The right environment: care, education and health
27. This chapter describes what we learned about the experience of young people in the schools. We looked at whether the schools provided an environment of safety, good care and education, paid attention to the young people's health, and measured their own performance against national care standards, quality indicators, regulations and guidance.
28. All the young people in this study attended classes with other young people. The particular needs of individual young people were usually taken into account when forming class groups. Some young people with significant additional support needs received a specially designed curriculum in a separate intensive support base. Where care staff, teachers and health care staff worked together closely, we found that there was a positive culture and the curriculum was well-planned and structured across 24 hours. This helped staff to understand their respective roles and responsibilities. Consequently we found that they had high expectations of the young people's learning and development.
29. The schools deployed a combination of approaches for promoting positive behaviour, with a range of special programmes to tackle problem behaviour and meet the specific needs of young people. These approaches and programmes were most effective when integrated into the personal and social education ( PSE) programme.
30. We found variation between the schools in the quality of relationships between staff and managers, staff members, and staff and young people. Senior managers played important roles in helping care and teaching staff to manage the young people's challenging behaviour consistently, promote positive behaviour, and celebrate achievements. Joint planning and effective support for staff were essential in sustaining good relationships between staff and young people. Where planning was less well organised these relationships suffered.
31. There were different standards of residential accommodation in the schools. One campus was carefully laid out to create a pleasant environment and thoughtful approaches to landscaping ensured all round good visibility. Lower tree branches had been removed, places where young people could conceal themselves had been identified and automatic security lighting installed. However, schools with extensive grounds posed challenges to supervision of the young people. We consider that schools should review and implement improved safety and security measures in their grounds.
32. The majority of the schools provided classrooms of a good size, 4 suitable resources, Information and Communication Technology ( ICT) and specialist accommodation for practical subjects. Risk assessments in practical classes varied. Some corridors were too narrow to ensure safe management of challenging behaviour. The absence of a quiet room within the education provision in which young people could calm down resulted in them being returned too frequently to residences.
33. The public areas of the schools were homely and comfortable. Young people were encouraged to personalise their bedrooms. Some bedrooms had en suite facilities which offered young people privacy and communicated respect. We considered that sharing toilet and bathing facilities could create unnecessary risks of opportunities for bullying and abuse. Staff told us of their concern about reaching a young person in an emergency, when this involved getting through two locked doors. However, one school did have an effective back-up system which gave staff emergency access. Careful thought should be given to 'designing out' any elements and features which may raise levels of risk.
'Preventing re-offending often starts with the external constraints and careful monitoring that can be provided by the environment in which the young person lives and by the people who care for him. However, as the work progresses with the young person this external control should give way to internal controls, insight and a real change in behaviour and thus a change in placement, which enables the young person to exercise these internal controls, may be appropriate.' (Bankers et al. 1999:55)
34. We found that sufficient numbers of staff with a good skills mix ensured safe care and education. Relationships between staff and young people generally appeared respectful, warm and positive. Clear boundaries for their behaviour, were consistently enforced, and their environment and routines were safe and predictable. Young people told us of staff who were approachable, listened to their concerns and gave good advice. Complaints made by young people were taken seriously, and they had good access to external advocacy services. However, some young people also reported that they felt bullied by other young people and that staff did not intervene to support them.
35. We found examples of good teamwork in meeting young people's needs and managing risks. The most effective approaches involved close integration between specialist interventions or programmes and day-to-day care. This is discussed further in Chapter 4. For example, there were regular meetings about individual young people and clear behaviour support plans were in place. However, the full impact of specialist intervention was sometimes limited as care staff were unclear about their responsibilities, lacked adequate training and had little support.
36. One of the biggest challenges for staff was tackling young people's sexually harmful behaviour. This behaviour did not stop on admission. Placing social workers expected care staff to closely supervise the young people and to keep them informed about their progress. Some social workers reported that they had not been appropriately informed about the school's response to incidents, for example when a young person complained about the use of restraint. Child protection training was offered to all staff, but it was not completed to an appropriate level and with sufficient frequency by all of those who were eligible.
37. The agencies involved in this review have discussed child protection processes with ADSW and agreed the following:
- all schools should conform to the child protection arrangements set up by the Child Protection Committee in the local area. Schools should advise the commissioning local authority of child protection referrals as the commissioning authority has the primary duty to investigate child protection issues for the child they have placed;
- commissioning local authorities and schools should notify the Care Commission of any child protection referral arising in the school. This will allow the Care Commission to consider any action they need take in addition to what the service provider or the commissioning local authority may deem necessary;
- commissioning local authorities and schools have a responsibility to consider whether to involve any relevant local authorities or others in risk assessment and management plans for young people who present risk of harm to others;
- commissioning local authorities and schools should make sure the young person, their carers and families are aware of their right to complain through the commissioning authority's complaints procedure, through the school's own complaints procedure or through the Care Commission;
- commissioning local authorities and schools should make sure the young person, their carers and families know how to raise concerns about alleged abuse; and
- commissioning authorities and schools should make young people, their carers and families aware of how they can contact advocacy or children's rights services who can help them raise allegations.
38. Whole school assemblies provided opportunities to celebrate successes and promote achievements. School councils played an important part in making sure young people's voices were heard and helped to promote a sense of shared responsibility.
39. Some schools had started to use the framework and principles of A Curriculum for Excellence 2004 ( ACE) to start to re-frame the structure of the curriculum across 24 hours. A broad curriculum enabled teachers to meet learning needs effectively. We found examples of vocational and enterprising activities which led to young people achieving some notable results in National Qualifications ( NQs).
40. The quality and effectiveness of joint work was at an early stage in most schools. There were some formal structures for joint working between care, education, health and specialist interventions. We did find evidence of developing strong whole-school approaches to PSE and health and wellbeing.
Particular strengths in these PSE programmes included:
- activities and experiences using the expressive arts. Young people spoke positively about their successes in activities which were frequently new to them;
- improved fitness and awareness of team skills, through cycling expeditions, playing in the football team and a running club;
- whole-service activities, sometimes linked to enterprising activities, and fund-raising for charities which increased young people's sense of empathy;
- evening and weekend activities in partnership with a local college, in subjects such as practical craft, mechanics and art; and
- links from the broader PSE agenda to the more specific and targeted programmes which addressed sexually harmful behaviour.
41. Schools had not always considered how to link generic aspects of PSE with the more specific and specialised programmes to address sexually harmful behaviour. Therefore there were fewer opportunities for a wider group of staff to become knowledgeable and skilled in this area.
42. Young people were prevented from achieving appropriate qualifications when the structure of the curriculum was not planned well. Learning opportunities available during the evenings and weekends should be planned to ensure they complement formal class work.
43. Care staff regularly supported teachers to manage difficult behaviour or risky situations.We observed good practice where care staff worked alongside teachers using their skills to help young people to engage with learning. However, we found examples of poor practice in which care staff just patrolled the education area to control the young people's behaviour. Care staff resented this role, which reinforced young people's negative perceptions of education.
44. Approaches to improving young people's social, emotional and personal development varied. Some young people were receiving impressive, well-coordinated programmes. But we did not find this consistently. We were concerned that one school had paid little or no attention to this aspect of care and education and consequently the needs of their young people were not well met.
45. The Looking After Children5 materials were often used effectively to set out the needs of the young person in relation to their physical, social and emotional well-being. This included a record of immunisations and other health needs. In the absence of a complete history of the child's health needs, schools carried out their own assessments. Areas of need were incorporated in the care plan, which noted the required input from the service itself or healthcare professionals.
46. Young people usually received age appropriate information about their health and well-being. However, we considered there could be greater integration with general health promotion strategies. The curriculum usually included elements of health promotion in PSE.
47. Schools employed a nurse or contracted with local professionals to provide health care and advice. Access to secondary health services was obtained appropriately. We found that the schools experienced difficulty in obtaining dental services, although most had arrangements in place for young people to be seen on an emergency basis. We did not consider the lack of regular dental care acceptable.
48. The arrangements with local health services to provide health care for young people from the NHS area or those who came from another area were not always accurately described. Arrangements for looked after young people to access local healthcare services should be clarified by managers at the time of admission. Staff at all levels should have greater awareness of the importance of promoting the health of the young people in their care, including their mental health and well-being.
49. In this chapter we have recognised the importance for the young people of an environment which brings together their needs for care, education and health. We did not find this in all of the schools. Effective practice in this area comprises a mixture of practical arrangements combined with good working practices and communication between staff. A good physical environment not only conveys value and respect for both staff and young people but also enhances safety. We found examples of good practice by schools which:
- provided en suite facilities as a contribution to creating a safe physical environment.(The use of en suite facilities should be subject to risk assessment and management);
- provided enough classrooms of a suitable size and facilities for practical work which were risk assessed;
- created a quiet space within the education area to enable young people to calm down and be supported to re-engage with learning as soon as possible;
- carried out a risk assessment of their grounds;
- planned an holistic curriculum across 24 hours, including specialist approaches and programme;
- made sure that staff were clear about their individual and complementary roles in delivering the overall curriculum and managing challenging behaviour in classes and residences; and
- had clear arrangements for young people to access local health care services including dental services.
50. Local authorities who provide comprehensive background information on the young people and their families at the time of referral give all staff the maximum opportunity to address the young person's behaviour and to help their development. In the next chapter we discuss the role of assessment and planning in the care of the young people.
All schools should update and improve their child protection procedures (and take account of the procedures agreed with ADSW at paragraph 37).