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CHAPTER SEVEN: THE EFFECTIVENESS OF INITIATIVES TARGETING VULNERABLE GROUPS

7.1 Introduction

Families facing the disadvantages associated with poor housing conditions, low income, unemployment or/and a lack of supportive relationships are vulnerable to a range of additional stresses, such as homelessness, and alcohol and drugs misuse. Earlier chapters in this document have noted initiatives specifically targeting, or including, groups experiencing a range of risk factors; however, it is important to include a focus on evidence relating specifically to those who are particularly vulnerable. This is not intended to be a comprehensive investigation of all such groups, but to flag up some examples and indicate what is known, or where work is in progress. The actual groups and issues covered in sections 7.3-7.6 were suggested by colleagues who contributed to the paper. The review of services in section 7.2 includes the perspectives and circumstances of families from additional risk groups, although it has not been possible to separate out individual experiences.

7.2 A review of services for vulnerable families with very young children

A review of local authority and health services to support vulnerable families with children aged 0-3 years was carried out in Scotland during 2000-2001 (Scottish Executive, 2003). The review was conducted by a team led by the Social Work Services Inspectorate and including HMI Education and health professionals. Fieldwork was carried out in five local authority areas chosen to reflect the range of demography, geography and service provision in Scotland. Although the review is now several years old, findings are still likely to be relevant.

The review examined the case records of 147 families with children aged 3 and under in touch with social work services. The majority of these families were experiencing profound and acute stresses:

• 39% of families had been the subject of child protection enquiries
• 37% of the index children were, or had been, named on the Child Protection Register
• 9% of the index children had been looked after in local authority accommodation
• 16% of the cases involved young mothers who had been accommodated by the local authority just before or during a pregnancy and were now parents of young children
• at the time of the review, the index child was looked after by the local authority in over a third of the sample cases
• 54% of the families were headed by a lone parent
• Almost one in five of the families were affected by mental illness and a similar proportion included a history of drug dependency or alcohol abuse
• In over a quarter of families there was a history of domestic abuse

7.2.1 What support do families receive?

The review found an extensive range of services offering practical help, information, parenting education and advice, and emotional support to parents in difficulty in each area.

The bulk of antenatal care and support was provided by midwives, most of whom perceived themselves as offering the same service to all new parents, regardless of specific risk factors. There was broad agreement about the range of factors which make particular groups of mothers and children at increased risk of early problems with care and bonding. Often these were associated with poorer take up of midwives' advice and support. Midwives working in areas of multiple disadvantage were more confident than colleagues in more affluent areas about combining support for parents with assessment of potential risk to their baby.

The health visitor was the key contact with health services. Most families had a designated health visitor, although levels of contact varied widely from weekly to very limited contact. Health visitors undertook surveillance of young children's growth and development and provided emotional support for mothers. Health visitors were in close contact with local child care resources and provided early referral to day care services when they perceived parents to be under stress. However, health visitors did not have a clear sense of their responsibilities towards vulnerable families, and practice varied widely.

The majority of health care was reactive: preventative work was focused on universal health surveillance and general health promotion advice, taking little account of the difficulties that vulnerable families may have in following advice offered.

Most contact with other health services centred around diagnosis and treatment of the individual patient. Specialist services rarely considered the family's wider circumstances unless there was evidence of immediate risk to a child.

Most of the families had an allocated social worker working with them. Social workers carried out assessments of families' situations and made referrals to other services, such as family or child care centres. There was little emphasis on social workers' direct work with families or counselling for parents, although there were examples of this being offered or arranged in more complex cases. Local authorities also provided families with material and financial help.

Many social workers made good use of specialist services (such as local child and adolescent mental health services and specialist substance misuse services). They also kept in touch with others services, particularly housing and benefits agencies, but there were lengthy delays in access to specialist services for families.

Family support workers offered practical advice and support to parents and sometimes offered respite by looking after children. These staff also played a part in monitoring children's development.

Out of hours or emergency services played a key part in dealing with crisis referrals. They experienced constraints and difficulties in working when other services and resources were unavailable, and often had no alternative but to spend time talking directly to families to understand their immediate circumstances and problems. Rural authorities have particular challenges in providing out of hours services across large areas. Out of hours staff were skilled and experienced and gathered a great deal of information and offered good professional insights into the supports needed. This contact was important in setting the context for families' further contact with daytime services.

Family centres brought together a range of practical, material and emotional supports for parents, usually underpinned by some form of child care. Some families had received constant support from their local family centre over a number of years and family centres seemed able to engage even isolated and unwilling parents well.

Voluntary sector support included home visiting services; parents' support groups; child care and play sessions; advice, advocacy and emotional support for young homeless people or people leaving local authority care; and specialist assessment of families with complex needs for the local authority.

Children with physical or learning disabilities or sensory impairment were managed poorly. There were lengthy delays in responding to referrals, making decisions and between contacts. The impact of the disability on the family as a whole was not taken into account in planning, and carers' needs were not consistently assessed.

The review also found that, unless there was an inter-agency child protection plan or supervision plan in place, support for families was poorly coordinated. All agencies agreed there was a need for better communication between services, but saw this as a need for change in systems of communication rather than changing their own practice.

7.2.2 How well do services meet the needs of these families and how far do they improve outcomes for children in need?

In more than half of the cases reviewed where there were concerns about children's safety, development or welfare, local authority social work involvement brought about some immediate improvement. Fears expressed by both families and professionals that social work departments were likely to permanently remove children from their parents' care were not reflected in reality. Local authorities went to great lengths to support parents in looking after their children at home. However, all professionals found it hard to judge what should be the threshold for removing children from their parents' care. Both health and social work services allowed children's care to drift below adequate standards for unacceptably long periods before taking protective action. The local authority's efforts to reunite the family also meant that insufficient attention was given to planning for the child in the event that the parents remained unable to fulfil their parental responsibilities.

In general, families had very negative perceptions of field social workers, which hindered them from seeking early help from social work services. However, families with experience of support from field social workers were more objective and realistic about the support available and valued contact with social workers. Referral and allocation procedures were not helpful in promoting an ethos of partnership with families.

Agencies relied too much on local policy or guidelines to direct professionals' decision making. These were applied regardless of evidence that indicated alternative options were more likely to safeguard and promote a child's welfare. However, the quality of social work practice and intervention was judged to be satisfactory or better in 64% of the cases examined.

Families reported that the services and support offered by local authority which they found particularly helpful were: child care provided by childminders, nurseries and family centres, and home visiting by home support workers. These services effectively provided respite and support for the most vulnerable families under stress.

In relation to health services, parents were most positive about professionals who took time to discuss their problems and were honest about the help they could provide, even if that was limited. Health visitors were seen as potential sources of support: they compensated for deficiencies in information provided by doctors, offered clear and simple explanations of health problems and treatments and gave practical help on health problems.

Almost all parents were very positive about the support they received from family centres. They particularly valued the respite afforded by family centres, the emotional support they received, and advice and social support from peers.

Parents argued that there was a need for more places, more staff and more support for themselves in child care provision. They wanted staff who could deal with specific special needs and were trained in specific issues such as learning how to play with children, dealing with disability, racism and resultant inequalities, and managing children's difficult and challenging behaviour.

Many parents had attended group work programmes in their local family centre or equivalent. The nature of these groups varied: some were parents' support groups with the agenda and activities set by parents themselves with help and practical support provided by a group worker; others were a set series of sessions bringing people with similar problems or stresses together to discuss how to solve these, or for educational programmes. People generally said that they found group work very helpful, especially when this included crèche facilities. They offered 'a bit of space' and the chance to meet people in the same situation.

Parents described the most helpful characteristics of group work as:

• the knowledge that you are not alone in your predicament;
• hearing others' experience and advice about what works;
• having other adults to talk to;
• knowing that the group will keep your business confidential;
• having interesting and different things to do, and 'getting out of the house'; and
• leaving your responsibilities behind.

Parents also identified common gaps in group work. They felt that their children could also benefit from groups, but that there seemed little available for younger children independently of adults. Most services demanded that parents were also present (such as mother and toddler groups and playgroups). There was little provision for fathers, especially single fathers, most groups being oriented towards women.

Parents observed their child acquiring skills and therefore saw the centres as providing measurable support for themselves and their child and were more open to advice from staff whom they perceived as having experience and expertise. Moreover, family centres provided an opportunity to see how centre staff interacted with their children and encouraged learning and development and good behaviour. Parents described their children as being much better behaved at the family centre and this being generalised when they returned home.

Parents felt less threatened by the fear of their child's removal in family or child care centres. Most parents knew that staff contributed to assessments and would report any concerns about a child, or a parent's interaction with their child to their social worker. But they saw social workers or senior staff as responsible for decisions about registration, changing plans or removal of a child from their care. They felt that centre staff were more readily available and had more time to listen to them and treated them as an individual in their own right rather than merely a parent of a child. The routines they picked up in the centre helped them institute routines at home too.

Both families and professionals found family centres offered great benefit but highlighted gaps in support, for example at evenings and weekends.

The service review provides a useful insight to the interaction between families and a range of services and service professionals. It is clear that parents particularly valued services which they felt supported them and their children in an unthreatening way and provided help and information in an informal setting. They felt such services should be expanded and be available out of office hours.

It is, perhaps, surprising that the section of the review which lists the health services with which families were in contact did not include GPs, bearing in mind that GPs have contact with almost all infants under the age of three. One issue is that few parents in the sample had a consistent relationship with a named GP and contacts were often hurried and unsatisfactory. It is noted in the report that parents felt GPs were too ready to prescribe tablets and unwilling to take time to listen to their problems and worries. It is not clear from the report whether this was the view of the majority but, if so, it may be that parents have unrealistic expectations of pressurised GP services. Nevertheless, a need is being expressed and the report makes it clear that parents in the sample valued service professionals who were prepared to listen, explain information and take time to understand problems.

The findings of this review informed the work of the Action Team on integrated services for children. Weblink to final report: http://www.scotland.gov.uk/Resource/Doc/47021/0025617.pdf

Summary: what does the review tell us about local authority and health services supporting vulnerable families?

• A wide range of services was offering support to families, but support was poorly coordinated unless there was an inter-agency child protection plan or supervision plan in place
• The health professionals providing the bulk of antenatal care and support either did not have a clear sense of their responsibilities to vulnerable families, or perceived themselves as offering the same service to all new parents, regardless of risk factors
• Families and professionals feared that social work departments would permanently remove children from their parents' care, although this was not reflected in reality
• Negative perceptions of field social workers hindered families from seeking early help from social work services, but families with experience of support were more objective and realistic
• Parents valued health professionals who took time to discuss problems and were honest about the help they could offer - health visitors were particularly appreciated for the practical support and advice they provided
• Parents were very positive about the support they received from family centres, particularly valuing respite, emotional support and advice and social support from peers
• Family centres provided safe environments for parents to acquire skills, build trusting relationships with staff and watch staff interacting with children. Parents wanted better information on a range of topics, and additional support at evenings and weekends
• Few parents had a consistent relationship with a named GP and contacts with GPs were described as hurried. Parents felt that GPs were too ready to prescribe tablets and unwilling to take time to listen to their problems and worries
• Parents in the sample valued service professionals who were prepared to listen, explain information and take time to understand problems.

7.3 People who are homeless, or at risk of becoming homeless

Housing has been a relatively neglected area in health inequalities research, although the strong relationship between homelessness and health is widely accepted. Poor health (physical and mental) can cause homelessness, through loss of employment and consequent difficulties meeting housing costs. In addition, homelessness can exacerbate risks to health, with problems associated with substance misuse becoming more pronounced and greater exposure to accident, injury and attack (Asthana and Halliday, 2006).

The number of people recorded as sleeping rough in Scotland is relatively low (328 in October 2003) (Thomson, 2005). However, when households staying in night shelters, low budget hotels and hostels, women's refuges, temporary structures, and with friends, are added to the equation, it becomes clear that a number of vulnerable adults who are/may become parents and young children are living in accommodation inappropriate to their needs. In Glasgow alone, in December 2004, 1624 households were living in hostel accommodation (Thomson, 2005).

Many people at risk of homelessness lack the knowledge and skills required to manage a tenancy and the self-confidence and interpersonal skills necessary to communicate with agencies and develop social networks. Young people, care leavers, ex-offenders, ex-service personnel, people with low educational achievement and literacy problems are particularly vulnerable.

A research project by Scottish Homes aimed to identify the range of life skills training provision available in Scotland, to examine evidence on the role of life skills training in resettlement and tenancy sustainment. Findings included the following:

• There is limited knowledge on the resettlement needs of many people, such as families, people from black and minority ethnic groups, and women.
• Life skills training appears to be well embedded in homelessness provision. The majority of projects were targeted solely at young people. There were wide variations in the length of time that life skills training was provided to clients
• None of the projects surveyed submitted details of formal service evaluations
• There is very little evidence of the effectiveness of life skills training as part of the resettlement and tenancy sustainment process
• There is a need for further research if effective services to prevent repeat homelessness are to be developed (Scottish Homes, 2001)

Evidence from Scotland: The Dundee Families Project

• The project, run by NCH Action for Children Scotland, provides services for families who are, or who are at risk of becoming, homeless due to anti-social behaviour. A range of services are offered through: individual and couple counselling, family support and group work. The three main service types are:

• Outreach: a preventive service offered to families in their existing homes
• Dispersed tenancies
• Core: temporary accommodation offered to the most needy families in a residential block for up to four families

• An evaluation was carried out by Glasgow University (Dillane et al, 2001). Key findings:
• • The project worked with 126 families in 4 years (1996-2000)
  • Council information on closed cases showed that the majority of families made good progress, particularly regarding housing issues; however, many still had serious childcare problems
  • Lower percentage of outreach services were successful (56%) compared to dispersed (82%) and core (83%)
  • The majority of respondents felt that a core small residential block was helpful in providing intensive support to families, although a few questioned the need for this
  • Parents and children were very positive about the service. Adults identified major changes in their housing situation, facilities for children, positive changes in family relationships and behaviour. Children thought the staff were helpful and their housing situation improved. They identified improvements both in their own and in their parents' behaviour
  • Evidence suggests that the project generates real cost savings, through stabilising families' housing situation, avoiding costs associated with eviction, homelessness administration and rehousing; and, in some cases, preventing the need for children to be placed in foster or residential care
  • Crucial ingredients were: good management, stable staff, shared ownership by other agencies, and a holistic approach.

Weblink to summary of final report: http://www.scotland.gov.uk/Resource/Doc/157971/0042705.pdf

7.4 Misuse of alcohol and other drugs

Over the past few years, there has been growing concern about the potential impact of adult problem drug and alcohol use upon children. Tobacco use has declined in recent years (the Scottish Health Survey 2003 reported a decrease in the percentage of male smokers from 34% in 1995 to 32% in 2003 and a decrease in females from 36% to 31% over the same period, along with a 4% increase in the percentage of both males and females not exposed to other people's smoke). However, alcohol consumption has been increasing (particularly among women and young people generally) and the misuse of a number of other psycho active drugs (such as cannabis, heroin, cocaine, benzodiazepines, amphetamines and solvents) has become much more widespread ( NHS Scotland, 2007).

Hidden Harm, published in 2003 by the UK's Advisory Council on the Misuse of Drugs ( ACMD), estimates that there are up to 60,000 children under 16 years old in Scotland who have a parent with a drug problem (approximately 5% of the total population group for this age). Further estimates indicate that 10,000-20,000 children live with a drug-using parent, while the number of babies born to drug-misusing mothers rose to nearly 18 per 1,000 in 2000 ( It's Everyone's Job to Make Sure I'm Alright, 2002). Hidden Harm also reports that, on average, 25% of children on child protection registers were there because of parental alcohol or drug use.

In the first sweep of the ' Growing Up in Scotland' survey, there was little variation in the average number of units of alcohol consumed, by area deprivation. However, respondents in more deprived areas were significantly more likely to say they drank five or more units on one occasion than those in less deprived areas. Reported illicit drug use was also patterned by disadvantage: mothers with no educational qualifications, mothers in the lowest income quintile and those in households in routine and semi-routine occupational groups were the most likely to say they had ever taken drugs. Younger mothers and lone parents were more likely to take drugs than older mothers and those in couple families (Anderson et al, 2007).

Hidden Harm highlighted the plight of children affected by parental drug use. The (then) Scottish Executive responded to the Hidden Harm report, covering not only the issues identified in the ACMD report about parental drug use and its impact on children, but also those related to parents with alcohol problems (Scottish Executive, 2004). Hidden Harm - Next Steps, (Scottish Executive, 2006a) set out a wide-ranging plan of action to make significant improvements to the lives of children in substances misusing households. The new Scottish Government has aligned the Hidden Harm programme with its early intervention agenda, ensuring a focus on prevention and capacity building, while strengthening the protection and wellbeing of children at risk. Every aspect of the agenda relating to children affected by substance misuse will draw on the principles and practice of Getting it Right for Every Child, contributing to three high level outcomes around information sharing, removing barriers and practice change (Scottish Executive, 2006b). The Scottish Government Drugs Strategy notes that an evidence base is to be developed in relation to approaches to intensive family support, and evaluation measures will be proposed for work across the range of priorities under the new agenda.

A scoping review commissioned by the (then) Scottish Executive (Scottish Executive, 2006c) aimed (as part of its remit) to collate knowledge and evidence on effective practice to address the issue of parental substance misuse. The review concluded that there is growing evidence that a range of services and interventions for children and families is developing, but there is a need for continued expansion of such responses, and for their rigorous evaluation. In addition, studies which were able to demonstrate their effectiveness at improving children's risk and protective factors and behaviours were not able to clarify which resilience factors determine positive outcomes. The review identified key gaps in the literature, including:

• Children's views (particularly in relation to impact, resilience factors, service needs, or views on existing service provision)
• A need to view parental substance misuse as part of a far wider, multi-dimensional picture

7.5 Children at risk of neglect or acting beyond the control of their parents

Local authorities are required to safeguard and promote the welfare of children in need and promote the upbringing of such children by their families, through the provision of a range of appropriate level of services (The Children (Scotland) Act 1995). As part of the evaluation of the implementation of Parenting Orders in Scotland, a literature review was conducted which re-examined the policy context to locate the rationale for the introduction of Parenting Orders, the evidence of risk and protective factors and inter-related issues of anti-social behaviour and child care, alongside effective approaches to family service provision (Curran et al., 2007 - unpublished paper). Many of the main findings from the literature review have been highlighted in earlier chapters of this document, but the following section summarises the key messages that relate to this specific group.

Risk and protective factors for potential neglect are known to be similar to the known risk factors for potential disruptive behaviour. While the overlap between factors associated with anti-social behaviour and criminal activity and disadvantage and neglect are well established, evidence on the precise mechanisms of the inter-relationship between anti-social behaviour, neglect and abuse remains limited. Much of the published material is from the US, although there is a growing body of UK research ( e.g. McCarthy et al., 2004). Research on resilience in children has documented a lengthy list of characteristics associated with positive outcomes. When children are helped to succeed, the most important influences are likely to be members of extended families, informal networks and positive peer association. Family factors such as parenting style, poor parental supervision, harsh and inconsistent discipline, parental conflict and parental rejection are associated with youth offending and anti-social behaviour. Evidence of early onset can emerge by the age of 3 and manifest by pre-school and school entry in isolation, poor achievement and difficult behaviour, consolidating through peer association in anti-social behaviour.

The successful engagement of parents and families is regarded as the cornerstone of success of support services and programmes in achieving desirable outcomes. However, the process of engagement can go awry and, although service provision is adequate and fit for purpose, more needs to be done to bolster practitioners' and strategists' attempts to resolve this issue. In Scotland, compulsory mechanisms for parents have been introduced in the form of Parenting Orders, provided for in Part 9 of the Antisocial Behaviour (Scotland) Act 2004. A 3 year National Pilot of Parenting Orders was launched in April 2005. Mechanisms were put in place to allow local authorities and the Scottish Children's Reporter Administration to apply to the Sheriff Courts for Parenting Orders with respect to parents failing to engage voluntarily with support services. The Parenting Order is intended as a last resort measure for the 'small minority' of parents who are unwilling to accept help in fulfilling their parental responsibilities when a clear need for support has been identified. However, the Parenting Order Legislation has attracted harsh criticism for the following reasons:

• Apparent conflict with existing practice philosophies in Scotland (with their focus on inclusive and voluntary intervention)
• Parenting Orders are likely to be stigmatising and reliant on inadequate pathological assumptions regarding the causes of offending and family dysfunction
• To apply punitive sanctions to parents failing to engage is heavy handed and unjust

Little use of Parenting Orders has been made in Scotland to date, so there is no empirical evidence to support the negative claims made against them or to support their use. In England and Wales, where the legislation has been in place since 2000, studies which included an examination of Parenting Orders practices expressed concerns about the disproportionate focus of the Orders on mothers, and on the high levels of need among the families in question. Nonetheless, they identified a degree of success in terms of impact on attendance. Studies also found that families had histories of unsatisfactory contact with support agencies prior to referral for a Parenting Order. This raises questions as to whether, if such families had had access to such support before, they would have required the compulsory measure at all.

7.6 Looked after children

One of the most powerful predictors of social exclusion in adult life is the experience of being in care. There is a well-established link between deprivation and children coming into care: factors such as unemployment, low income, inadequate accommodation and lone-parent status are likely to threaten the stability of family life (Asthana and Halliday). All children who are looked after have experienced the trauma of being separated from their birth parents. Many have also experienced neglect, abuse, rejection and the early effects on their development of parental substance misuse.

The number of looked after children in Scotland varies all the time, as children start and stop being looked after. On 31 March 2005, 12,185 children were being looked after by local authorities: 1.1% of all children and young people in Scotland. The number of very young children who were looked after increased during the year 2004-05 (a 15% increase in the numbers of boys aged 0-4 years and a 7% increase for girls in the same age range). In 2005 the number of very young children who were looked after was 0.5% of the child population of Scotland (Social Work Inspection Agency, 2006). (On 31 March 2006, the total number of looked after children and young people was 12,966 (Scottish Executive, 2007).)

A survey carried out in 2002-03 by the Office of National Statistics (Meltzer et al., 2004) found that, among young people (aged 5-17 years) looked after by local authorities in Scotland, 45% were assessed as having a mental disorder: 38% had clinically significant conduct disorders; 16% were assessed as having emotional disorders; and 10% were rates as hyperactive. Two thirds of all looked after children were reported to have at least one physical complaint. Approximately one third had officially recognised special educational needs. In relation to lifestyle behaviours, 44% of children aged 11-17 years reported they were current smokers; 39% had used cannabis at some point in their lives and 25% drank alcohol at least once a month. Twelve percent of children who reported drinking alcohol also said they had started doing so at the age of 10, or younger. Around a third of young people (aged 11-17) reported they had had sexual intercourse and 17% had experienced sexual abuse or rape

Only 1% of all looked after children go on to university, compared with 50% of the general population; 46% of young women and 59% of young men leave school without any qualifications ( BAAF and TFN 2005). Frequent movement within the care system, school exclusion and non-attendance have all been linked to educational under-achievement (Asthana and Halliday). Some estimates suggest that children in care are ten times more likely to be excluded than those outside the care system (Brodie, 2000; Goddard, 2000).

The poor educational participation and performance of looked after children has become a focus of policy concern, not least because educational disadvantage leads to disadvantage in other areas, ultimately reducing the opportunities available to successive generations. The Scottish Government has reinforced the commitment made by the previous administration to work towards improving outcomes for all children who are looked after, and to support those who care for them (Scottish Government, 2007; Scottish Executive, 2007). Evidence of effective interventions to support looked after children (both during childhood and early adulthood, when they are particularly vulnerable to early and unplanned parenthood) is sparse. However, it is known that:

• Placement stability and encouragement of carers is important for achieving educational success.
• Education and employment prospects after the age of 16 can be improved by careful assessment of each young person's capabilities and by working with them to increase their employability (Curtis and Roberts, date unknown).

Findings from two recent research projects in Scotland reinforce these messages.

Evidence from Scotland: extraordinary lives

• A major review (Social Work Inspectorate Agency, 2006) aimed to demonstrate what good care for children and young people looked after by local authorities looks like
• A number of methods were used to synthesise data: consultation with 200 young people and adults; examples of good practice; reviews of policy; examination of government report (1964-2006); exploration of findings from research; the experiences of 32 young people
• The review has six key messages:
• • Looked after children can overcome adversity in childhood and lead successful adult lives
  • Too many adults have low expectations of what looked after children can achieve
  • Relationships with skilled adults can help looked after children develop successfully
  • Children being looked after away from home need stability and the chance to put down roots
  • Tackling the disadvantage and discrimination still experienced by many looked after children requires planning at every level in a local authority, and between them and their partners in delivering children's services
  • Developing an understanding of what children and young people think about services intended to help them supports effective engagement and long-term service planning

Evidence from Scotland: celebrating success

• A small qualitative research project (Happer et al., 2006) aimed to focus on what helped young people who have been looked after to become and feel successful
• Interviews were carried out with 30 adults and young people
• Five factors emerged as critical to the success of the study participants:
• • Having people who care about you
  • Experiencing stability
  • Being given high expectations
  • Receiving encouragement and support
  • Being able to participate and achieve
• The study focused on a small, selected group. While it is important to learn from their experiences, it cannot be assumed that replicating their experiences would automatically lead to improved outcomes for every child who is looked after

The Quality Protects Initiatives offer a way to start to monitor and improve the looked after experience for children. The website offers a Good Practice section, although the interventions described have not been evaluated: http://www.doh.gov.uk/qualityprotects/gp_db/index.htm

It should be noted that most of the initiatives to avert pregnancy at a young age (discussed in Chapter Two) will be particularly relevant to young people who are, or have been, in the care system.

Summary: what do we know about the effectiveness of interventions targeting particular vulnerable groups?

• The evidence base is currently thin in relation to initiatives targeting families who are (or are at risk of becoming) homeless, people who misuse drugs and alcohol and young people who are, or have been looked after. However there are some promising initiatives in Scotland that have undergone evaluation
• The Dundee Families Project provides a range of services for families who are, or who are at risk of becoming, homeless. The initiative is appreciated by parents and children and, when implemented as intended by a stable staffing structure, generates real cost savings
• In relation to supporting looked after children, the evidence suggests that placement stability and the encouragement of carers is important for achieving educational success. Education and employment prospects after the age of 16 can be improved by careful assessment of each young person's capabilities and by working with them to increase their employability. In Scotland, these messages are reinforced by findings from a recent major review and a qualitative research project
• The case for using compulsory measures to engage parents who are unwilling to accept help to fulfil their responsibilities remains unproven. Parenting Orders have been the subject of harsh criticism and have been little used in Scotland to date
• Outcomes of initiatives highlighted throughout this report which target high risk groups as an adjunct to universal provision are likely to be useful to service planners and policy makers
• Messages from the review of services for vulnerable families discussed earlier in the chapter are also relevant

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