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June Thoburn Special Edition

Routes to permanence for children who need out-of-home care: An evidence overview*

*This is a much shortened version of a submission to the Care Review – available on APSW website (APSW.org.uk). Most references are omitted as are the detailed pointers to improvement. 

Alternative ‘routes to permanence’- overview of legislation, policy and practice

‘Permanence’ is frequently used as a summary term for a complex set of aims and experiences. It, and terms such as ‘family for life’, are ‘shorthand’ terms for a child’s need for stability, continuity, family membership, being loved and loving. It is often placed alongside a child’s and adult’s need for a sense of personal and cultural identity. Over the past 40 years the emphasis on the different ‘routes to permanence’ has shifted from returning children safely to their families, seeking to ensuring stability for children who remain in long term foster care, and securing exits from care to ‘legal permanence’ in adoptive and kinship families.

International and national research has identified the key variables to be considered when deciding which ‘route to permanence’ might be most likely to ‘work’ in different circumstances. Age at entering care and at placement with a substitute family is a ‘proxy’ variable for weighing the likelihood of the placement lasting into adulthood and beyond. However, some young people moving into a foster family in their teens put down roots that remain for them in adulthood. Recognition of this contextual knowledge is firmly embedded in the 2015 DfE guidance[1]. The two preferred ‘permanence’ options are:

  • Leaving care by safe return to parent/s able to meet the child’s safety and long-term wellbeing needs;
  • And, leaving care to live on a secure legal basis with kin.

In accordance with the UN Convention on the Rights of the Child and the Children Act 1989[2], these must first be considered and services provided to support the likelihood that they will meet the child’s stability, identity and protection needs throughout childhood. If neither are viable options, the appropriate long term placement for each child will be chosen from: remaining in secure long-term foster care, leaving care via adoption or – since the early 2000s – special guardianship; and in some circumstances (and almost always for older entrants to care or those for whom a planned ‘permanence’ option has disrupted) a planned stable placement in a children’s home.

An overview of the current knowledge base on alternative permanence options

There have been many research studies over this period. Still highly relevant to the present knowledge base are the DH Messages from Research overviews disseminating research findings from across placement options[3]. These, and the research-based Principles and Practice in Regulations and Guidance[4] should be the starting point for the evidence evaluation stream of a review that is considering fundamental change that may impact on placement choices for children in care.

The over-arching messages are: 

  • If children are assessed as needing long term care away from their parent/s, it is likely that they will have experienced inter-uterine or post-birth trauma, neglect or other harms. Additionally, all will have experienced the trauma of at least some separation and loss from adults (parents, relatives and/or foster carers) to whom they have become close. Separation can be traumatic even if attachments have been problematic.
  • Children who need out-of-home care at any age are likely to have some additional needs for support. At least episodically at times of stress, they and those who become their ‘permanent’ family will need supportive, practical and sometimes intensive therapeutic services, as they grow up and move into adulthood, and for some, as they parent their own children.  Parenting these children, presents special challenges. All members of the ‘kinship network’ (including birth and new family members) are likely to need skilled and empathic assistance in the early stages of the placement and then periodically at key development stages and times of stress.
  • Whilst all young people should remain part of their family beyond 18, young adults who have been in care because of maltreatment or neglect are likely to continue to need to call on aspects of ‘parenting’ (often to an extent beyond what would be the case for an ‘average’ young adult).
  • The 1989 Children Act provided a sound basis for meeting the welfare, participation, protection and identity needs of children in need of additional services, including needing to be placed in ‘out-of-home’ care.
  • Measures to reduce unnecessary changes have improved the stability for those placed as toddlers and in their middle years. Most infant entrants who cannot return safely to parents are adopted or placed with kin and services for them have improved (see below). Placement instability remains a serious problem for a small but worrying group of older entrants to care, or those whose permanent placements (in foster or adoptive families) disrupt in adolescence. This problem is exacerbated by the fragmentation of placement services that has become more marked in recent years.
  • Despite the challenges, most children who need to enter care do as well or better than similar children who do not enter care. Some do very well, and some do very badly. Depending on their age when entering care, many will need longer than the average child, to move into successful adult life[5].
  •  Short term care or episodic care in the same placement, as part of a relationship-based family support service (as envisaged by S.20 of the Children Act 1989) can make it possible for some children to remain in in kinship care or return to parents  in a planned way. 

Alternative routes to permanence: how well do they do and what must be done do make them better?

Return home from care: the first permanence option   

 Leaving aside those who come into care for a planned or emergency short period or (often involving children or a parent with a disability), have a series of placements or a long term ‘shared care’ placement in the same setting, the conclusion from research using a range of methods in different countries is that return home from care is the least ‘successful’ ‘permanence’ option[6]

The main reason why necessary improvements identified by researchers (all possible under current legislation) have not happened is the failure of policy-makers to take on board the point made above: these are likely to have additional needs resulting from the experience of trauma, separation and loss, are likely to present challenges to their parents, and likely to need high quality services over long periods of time.  This has been understood with respect to adopters and kinship carers, but the evidence shows that parents and children ‘reunified’ from care receive at best a short term, possibly ‘intensive’ service.[7] 

Leaving care via a Special Guardianship Order

With respect to kinship care, there is a growing body of research indicating that, despite kinship guardians being on average older, and living in poorer economic circumstances, the actual placement break-down rate is low. Qualitative research reporting on the views of carers, and young people finds generally high levels of satisfaction[8].  Some of the points made above with respect to return to birth parents are relevant to service needs of kinship carers and their families. As with returning to a parent, for some kinship families a longer-term relationship-based flexible service may be needed, though most often on an ‘episodic’ basis. Assistance with family contact arrangements is often needed and sometimes on a long-term basis. As for children in long term foster and adoptive families, if a child in a kinship family needs to enter care, support to the family which avoids blaming can succeed in maintaining a sense of family belonging. 

Leaving Care via an adoption order

A large volume of research reports on adoptions from care and alternative long-term placements.[9]  These report a very low rate of adoption breakdown/ disruption (before or after the adoption order) varying between less than 5% and around 20% depending on the age and characteristics of the children in the study. In England, the ages of children placed from care for adoption have decreased and most are now placed when under aged 2 and very few when over 3.  Although actual placement breakdown is low, studies report considerable distress for somewhere between a third and a half of the families, especially during teenage years.

Recognition of these issues has resulted in the development of policies and practice to assist and support adoptive families, not just at the time of placement, but also, at the request of the adopters and older children when stresses are experienced. Of particular importance is getting the appropriate balance at the recruitment stage between information about the rewards and the possible challenges of adoptive family life. Love and the wish to help a child are essential, but not enough.

Planned long term foster family care

Most studies report that children placed when young with a foster family intended to be their ‘family for life’ are likely to remain there till adulthood and beyond and to have good wellbeing. However, in England, very few children under the age of 3 are placed in a planned long-term foster family. Since most adoptees reported on in longitudinal studies have joined their new families as infants, but very few join their long-term foster families when under five, valid outcome comparisons between adoption and long term foster care cannot be made[10].  This is important since at any one date between 35% and 40%   of children in care are in planned long term foster families[11].  Children in stable foster family care have the advantage over most adopted children that most are enabled to retain appropriate and meaningful links with their adult birth relatives and siblings. Too few LAs recognise the need to recruit foster parents who are willing and able to welcome a child as a full member of their family for as long as needed and probably into adult life, whilst also understanding the special needs of a child in care and the importance of being members of ‘the team around the child’.

Residential care as a permanence option for older young people

There is a widely held view and policy for many years that sees placement in a children’s home, for anything but a brief emergency or assessment purpose, as a ‘last resort’. Consequently, most of the small number who are placed in a children’s home with the intention that they will put down roots and make relationships with skilled and committed members of staff (who will be there for them to age 18 and beyond) will have had multiple foster care placements or experienced the breakdown of a planned adoptive or long term foster family placement or unsuccessful return to the family. Research supports the conclusion that some young people prefer to be looked after in a children’s home, where they can remain till they are ready to leave around the age of 18 and with which they can retain a ‘sense of belonging’[12]. Maintaining relationships with staff they are close to and also other residents can make all the difference as they move into adult life.

Concluding Comment

It is important to note that children and young people enter public out-of-home care in all countries and parts of countries.  Numbers vary depending on policies and contexts, and especially on levels of poverty and material deprivation[13] and on the aims for the care system[14]. There is no ‘right’ or ‘wrong’ number/ rate in care- the aim should be to provide high quality, loving parenting for those who need it and to support within the community those whose needs for love, care and protection can be met within the family home. Whilst public policy should aim to keep numbers needing out-of-home care as low as possible, every effort should be made to provide a very high quality of care to meet the varying needs of all children in care and care leavers and combat, for the young people themselves, and for the public at large, any sense that ‘care is a bad place to be’.

Prof. June Thoburn,

Emeritus Professor of Social Work

University of East Anglia

@Junethobu


[1] Department for Education 2015 Permanence, long-term foster placements and ceasing to look after a child: Statutory guidance for local authorities.London: DfE.

[2] See most recently the report of Family Rights Group 2017. Holding the risk: The balance between child protection and the right to family life. Which combines the voices of care experienced people and research.

[3]  DH (2001) The Children Act Now: Messages from research. London: TSO followed by research DH/DCSF-commissioned overviews on foster care, residential care. adoption, placements of teenagers, the last one being: Thomas, C. (2013) Adoption for looked after children: messages from research An overview of the Adoption Research Initiative. London: BAAF https://www.adoptionresearchinitiative.org.uk/initiative.html).  

[4] DH (1990) Principles and Practice in Regulations and Guidance. London: HMSO.

 See also Thoburn, J. Child Placement: Principles and Practice (1994) Ashgate

[5] See especially,  Stein M (2019) Supporting young people from care to adulthood: international practice, Child and Family Social Work, 24; 400-405  and see Prof Stein’s submission to this Review

[6] See Thoburn, J., Robinson, J. and Anderson, B. (2012) Returning Children from Public Care. London: Social Care Institute for Excellence Research Briefing 42. http://www.scie.org.uk/publications/briefings/briefing42/
 Farmer, E. (2018) Reunification from Out-of-home care: A research overview of good practice: University of Bristol   http://www.bristol.ac.uk/sps/research/projects/completed/2016/returninghome/ 

[7] See Farmer, E. and Patsios, D. 2016. Evaluation Report on Implementing the Reunification Practice Framework.Bristol: University of Bristol 

[8] Farmer, E. (2010) What factors relate to good placement outcomes in kinship care? British Journal of Social Work. 40 (2)

[9] Neil, E., Beek, M., Ward, E. (2014) Contact after Adoption: A longitudinal study of adopted young people and their adoptive parents and birth relatives. London: BAAF.

[10] Biehal, N. (2014) A Sense of Belonging: Meanings of Family and Home in Long-Term Foster Care British Journal of Social Work, 44, (4) 971

[11]Schofield, G., & Beek, M (2009). Growing up in foster care: providing a secure base through adolescence. Child and Family Social Work, 7(1),3  See overview submitted to this Review by Professor Gillian Schofield ‘Long-term foster care as a permanence option’

[12] Stein, M. and Munro, E. (2008) Young People’s Transitions from Care to Adulthood: International Research and Practice, London, Jessica Kingsley Report of the Care Experienced Conference, Past Present and Future April 2019 www.careexperiencedconference.com

Our Care our Say https://ourcareoursay.wordpress.com/our-care-our-say-is-this-the-time-people-are-going-to-listen/

Every Child Leaving Care Matters (2917) Caring Teams: Staying Close   https://eclcm.org/publications/

[13] Bywaters, P., Brady, G., Bunting, L., Daniel, B., Featherstone, B., Jones, C., Morris, K., Scourfield, J., Sparks, T., & Webb, C. (2018). Inequalities in English child protection practice under austerity: A universal challenge? Child & Family Social Work, 23(1), 53-61

[14] Thoburn, J. 2010.  Achieving safety, stability and belonging for children in out-of-home care.  The search for ‘what works’ across national boundaries. International Journal of Child and Family Welfare, 12(1-2): 34-48