Adoption Support Fund
I have case managed a number of clients recently whose therapy was funded by the Adoption Support Fund (ASF). Working with these clients afforded me the experience of understanding the challenges faced and sometimes heartache felt by parents who months after adopting a child are still struggling to manage behavioural challenges and emotional needs. Some discovering that their child has mental health problems or developmental difficulties.
What has been described to me as pure frustration by parents, I am informed by my team that these mental health difficulties could and in some cases, should have been identified during the adoption process. Nearly all the parents I asked the question, “Would you have still adopted them, if you had known?” all but one of them answered “yes”, but some support would be nice.
So with other parents considering adoption in mind, or those engaged already in the process, maybe those who are working within children’s services, I thought I would share my own experiences from the management/practitioner perspective of working with families funded by the Adoption Support Fund.
I am not, I would like to make clear a healthcare professional and so my opinions, and my experiences are purely taken from the case management perspective of my practice and those opinions generally shared amongst my team.
Firstly, let me introduce myself. I am the Practice Manager for The Practice MK, a multi-disciplinary psychological practice in Milton Keynes. We currently have 16 highly trained and experienced practitioners providing their services through us.
Our Associates include:
- Clinical, Educational, Forensic and Occupational Psychologists
- Counsellors and Therapists
We provide a range of psychology based services and specialise in autism diagnostics and trauma.
Over the years we have established ourselves as a ‘go to place’ or as one Local Authority recently put it, “a one stop shop” to deliver comprehensive psychological assessments, provide treatment plans and deliver ongoing short or long term therapy whilst reporting back to instructing clients and keeping them informed on the progress of such therapy.
In 2016 we provided a number of services to parents seeking support for their adoptive children and by case managing these clients I was able to understand from the parents perspective the challenges families who adopt sometimes experience.
Some of the challenges I was made aware of included:
- Not being prepared adequately for supporting children with potential mental health problems
- Lack of pre-adoption assessment information.
- Emotional support for parents themselves struggling to manage their children’s behavioural and emotional difficulties.
I tried to break down into boxes the conversations I have had with over 25 sets of parents who have adopted children and come to us from all over the UK to access our services. To be honest, the majority shared the same experience. They had adopted a child, there were some behavioural difficulties observed which was initially described as ‘settling in problems’ or they were told “just give them time”. Managing the behavioural and emotional challenges became harder as time went by. Problems started being noticed at school. Parents were becoming tired and drained, and well, you can probably already identify the cycle forming.
Before I go further into my own experiences I thought it best to set out what the Adoption Support Fund is and to put some context to this article.
Some interesting facts
As of the 31st March 2016 the number of children being ‘looked after’ hit 70,440. This includes all children within foster placements or placed for adoption or residing in secure or residential accommodation (Department for Education, 2016).
A child is considered to be ‘looked after’ if they are in the care of the local authority for more than 24 hours.
According to UK Government statistics the majority of looked after children are placed with foster carers. In 2016 the number of looked after children in foster placements was recorded as 51,850 (74%) (Department for Education, 2016).
Children who were taken into care by the Local Authority during 2016, 4,690 of them were adopted. The only year that numbers actually fell, down from 5,360 in 2015.
Children who are looked after are more likely to have mental health problems compared to children who are not.
45% of children aged between 5 and 17 years in England, looked after by the Local Authority were assessed as having a mental disorder. 37% had clinically significant conduct disorders and 12% were assessed with emotional disorders, anxiety and depression. Only 4% were assessed with pervasive developmental disorders, tics and eating disorders (Meltzer H, et all, 2003).
Meltzer found that 5 to 10 years olds, looked after by the Local Authority were five times more likely to have mental disorders than those children in private households. (Meltzer H et al, 2000).
This is probably not surprising given that the Department of Health estimated in 2001 that 62% of children taken into care were subjected to abuse or neglect. This was the same between 2013 and 2014 according to the Department for Education in their report, ‘Children in care’ (Department for Education, 2014).
Reviewing the past 5 years of data it becomes clear that year on year more children are taking into care. This means more adoptive parents or carers are sought by the Local Authority to help look after children and provide for their needs.
Sadly, this also means more children will require short and long term therapy which asks the question, who will pay for it?
Adoption Support Fund
In 2013 the Government via the Department for Education published a report setting out proposals to attract more parents to adopt children. This led to the launch of the Adoption Support Fund in 2015 which allowed Local Authorities in England to apply for funding to provide post adoption therapeutic support.
The Adoption Support Fund (ASF) is available to assist families who have legally adopted children, up to and including the age of 21 from a local authority in England, or adopted from overseas.
Families looking for support require an assessment by the Local Authority. This is a legal obligation of all Local Authorities who have responsibility for assessing adoption needs for three years after the adoption order.
Due to the success of the ASF, on the 25th January 2017, Edward Timpson, MP and Minister of State for Vulnerable Children and Families wrote a letter to the Director of Children’s Services detailing the ‘fair access limit’ which places a limit of £5000 per child under the ASF. For those requiring more specialist services an additional £2,500 may be made available. If additional funding is required, provided the Local Authority can meet the criteria, a funding match will be agreed between the ASF and the Local Authority. The current spend on average per child, Mr Timpson says is approximately £4000 (Adoption Support Fund [ASF], 2016).
He also confirmed that an increase in the ASF budget to £28m (20% increase) would allow more families to access the fund. Since its England wide launch in May 2015 over 12,500 families have accessed the fund.
Who provides the therapeutic support?
Who provides such therapy under the fund varies between Local Authorities. Some have interdepartmental agreements with their local NHS trust, some will rely on private organisations to provide specialist services that are either unavailable locally or have excessive waiting lists.
What support options are available under the funding?
Under the ASF current rules a number of therapy or assessment options are available. Whilst not feasible to list all of them the following is a summary of what can be used (ASF, 2016).
- Creative Therapies
- MDT assessments including neurodevelopmental
- Parenting support courses
- Filial Therapy
- Life Story Work
Some notable exclusions do apply, most of which are therapy based options with care givers and certain types of assessment, for example speech and language therapy.
Even with some questionable exclusions, to be fair, the fund has embraced a wide range of therapy options for practitioners to consider when working with clients under the ASF. I like that systemic family therapy is included as for children with attachment disorder, this type of therapy delivered over time can help build attachments and trust with their new family.
One option ‘out of scope’ is educational and cognitive assessments (unless part of an MDT assessment). Parents seeking educational support for children they have adopted tell me this is one area they would like to see included in the options.
It is reported that between 25 and 40% of people with learning disabilities also experience mental health problems (Mental Health Foundation, n.d).
The prevalence of psychiatric disorders among children with learning disabilities is 36% compared to 8% among children without learning disabilities (Emerson E et al, 2012).
Parents trying to evidence the need for an Educational Health and Care Plan (EHCP) are often left to privately fund the assessments required as learning difficulties alone would seem to exclude them from accessing funding under the ASF.
The Process of obtaining funding
The process below is how a parent or caregiver can access funding for their adoptive child.
- Approach your local authority for an assessment of adoption support needs.
- The local authority that places the child with you is responsible for assessing your adoption support needs for three years after the adoption. After that, it becomes the responsibility of the local authority where you live.
- Local authorities will be able to submit applications for funding before an Adoption Order, so adopters can receive a continuous package of support from the time of placement.
- The local authority considers if therapeutic support is needed, the type required and if it is eligible for payments from the fund.
- The adopter and the local authority will look at the support that is available.
- The local authority applies directly to the Adoption Support Fund on behalf of the adopter.
- The Adoption Support Fund approves the funding and the funds are transferred to the local authority who then purchases the support.
Our experiences and thoughts
Initially we were frustrated by the process and let me explain why. It should be made clear that the assessment made by the Local Authority is not the same as having an assessment with, for example, a Clinical Psychologist who specialises in looked after children.
The assessment in point 1 above is to look at the needs of the adoptive family and to ensure those needs meet the ASF eligibility as described in point 2. The Local Authority require confirmation from the ASF that funding will be approved before contracting with a provider of such services. At some stage they may request an estimate of fees from the provider to support an application to the ASF.
If you are thinking about an egg and a chicken at this point you know what I’m about to say next. If the child / family has not yet been assessed by a suitably qualified practitioner to determine clinically, the most appropriate therapy or support options, how do Local Authorities know how much funding to apply for and what services they are seeking.
I will admit this stirred some frustration with my psychologists, however, we eventually developed a model which provided flexibility to the issue. This essentially involves providing the Local Authority with a generic estimate or service provision which enables flexibility to tailor the support and therapy options following the completion of the clinical assessment.
What I would like to see is a more structured approach taken by the ASF. Why not allow Local Authorities to apply for an assessment of needs (clinically not eligibility) and permit suitably qualified healthcare practitioners to provide a treatment plan evidenced by standardised assessments and observations with the family. This would most likely be Psychologists who specialise in working with looked after children.
Fees for this stage I propose should be standard, capped by the ASF to include consultations, initial assessments and treatment plans. Once in possession of the treatment plan Local Authorities could source approved practitioners to deliver the therapy recommended in the treatment plan or if in any disagreement, request a second opinion or order a review of the case by another psychologist, again with capped fees.
Practitioners who are contacted to provide the therapy should then be asked for an estimate of fees which clearly match the treatment plan. A second application to the ASF should then be submitted with the treatment plan and estimated of fees by the therapist or healthcare practitioner delivering on the plan.
This may on one hand sound like additional work is being created but on the other, a standardised and consistent framework would be created in determining how short and long term therapy is funded.
This may have avoided once such problem a client of ours experienced when their Local Authority sent them to a highly specialised systemic therapist who in their assessment of the family determined that 18 sessions of family therapy should be considered (no coincidence I promise).
Now, the therapist was not wrong in her formulation of what the family required. Our Psychologist agreed completely that up to 18 sessions of systemic therapy should be considered.
What the therapist didn’t assess for and what they didn’t identify was the trauma experienced by the child including significant domestic violence they experienced between the ages of 5 and 10.
After 12 sessions and no sign of improvement the parents withdrew from therapy and instead investigated online other possible solutions. That led them to us and following a lengthy consultation and assessment, it was determined that the child, now 13, would undergo trauma based therapy before attempting any systemic family therapy.
I am pleased to say that after several months of working with the family we are told things at home are improving. We also delivered a full educational assessment but only because our Clinical Director was so angry that this part would not be funded she did it for free!
My point is, that its crucial the ASF consider two stages to funding. Assessment and Therapy and consider standardising the process for consistency and to help manage the budget.
Talking about money, with more families believed to be seeking access to the fund in 2017, even with the increased budget of £28m for 2017/2018, will the fund be able to support all those who need it?
I am not a statistician and if I’m being honest I was not that good at maths either, so this next thought of mine may light the end to a few people’s fireworks. If you look at the statistics involving children who are adopted over the past 5 years I estimate at least 5,500 will be adopted during 2017. Consider 45% of children looked after between the age of 5 and 17 are assessed as having a mental disorder (Meltzer. H et al, 2003) and although I do not have exact figures for those older, let’s say for arguments sake is similar.
I estimate at least 2,475 additional children may require access to the fund up to March 2018. To support the additional children likely to require support, a minimum of £10m would be needed to fund the ASF during this period. But am I missing something? Mr Timpson himself wrote “but demand for support is over twice the level forecast” in his open letter to the Director of Children’s Services in October 2016. Maybe he tried using my formula at first and discovered what I am now discovering.
My estimate does not seem accurate or even close when you consider over 9,000 families received agreement for funding over £30m of therapeutic support in less than 18 months, up until October 2016 (ASF, 2016). This equates to an average spend of £3,333 per child.
Between October 2016 and January 2017 a further 1500 families are reported to have accessed £8m of funding which brings the average up to £3619 per child.
If this trend continues it is more feasible that at least 6000 families will require access to the fund during 2017. I hope this bit doesn’t embarrass me but take 10,500 families and divide by 21 (18 months + 3 for October to January) and you get 500 (times by 12) equals 6000. I did this several times before posting!
Based on this estimate which looks at the current trend and taking Mr Timpson’s average reported spend per child under the ASF is £4,000, you would need £24m to fund the ASF.
A budget of £28m therefore looks attractive and rather generous considering the times we live in. Will it be enough though? I would like to see some figures published on individual Local Authorities spending under the ASF and what services were purchased.
There will of course always be complex cases which require additional funding for assessment and diagnostic work but these should be the exception not the norm.
Given that many Local Authorities are having to save money in all other areas of business it would be sensible to consider that if they can assess the ASF they will which will result in more families being funded through the ASF going forward.
I believe a standardised assessment process with capped fees could easily be achieved and would provide greater control over budgeting going forward to ensure every child requires access to the fund is supported.
I welcome thoughts on the subject, in particular my maths but please be polite, it was never my strongest subject at school!
Notes for the Editor
The Practice MK is a private multi-disciplinary psychological practice in Milton Keynes that specialises in Autism Spectrum Conditions
The article was written by Dominic Goodsell, Director and Practice Manager.
The Practice MK has 16 Associates working in the field of psychology and delivers counselling, therapy, educational and psychological assessments. It also delivers a specialist trauma clinic and therapeutic adoption and fostering service.
Department for Education. (2016). Children Looked after in England including adoption:2015 to 2016. Retrieved on 01/03/17 from https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2015-to-2016
Main Text:SFR41/2016, Retrieved on 01/03/17 from, https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2015-to-2016#history
Meltzer, H et al (2003), The Mental Health of young people by local authorities in England, London: The Stationery Office (TSO)
Department for Education. (2014). Children in Care. Retrieved on 01/03/17 from, https://www.nao.org.uk/wp-content/uploads/2014/11/Children-in-care1.pdf
Letter to Children’s Services, 01/03/17, http://www.adoptionsupportfund.co.uk/Portals/0/ET%2025-01.pdf?ver=2017-02-03-121235-803
Adoption Support Fund, Service Categorisation Guidance, 22/04/16, http://www.adoptionsupportfund.co.uk/Portals/0/Service%20Categorisation%20Guidance_22%20April%202016_V2.pdf
Experiences from private clients of The Practice MK
Emerson E, Hatton C, Robertson J,Roberts H, Baines S, Glover G (2012). People with Learning Disabilities in England 2011. Improving Health and Lives: Learning Disability Observatory.
Adoption Support Fund. 2016. The Adoption Support Fund- 16/17 Budgetary Review. Retrieved 06/03/17 from http://www.adoptionsupportfund.co.uk/Portals/0/ETASF.pdf