to be Specific, Measurable, Agreed (with families), Realistic and Timed (SMART concept Drucker 1954; applied to social work assessment in Brown et al, 2012). They must also relate directly to decisions about the stages of work needed for addressing the particular needs identified. For example:

  • ‘Andrea reports that she is less worried about the negative impact contact with her mother might have on Rosie’s behaviour.’
  • ‘Lena has explained to the social worker why it is important for Rosie to establish a positive relationship with her mother and reports she is more positive about contact.’

Plans

Only when there is clarity about need and desired outcomes is it possible to spell out the work that is most likely to address those needs and achieve the outcomes.

At this stage, decisions can be made about which professional from the team around the child is likely to be most effective in working with this particular child and family. Desired outcomes set out in the plan for Rosie and her family might include:

  • ‘The supervising social worker will work with Andrea to help her understand the connections between Rosie’s behaviour and her need to see her mother.’
  • ‘The social worker will meet with Lena to talk about the importance of identity for children who are not living with their birth families.’

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Key Questions_iconKey questions

Topic 12: Developing Effective Care Plans PDF final 06/05/14Download these notes in the topic PDF:
Child Development Final PDF 06.05.14

 

12 Care planning exercises and questions as a Word DOCX fileDownload the questions and exercises as a Word DOCX file:
12 Care planning exercises and questions as a Word DOCX file 01/05/14

Download the questions and exercises as a Word 97-2003 DOC file:
DfE Topic 12 Care planning exercises 01/05/14 .DOC

 

Key questions for developing effective care plans

Methods
Suitable for self–directed learning or reflection with a colleague or supervisor. You will need access to a recent care plan.

Learning Outcome
To review how a recent care plan addresses a child’s needs.

Time Required
30 minutes review and 30 minutes reflection with a colleague or supervisor.

Process
Review a recent case and care plan and assess the extent to which the following areas have been addressed:

  • How have adverse circumstances undermined the child’s sense of self and what will be done to rebuild this for the child?
  • How has the child been affected by past relationships?
  • What steps will be taken to preserve and sustain positive relationships or to replace or improve less positive ones so that the child can be assured of good-quality relationships that will endure into adulthood?
  • How are the parental problems that led to the child becoming looked after being addressed?
  • How is the child’s connection to their birth family – parents, siblings and other family members – being nurtured and preserved?

 

Key questions for including the child’s perspective in care plans

Methods
Suitable for self–directed learning or reflection with a colleague or supervisor. You will need access to a recent care plan.

Learning Outcome
To review how a child’s perspective is included in their care plan.

Time Required
30 minutes review and 30 minutes reflection with a colleague or supervisor.

Process
Review a recent case and care plan and assess the extent to which the following areas have been addressed:

  • Who is having ongoing conversations with the child to ascertain their wishes and feelings?
  • How is the meaning of the child’s behaviour being understood?
  • Who is trying to imagine how the world looks from the child’s perspective?
  • How is the child’s perspective being included in the care plan?

 

Key questions for monitoring care plans

Methods
Suitable for self–directed learning or reflection with a colleague or supervisor. You will need access to a recent care plan.

Learning Outcome
To review how care plans are monitored.

Time Required
30 minutes review and 30 minutes reflection with a colleague or supervisor.

Process
Review a recent case and care plan and assess the extent to which the following areas have been addressed:

  • To what extent does the care plan provide sufficient evidence and analysis of the child’s situation?
  • What assessments/tools have been used to inform the plan?
  • How effectively has the child’s perspective been included in the care plan?
  • How will the plan help the child to develop and maintain safe and secure relationships?
  • How does the plan aim to support the child’s connection to their birth family?
  • How can social workers be supported to establish positive relationships with children and their birth families?

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keymessages_iconExercise

Topic 12: Developing Effective Care Plans PDF final 06/05/14Download these notes in the topic PDF:
Child Development Final PDF 06.05.14

 

12 Care planning exercises and questions as a Word DOCX fileDownload the questions and exercises as a Word DOCX file:
12 Care planning exercises and questions as a Word DOCX file 06/05/14

Download the questions and exercises as a Word 97-2003 DOC file:
DfE Topic 12 Care planning exercises 01/05/14 .DOC

 

Case study – Rosie

Methods
Suitable for a small group discussion. Individuals will need a copy of the case study for Rosie and the handout of the framework for thinking summary.

Learning Outcome
To practice using the need, outcome and plan “framework for thinking”.

Time Required
30 minutes for discussion plus 15 minutes for feedback

Process
Give each group a hand-out of the case study for Rosie and the framework for thinking summary and ask each group to appoint someone to feedback their ideas.

Ask the group to read the case study and the framework for thinking summary and answer the following questions.

  1. How would you describe Rosie’s needs:
  • in universal terms?
  • in service terms?
  • in terms of need for assessment?
  1. What SMART outcomes could you consider for each of these needs?
  2. In order to achieve these outcomes, which professional from the team around the child is likely to be most effective in working with Rosie and her family?

A framework for thinking summary

A simple ‘framework for thinking’ based on the linked concepts of need, outcome and plan found in many assessment templates can help everyone involved in the child’s life work together to formulate, deliver and review plans that start with needs and have a clear focus on desired outcomes.

The practical needs-led and outcome-focused Analytical Framework for Thinking builds on the Matching Needs and Services planning tool (designed originally by the Dartington Social Research Unit). The framework has been developed over 14 years and implemented in practice across various English and Welsh local authorities.

Need

The framework helps practitioners to use the concept of need in a very particular way. Here the Rosie case study is used to show how the framework encourages practitioners to move away from describing need:

  • in universal terms – for example: ‘Rosie needs to be safe’, or
  • in service terms – for example: ‘Rosie needs family therapy’, or
  • in terms of need for assessment – for example: ‘Rosie needs a psychiatric assessment.’

Instead, needs are described in more specific terms, as in:

  • ‘Rosie needs well-managed contact with her mother.’
  • ‘Rosie needs Lena (grandmother) and Andrea (foster carer) to understand why contact is important.’

This precision in describing need increases the chances of developing interventions that will address the specific needs of each child and relevant family members.

Outcomes

Desired outcomes should conform to the SMART standard – that is they need to be Specific, Measurable, Agreed (with families), Realistic and Timed (SMART concept Drucker 1954; applied to social work assessment in Brown et al, 2012). They must also relate directly to decisions about the stages of work needed for addressing the particular needs identified. For example:

  • ‘Andrea reports that she is less worried about the negative impact contact with her mother might have on Rosie’s behaviour.’
  • ‘Lena has explained to the social worker why it is important for Rosie to establish a positive relationship with her mother and reports she is more positive about contact.’

Plans

Only when there is clarity about need and desired outcomes is it possible to spell out the work that is most likely to address those needs and achieve the outcomes.

At this stage, decisions can be made about which professional from the team around the child is likely to be most effective in working with this particular child and family. Desired outcomes set out in the plan for Rosie and her family might include:

  • ‘The supervising social worker will work with Andrea to help her understand the connections between Rosie’s behaviour and her need to see her mother.’
  • ‘The social worker will meet with Lena to talk about the importance of identity for children who are not living with their birth families.’

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keymessages_iconReferences

Topic 12: Developing Effective Care Plans PDF final 06/05/14Download these notes in the topic PDF:
Child Development Final PDF 14.04.14

 

  • Boddy J (2013) Understanding Permanence for Looked After Children: A review of research for the Care Inquiry. London: The Care Inquiry
  • Brown L, Moore S and Turney D (2012) Analysis and Critical Thinking in Assessment Resource Pack. Dartington: Research in Practice
  • Cossar J and Neil E (2013) ‘Making Sense of Siblings: Connections and severances in post-adoption contact’ Child & Family Social Work 18 (1) 67–76
  • Drucker P (1954) The Practice of Management. New York: Harper & Brothers
  • Farmer E (2010) ‘What Factors Relate to Good Placement Outcomes in Kinship Care?’ British Journal of Social Work 40 (2) 426-444
  • Howe D (2005) Child Abuse and Neglect: Attachment, development and intervention. Basingstoke: Palgrave Macmillan
  • Jelicic H, Hart D, La Valle I, Fauth R, Gill C and Shaw C (2013) The Role of Independent Reviewing Officers (IROs) in England: Findings from a national survey. London: National Children’s Bureau
  • Little M, Madge J, Mount K, Ryan M and Tunnard J (1999) Matching Needs and Services. (2nd edition) Dartington: Academic Press
  • Schofield G and Beek M (2005) ‘Risk and Resilience in Long-term Foster Care’ British Journal of Social Work 35 (8) 1283–1301
  • Sinclair I (2005) Fostering Now: Messages from research. London: Jessica Kingsley Publishers
  • Sinclair I, Baker C, Lee J and Gibbs I (2007) The Pursuit of Permanence: A study of the English child care system. London: Jessica Kingsley Publishers
  • The Care Inquiry (2013) Making Not Breaking. Building relationships for our most vulnerable children. London: Nuffield Foundation
  • Turney D (2009) Analysis and Critical Thinking in Assessment: A literature review. Dartington: Research in Practice

 

 

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