using the ‘looking after children’ dimensions to collect aggregate data on well-being

Child and Family Social Work 2002, 7, pp 189–201 © 2002 Blackwell Science Ltd

INTRODUCTION

The Looking After Children (LAC) schedules arenow an established part of the review process for children looked after by local authorities in Englandand Wales (Ward 1995).They are also used in severalother countries around the world (see, for example,Clare 1997; Kufeldt et al. 2000). The seven dimen-sions of well-being – health, education, identity, emo-tional and behavioural development, family and socialrelationships, social presentation, and self-care – havenow been integrated into the Department of Health’snew assessment framework (Department of Health2000a) to be used with children in need and those atrisk of maltreatment as well as those who are lookedafter away from their parents. In 2001–2002 theDepartment of Health expressed its confidence in theLAC approach by developing it into an ‘integratedchildren’s system’ for recording and reviewing theprogress of all children provided with a statutoryservice as ‘children in need’ (as defined by the Children Act 1989, sect. 17) (Rose 2002).

Parker (1998) and Ward (1998) have described thedevelopment of the schedules from a set of tools foruse by researchers to gain more consistency in theevaluation of outcomes, to instruments to facilitateimproved planning for individual children and groupsof children.The LAC system has been heavily backed(both financially and in public statements and officialguidance) by the Department of Health and SocialServices Inspectorate. It is therefore not surprisingthat any critique of their efficacy as practice and per-formance management tools has tended to be largelyanecdotal and to come from individual social workersrather than from commentators in the academic andprofessional literature. Knight & Caveney (1998)expressed reservations about the assumptions andvalues underlying the ‘LAC approach’ to monitoringpractice with individual families, but little has beenwritten about the LAC system as a method of col-lecting aggregate data to aid planning and resourceallocation decisions. Parker (1998) and Ward (1998)point out some of the problems to be overcome if theschedules are to be used as monitoring tools to collect

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Using the ‘Looking After Children’ dimensions to collectaggregate data on well-being

Sue Bailey*, June Thoburn* and Hilary Wakeham†*Centre for Research on the Child and Family, School of Social Work and Psychosocial Studies, University of East Anglia,

Norwich, and †Gloucester Social Services Department, Gloucester, UK

Correspondence:Sue Bailey,Centre for Research on the Child andFamily,School of Social Work andPsychosocial Studies,University of East Anglia,Norwich NR4 7TJ,UKE-mail: [email protected]

Keywords: child placement, children incare, data analysis, fostering, outcomes

Accepted for publication: April 2002

ABSTRACT

The Department of Health has funded the development of a set ofschedules for collating information on and monitoring the progressof children looked after by local authorities. An additional aspirationunderlying official encouragement of the use of these ‘Looking AfterChildren’ (LAC) materials was that they would provide aggregate datato feed into national and local policy and planning. Progress on thisaim has been slow, in part because instruments designed to aid prac-tice in individual cases have not adapted easily to the hoped for dualrole, and in part because completion rates have been patchy andoften poor. This paper describes an action research project designedto use the children’s reviewing system to collect aggregate data onthe LAC dimensions of well-being. It comments on the viability ofthis method of aggregate data collection as well as locating the infor-mation on a cohort of 96 children in the context of other studies,and debates about whether the state can be a ‘good parent’.

Using the ‘Looking After Children’ dimensions to collect data on well-being S Bailey, J Thoburn and H Wakeham


aggregate data on whole groups of ‘looked after’ chil-dren or other children receiving a service as ‘childrenin need’. A ‘process’ study of the extent to which theAssessment and Action Records (AARs) were com-pleted did not engender confidence in the future ofthe schedules themselves as routinely collectedsources of reliable aggregate data:

Aggregated information about groups of children will be seri-

ously flawed if only 36% of AARs are completed. This has

implications for the collection of data for the [government’s]

children’s services objectives. (Scott 1999, p. 23)

Ward & Skuse (2001) provide early findings from alongitudinal study of a cohort of 249 children whostarted to be looked after by six English local author-ities in 1996 and remained looked after for at least 12months. They echo Scott’s finding that completion ofthe Assessment and Action schedules is variable topoor, but that the Essential Information Records aremore reliable sources of data on the characteristics ofchildren.

Progress in meeting an important secondary aim ofthe introduction of the LAC materials – as a sourceof national and local aggregate data for planning purposes – has therefore been slow. This is despite the fact that several Department of Health fundedresearch studies (Department of Health 2001a) havedevised ways of using the LAC dimensions to collectaggregate data on research cohorts.This paper reportson an action research project that adapted a method-ology, initially developed for the purpose of collectingresearch data, in order to provide aggregate data onlooked after children.

THE ACTION RESEARCH PROJECT:USING THE REVIEW SYSTEM TOCOLLECT AGGREGATE DATA

Researchers who used the LAC dimensions of well-being in three research studies (Brandon et al. 1999;Thoburn et al. 2000a,b) took the opportunity in thecourse of dissemination of findings to participatingagencies to discuss the impact of the LAC system withsocial workers and managers. We concluded that, ifused as intended alongside well-established principlesof good practice, the systematic collection of infor-mation on key aspects of a child’s well-being can bea positive tool for recording and reviewing the casesof individual children. There was evidence fromresearch participants and social workers that, in thehands of skilled and client-centred professionals, theschedules are valued by parents, young people and

their carers and do not impede creative practice. Forthe recently qualified, they appeared to provide acrucial aide memoire to the steps to be taken when children are cared for away from home. Grimshaw &Sinclair (1997), in a study of the review processes inthree local authorities, concluded that the LACsystem was generally helpful. However, they stressedtwo essential requirements if looked after childrenreviews were to be effective: (i) the review should bea process and not a single meeting; and (ii) whatevertools and systems are used, they should encourageand not impede judgements about progress and plansfor individual children:

If social workers are not asked to use their judgement in

individual cases, they may come to expect guidance and

procedures to make their decisions for them. (Grimshaw &

Sinclair 1997, p. 44)

However, on being turned into practice tools, theschedules and recording system have moved awayfrom one of their original purposes as research andmanagement instruments to aid the collection andaggregation of comparable data on groups of children(Parker et al. 1991). The schedules therefore had tobe adapted for use in the research studies cited above. Following a presentation of findings from theSafeguarding Children study (Brandon et al. 1999), toan English county social services department, theresearchers were invited to work with a reviewingofficer to provide aggregate data on care careers andwell-being for all the children looked after in two areasof the county. Initially the aim of this low-budgetproject was to provide data for use in service planningand review in two area teams. The intention was toreview the initiative with a view to ‘rolling it out’ tothe whole department if it were to produce valid andhelpful data, thus increasing numbers and the valid-ity of the resulting data analysis.

In consultation with children’s services managersand team leaders it was agreed that the data collec-tion process should be integrated into the normalreviewing system for individual children. The twinaims were to provide aggregated data on looked afterchildren and to make a contribution to the quality ofthe service provided to individual children, thusreducing the risk of the pilot project being experi-enced as yet another drain on precious social worktime.The data collection process involved the review-ing officer and the child’s social worker meeting asquickly as possible after the review meeting for eachchild who had been looked after for at least sixmonths, and then annually. (The reviewing officers

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chair the statutory case reviews of children in localauthority care in England and Wales and often have a quality control function in respect of the reviewprocess. Grimshaw & Sinclair (1997) provide ahelpful discussion of the different organizationalarrangements, particularly in terms of their relation-ship with the case-accountable line manager.) In somecases the opportunity was taken to have a moreextended discussion around any worrying aspects ofthe case pointed up by the rating process. The sched-ules required them to agree a rating for each of the(expanded) LAC dimensions on a four-point scale:above average, average, below average, or poor. Theinstructions give some assistance on ‘average’, and the continuity provided by the presence of the samereviewing officer ensured at least some degree of standardization. The rubric stated:

In making a rating, have in mind a child of a similar age, from

a similar social and income group (with a similar physical or

learning disability if relevant) who is doing averagely well and

where social work assistance has not been necessary.

To avoid any possibility of a negative ‘labelling’ effectfrom this broad rating process, it was decided that,during the action research phase of the project, theschedules and ratings would not be placed on thechild’s file but would be sent to the Universityresearchers for analysis. This practice was to bereviewed if a decision were taken that this method ofaggregate data collection would be continued andextended throughout the department.

The data collected in order to monitor and reviewthe progress of these children did not rely on theAssessment and Action Records and other LACschedules alone, but were drawn from the totality ofinformation available to the reviewing officer andsocial worker – from parents, young people, carers,teachers and health professionals, including psychi-atric reports and the information which emerged inthe course of all meetings held during the reviewprocess. A four-page schedule was adapted by theauthors from the data collection instrument used inearlier research studies. The reviewing officer pilotedthese schedules and changes were made, includingincreasing the original seven LAC dimensions to nine:during the pilot stage workers found that two of the dimensions produced information that was toodiverse to be contained within a single rating. Theysuggested that information on ethnic and culturalidentity should be rated separately frompersonal/family identity and biography; and thatfamily relationships should be rated separately from

peer/social relationships. (In the light of commentsmade on the schedules, it would have been appropri-ate to separate out relationships with the birth familyand with the foster family.) The schedule also col-lected data on age, sex, ethnicity, time in placement,and number of moves of the sort required for theQuality Protects returns (Department of Health 1999).

The reason for this ‘distillation’ of these ratingsfrom the much fuller information available to thereview, rather than the use of the data on the Assess-ment and Action Record schedules themselves, is thatit was concluded from the research studies that, onsome dimensions more than others, the schedules donot yield the type of data which can be aggregated foruse by planners and managers. Discussions had indi-cated that when used as practice tools with youngpeople, their parents and carers, a ‘spin’ is sometimesput on the evaluative parts of the schedules.To praiseand encourage, a tiny move forward, or even standingstill, may be recorded more positively than a more dis-passionate judgement would require. Also, much ofthe information on the schedules is of a process ratherthan an evaluative nature. Items such as ‘has the childvisited the dentist’ do not yield information on well-being on specific dimensions, though they may wellfeed into a conclusion about well-being – a fear ofgoing to the dentist may well contribute to a rating on the emotional and behavioural developmentdimension.

A secondary aim of the data collection process wasthat the case management service for the individualchild should benefit from it by enhancing the place ofsocial work judgement in the planning process, asadvocated by Grimshaw & Sinclair (1997). In thehurly-burly of child and family social work, the socialworker and reviewing officer usually move on imme-diately after the review meeting to the next crisis ormeeting, without finding time to evaluate the meaningfor the child’s future well-being of the informationthat has been shared at the review. There is rarely aspace for reflection. How well is the child really doing?Is she making progress on one dimension but slippingback on another? Even if she is making progress, isthis masking the fact that overall her well-being is verypoor on some or all dimensions? In making time todiscuss the question ‘So what do we really think aboutMary’s educational achievement/emotional well-being?’, the worker and reviewing officer may become aware that something more fundamental byway of remedial action has to happen, which was overlooked amongst all the other agendas of thereview process.

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FINDINGS

A profile of the children

This group of children, on whom data were collectedbetween 1997 and 1999, broadly fits the pattern oflooked after children in the UK as a whole as por-trayed in Department of Health annual statistics(Department of Health 2000b). Half were agedbetween 10 and 15 and just over half were boys (Table1).The proportions of boys and girls exactly mirroredthose for all children looked after by local authoritiesin England (54% boys and 46% girls). However, thereare some differences between this group and theEngland statistics in respect of age groups. Fewer wereunder 5 (14% compared with 20% for England as awhole), but more were in the 5–9 age group (28%compared with 21% for England) and the 10–15group (50% compared with the England proportionof 42%). There was a difference between the 8% inthis group who were aged 16 or over and the 18% in the national statistics, a point to which we return.In part these differences may be explained by theEngland statistics including children and youngpeople who stay for only a few days or weeks, whilstour sample includes only those who stayed for at leastsix months. For example, more in the youngest groupare accommodated for a comparatively short periodof time.

Seventy-five of the children (78%) were of whiteEuropean ethnic origin, 18 (19%) of mixed raceparentage, and both parents of 3 (3%) were ofAfrican-Caribbean descent. Table 2 shows that 72%were in foster or adoptive family placements (includ-ing those in boarding school during term time whoselong-term home was with a particular family) andonly 15% in group care settings.

Placement type was broadly similar for both boysand girls, with 33 boys and 32 girls with foster carers.The only differences in placement were with thegroup of young people in children’s homes, with six

of the seven in this category being male. Four of thefive at boarding school were also male. In later analy-sis placement type is reduced to three broad cat-egories: with relatives (including the one child athome with parents); with foster carers; or in groupcare (including children’s homes, boarding school and‘other’ placement – which included independentliving and in youth custody).

Questions were also asked about the duration of thecurrent placement of the child, which depends in parton the age of the child. The length in months of thecurrent placement is shown in Table 3. It can be seenthat the boys in the study were more likely to havebeen in their current placement for longer than thegirls in the study (48% of boys and 34% of girls havingbeen in the same placement for over a year). Anotherway to represent this finding is that the average lengthof the current placement was 28 months for the boysand only 18 months for the girls. This may resulteither from girls returning home more quickly or fromboys’ placements lasting longer. We shall learn moreabout this at a later stage when the schedules arerepeated on the same children.

When the duration of the current placement is con-sidered alongside the age of the young person (Table4), it is those in the 10–15 age group whose place-ments had lasted for the shortest period of time. Thesmall numbers in the 16+ group, and the relative

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Table 1 Age and sex of child

Age Males Females Total

0–4 4 (7%) 9 (20%) 13 (14%)5–9 17 (33%) 10 (23%) 27 (28%)10–15 26 (50%) 22 (50%) 48 (50%)16 and over 5 (10%) 3 (7%) 8 (8%)

Total 52 (100%) 44 (100%) 96 (100%)

Table 2 Placement type

Home with parent/s* 1 (1%)With relatives as foster carers 6 (6%)Foster carers not related to child 65 (68%)Placed with adopters 1 (1%)Long-term group care 6 (6%)Children’s home 7 (7%)Boarding school 2 (2%)Boarding school and foster carers 3 (3%)‘Other’ 5 (5%)

*This group is under-represented when compared with nationalstatistics.

Table 3 Duration of the current placement

Duration Males Females Total

6 months and less 19 (37%) 16 (36%) 35 (36%)7–12 months 8 (15%) 13 (30%) 21 (22%)13–36 months 13 (25%) 7 (16%) 20 (21%)Over 36 months 12 (23%) 8 (18%) 20 (21%)



length of their placements when compared with the10–15 group, may reflect ‘leaving care’ policies in thatonly those well settled in long-term foster families areremaining ‘looked after’. Others may have left care oraccommodation at 16 or 17 via ‘leaving care’ schemes.(It will be interesting to see whether this changes insubsequent years in response to the Quality Protectstarget of more young people remaining ‘looked after’until they reach the age of 18.)

Turning to the duration of the current placementin the context of the type of placement (Table 5),almost half of the young people in foster care had beenin that placement for a year or more, with about aquarter being in the same placement for three yearsor more. This compares with less than a quarter ofthose in group care having been in that placement forover a year.This placement pattern may result from ageneral view that group care (other than boardingeducation) should be seen as a short-term option.Thesmall group of those placed with a relative had eitherbeen in that placement for less than six months ormore than three years.Table 6 indicates that these twoareas were doing well on a key government perfor-mance indicator for looked after children. Only 10%of the children had three or more placements withinthe previous 12 months, well inside the governmenttarget of no more than 16%. We return in the discus-sion section to this question of stability as a perfor-mance indicator, but note here that remaining in thesame placement does not necessarily mean that thechild is ‘well placed’. Berridge & Cleaver (1987) andRowe et al. (1989) found that some children stayedtoo long in placements that eventually broke down indistressing circumstances.

There was no difference between boys and girls inrespect of placement stability, but variations werenoted according to the type of placement (Table 7).Nearly three-quarters of the young people placed with

a relative or with foster carers had experienced noplacement change in the previous 12 months, andnone had experienced more than two changes.This isin contrast to the young people in group care, over aquarter of whom had experienced three or morechanges of placement in the preceding year. Only 10young people whose main placement was in groupcare (including some who had been looked after forless than the full 12 months) had had no change ofplacement. This may in part be explained by the tendency noted by Rowe et al. (1989) for residentialcare rather than foster care to be used as an emer-gency or transition placement, especially when fosterfamily placements break down.

When placement changes are considered alongsidethe age of the child, the main volatility is in the 10–15age group. Nearly one-fifth (19%) of these youngpeople had experienced two or more changes of place-ment in the previous 12 months, compared with nonein the 0–4 and 16+ age groups and 4% in the 5–9 agegroup.

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Table 4 Duration of the current placement by age ofchild*

Duration Age 5–9 Age 10–15 Age 16+

6 months and less 6 (22%) 22 (46%) 1 (12.5%)7–12 months 6 (22%) 8 (17%) 1 (12.5%)13–36 months 9 (33%) 8 (17%) 2 (25%)Over 36 months 6 (22%) 10 (21%) 4 (50%)

*The youngest age group, those aged 0–4 years, is omitted fromTables 4 and 5, since the potential length of stay is artificiallyrestricted by their young age.

Table 5 Duration of the current placement by type ofplacement

Duration Relatives Foster care Group care

6 months and less 4 (57%) 20 (30%) 11 (48%)7–12 months – 14 (21%) 7 (30%)13–36 months – 17 (26%) 3 (13%)Over 36 months 3 (43%) 15 (23%) 2 (9%)

Table 6 Number of placements in previous 12 months

1 64 (67%)2 22 (23%)3 4 (4%)4 4 (4%)5 or more 2 (2%)

Table 7 Placement changes in the previous 12 months bytype of placement

Relatives Foster care Group care

No changes 5 (72%) 49 (74%) 10 (43%)1 change 1 (14%) 16 (24%) 5 (22%)2 changes 1 (14%) 1 (2%) 2 (9%)3 or more changes – – 6 (26%)



The children’s well-being

For the purpose of this analysis the ‘above average’rating used for four of the dimensions (education,emotional and behavioural development, social rela-tionships and social presentation) is combined withthe ‘average’ rating and included in the tables underthe ‘good/only rare problems’ heading. (For thecohort as a whole, only seven were rated as aboveaverage – two on the social presentation dimensionand five on the ‘educational attainment’ dimension.)In the tables below, cases where there was insufficientinformation, or the child was too young for a mean-ingful reply, have been omitted.

The most positive ratings were made on the dimen-sions of health, ethnic/cultural identity and self-care(Table 8). Family relationships were more likely topolarize between ‘good’ and ‘poor’ ratings, and lessthan half were rated as ‘good’ or ‘only rare problems’on the education and emotional and behaviouraldevelopment dimensions.

To learn more about these children, the well-beingratings on education and emotional and behaviouraldevelopment were considered in the light of the characteristics of the children and their placement histories over the preceding year.

Educational performance

In the light of consistent research findings pointing tolow educational achievement amongst young peoplein care and leaving care (Aldgate et al. 1993; Biehalet al. 1995; Jackson & Martin 1998, 2002; Stein 1998)the government has placed particular emphasis onthis key indicator, and in 2001 it produced nationalstatistics highlighting the problem (Department ofHealth 2001b). In the areas in our study, more of the

girls were doing at least averagely well educationallythan was the case with the boys. Of the five childrenconsidered to be above average in their educationalperformance, four were girls. Conversely, of the 13children judged to be ‘poor’ in this dimension, 10were boys. There was a trend (see Table 9) towardsthe younger children being more likely to be rated as average or above in educational performance.However, as Table 9 shows, these differences were notstatistically significant, and caution is urged in theirinterpretation since variables overlap and numbers aretoo small to control for this effect. For example, chil-dren of mixed race parentage were more likely to berated as ‘average or above’; but they were predomi-nantly in the younger age groups. It is not possiblewith small numbers to disentangle the differentfactors at work. (Two-thirds of the children of whiteEuropean heritage were aged 10 years or more, com-pared with only a quarter of children of mixed raceparentage.) With the larger data sets now more readilyavailable to agencies through the more detailedDepartment of Health statistical returns (Departmentof Health 2000b) some of these problems have beenovercome. However, data on well-being and on edu-cational attainment other than in public examinationsare not included in these data sets so information onchildren under 16 is not routinely available (Depart-ment of Health 2001b).

Table 10 explores the relationship between educa-tion and length of, changes in, and type of placement.The warning issued earlier about overlapping vari-ables needs to be borne in mind again here. However,the figures in this small sample point to the expectedassociation between better educational performanceand:∑ length of current placement (on the borderline of

significance at the 5% level);

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Table 8 Ratings on indicators of well-being and progress

Indicator Poor Some problems Good/only rare problems No. of cases

Health 0 17 (18%) 79 (82%) n = 96Educational attainment 13 (14%) 40 (43%) 41 (43%) n = 94Personal identity 9 (10%) 29 (33%) 49 (56%) n = 87Ethnic/cultural identity 3 (3%) 7 (8%) 77 (89%) n = 87Emotional and 15 (16%) 50 (53%) 30 (31%) n = 95

behavioural developmentFamily relationships 19 (20%) 16 (17%) 61 (63%) n = 96Social/ peer relationships 15 (16%) 22 (23%) 59 (61%) n = 96Social presentation 6 (6%) 29 (30%) 61 (64%) n = 96Self-care 1 (1%) 21 (25%) 64 (74%) n = 86



∑ lack of change of placement; and∑ placement with a relative or with foster carers, as

opposed to placement in group care.It was likely that the age of the child would affect theabove findings, and further analysis of the data didindeed show that longer placements, and above all alack of changes in placement, were statistically signifi-cantly linked with average or above average educa-tional performance in the case of 10–15 year olds. Itseems likely that some of these children were placedwhen younger and had developed a ‘sense of perma-nence’ (Thoburn 1990). This would be in line with

the conclusions of Aldgate et al. (1993) from an earlierstudy which looked specifically at educational per-formance of ‘looked after’ children; Minty’s (1999)overview of outcomes of long-term foster care; theKufeldt Canadian studies (Kufeldt et al.2000; Kufeldt2002); and Jackson & Martin’s (2002) study of youngpeople in care who had gone on to higher education.The trend towards higher ratings on educational per-formance for those with greater stability of placementwas not statistically significant for the 5–9 year olds,and those aged 16 or over.

Further analysis showed that the link between

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Table 9 Education rating and characteristics of the child

Average or Some problems, Statistical Characteristic above average or poor education rating No. of cases significance (c2)

Sex of childMale 20 (39%) 31 (61%) n = 51Female 21 (49%) 22 (51%) n = 43 NS

Age of child0–4 6 (55%) 5 (45%) n = 115–9 12 (44%) 15 (56%) n = 2710–15 21 (44%) 27 (56%) n = 4816 and over 2 (25%) 6 (75%) n = 8 NS

EthnicityWhite European 30 (41%) 43 (59%) n = 73Mixed parentage 10 (56%) 8 (44%) n = 18African-Caribbean* 1 2 n = 3 NS

*Percentages are not given when numbers are very small, as they may be misleading.NS, not significant.

Table 10 Education rating and characteristics of placement

Average or Some problems, Statistical Characteristic above average or poor education rating No. of cases significance (c2)

Placement lengthOver 3 years 12 (60%) 8 (40%) n = 2013–36 months 12 (60%) 8 (40%) n = 207–12 months 7 (35%) 13 (65%) n = 20Up to 6 months 10 (29%) 24 (71%) n = 34 P = 0.0513

Number of placement changesNo changes 35 (56%) 28 (44%) n = 63One change 6 (29%) 15 (71%) n = 21Two changes – 4 n = 4Three changes – 4 n = 4Four or more changes – 2 n = 2 P = 0.0098

Placement typeWith relatives 6 (86%) 1 n = 7Foster carers 31 (48%) 33 (52%) n = 64Group care, children’s home, 4 (17%) 19 (83%) n = 23 P = 0.0024

boarding school etc.



placement stability and average or above averageattainment was highly significant for the girls in thestudy, but not significant for the boys.

Emotional and behavioural development

A similar pattern emerges when the emotional andbehavioural development of the children is considered(Table 11).Whilst no child was considered to be aboveaverage in his or her emotional and behavioural de-velopment, there was a link between average de-velopment and stability, length of placement, andplacement with relatives.The link was statistically sig-nificant for all three factors, and was highly significantas regards placement changes, and the type of place-ment. (One should, however, be cautious aboutimplying causality in any one direction. It may bethose young people who have ‘problems’ are hard toplace and frequently move, rather than the oppositeinterpretation, that being frequently moved gives riseto emotional and behavioural problems.)

Age and gender as relevant variables

Gender appeared to be of less importance to emo-tional and behavioural development than it was toeducational performance, although there was a trendtowards the girls being slightly more likely to score an‘average’ on this indicator than the boys (36% vs.27%, respectively). A higher proportion of girls also

scored well on the dimensions of family relationships(rated as good for 70% of the girls, as against 58% ofthe boys). On the other hand, boys were more likelythan girls to be rated positively on the dimensions ofpersonal identity and ethnic and cultural identity.

Unsurprisingly, more children in the youngest agegroup had positive ratings in respect of emotional andbehavioural development. However, our findings aresimilar to those of Berridge & Cleaver (1987), whofound that pre-adolescent foster children were aslikely as teenagers to have emotional or behaviouralproblems. Younger children were more likely to haveat least average ratings on the dimensions of social andfamily relationships.

Measuring progress for the longer-stayers

For the 49 children on whom a second schedule wascompleted 12 months later, it was possible to comparethe ratings and consider progress during the year aswell as well-being at a point in time. As time goes on,these progress ratings will become available on alllong-stayers, with the larger numbers permitting morerobust analysis. The data on the first 49 are reportedhere to illustrate how this method of data collectioncan be used to monitor and analyse change over timefor cohorts of children, and to provide pointers to theareas where improvements are most needed.

Of the children in this cohort, 26 were boys and 23were girls; 35 were white European, 12 were of mixed

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Table 11 Emotional and behavioural development and characteristics of placement

Average emotional and StatisticalCharacteristic behavioural development Some problems Many difficulties No. of cases significance (c2)

Placement lengthOver 3 years 9 (45%) 10 (50%) 1 n = 2013–36 months 10 (50%) 9 (45%) 1 n = 207–12 months 6 (30%) 10 (50%) 4 (20%) n = 20Up to 6 months 5 (14%) 21 (60%) 9 (26%) n = 35 P = 0.0496

Number of placement changesNo changes 25 (40%) 34 (54%) 4 (6%) n = 63One change 4 (18%) 10 (46%) 8 (36%) n = 22Two changes – 4 – n = 4Three changes 1 2 1 n = 4Four or more changes – – 2 n = 2 P = 0.0008

Placement typeWith relatives 4 (57%) 3 (43%) – n = 7Foster carers 24 (37%) 35 (55%) 6 (9%) n = 65Group care, children’s home, 2 (9%) 12 (52%) 9 (39%) n = 23 P = 0.0021

boarding school, etc.



parentage, and two were of African-Caribbean herit-age. Proportions in the different placement types werebroadly similar to those for the full cohort.The infor-mation on stability also mirrors the larger picture,with 70% remaining in the same placement during theyear and 20% having had one change of placementsince the previous record was completed. Thirty-oneper cent had been in the same placement for threeyears or more.

Turning to the ratings of well-being,Table 12 showsthat, although those completing the schedules did nothave access to the schedules for the previous year,most children were given the same ratings. Thisshould not be taken to imply that there had been noprogress, since the rating bands are broad, and a childmay have made some improvement but still be con-sidered to be performing below the average for a childof his or her age and broad range of ability. Occa-sionally the child was too young in the previous yearto have been given a ‘rating’ on a specific dimension.To obtain an initial feel for the group’s progress (orlack of it), one can consider the total of 435 ratings,obtained for the nine dimensions across the group of49 children. Of these ratings 332 (76%) wereunchanged between the two time periods, and of these258 were adjudged to have been good or average inthe first year and remained so in the second. Theremaining 74 had been adjudged to be poor in thefirst year, and had remained poor in the second year.

Approximately a quarter of the ratings had regis-tered a change; of these 103 changes 74 were a changefor the better and only 29 showed a deterioration.

Turning to a consideration of changes in specific

aspects of well-being, there were more cases where alower rating was recorded on the dimensions of per-sonal identity and family relationships than on theother dimensions, a finding which echoes the work ofMillham et al. (1986), who reported on children’s lossof links with their birth families when they stayedlonger in care. However, more children had alsoimproved on these dimensions, pointing to a conclu-sion that, for some children at least, a longer experi-ence of being looked after helped them to make moresense of their lives. Perhaps most encouraging is thefinding that 13 children moved up the scale on emo-tional and behavioural development. Numbers at thisearly stage are still small, but it was of some interestto look more closely at those who improved on thisdimension. Of the 13 ‘improvers’:∑ seven were with foster carers, three in group care or

a children’s home, one in lodgings, and two ‘others’;∑ seven were boys and six were girls;∑ eight had experienced no changes in placement, but

four had had one placement change, and theremaining child had experienced four changes inthe preceding 12 months;

∑ two were aged 5–9, whilst seven were aged 10–15and four were aged 16 or over.The ‘improvers’ wereleast likely to be in the 5–9 age group.Turning to those for whom well-being ratings had

gone down, two of the six who were rated lower onthe family relationships dimension were in fosterfamily care, three were in children’s homes and onewas in lodgings.Two had had no change of placementin the preceding year but two had had two, one hadthree and one had four changes of placement. On thepersonal identity dimension, three of those whose

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Table 12 Changes in well-being ratings on the nine dimensions

Good and Problematic and Dimension remained good remained problematic Improved Deteriorated No. of cases

Education 19 20 8 2 n = 49Personal identity 20 10 12 5 n = 47Ethnic/cultural 40 4 2 1 n = 47

identityFamily relationships 31 1 11 6 n = 49Social relationships 31 10 8 0 n = 49Social presentation 32 7 7 3 n = 49Emotional and behavioural 15 17 13 4 n = 49

developmentSelf-care 33 4 8 2 n = 47Health 37 1 5 6 n = 49

Aggregate 258 74 74 29 n = 435



ratings indicated a deterioration were in foster familycare, one in a children’s home and one in lodgings.

DISCUSSION

The use of the review system to collect aggregatedata on looked after children

The LAC dimensions of well-being as a frameworkfor assessment at individual child and agency levelhave been widely accepted. However, there is roomfor debate as to whether the collection of better infor-mation has led to better planning and judgements inindividual cases as well as for groups of children. AsClare (1997, p. 34) points out, ‘The emphasis mustremain on tools to enhance professional judgementrather than the introduction of another additional andunnecessary bureaucratic imposition’. This conclu-sion is similar to that of Grimshaw & Sinclair (1997)cited above. A hypothesis behind this project was thatthe requirement for two key ‘actors’ in the review pro-cess, the reviewing officer and the case-accountablesocial worker, to spend time together to collect theirthoughts after the review meeting, and reach a judge-ment on all the evidence collected during the reviewprocess about how well the child was doing on eachof the LAC dimensions, would result in the collectionof aggregate data in a way which would also benefitplanning for the individual child. The project wasfunded on a shoestring and no research time wasavailable for an independent evaluation of the socialworkers’ perceptions of the process. The reviewingofficer was clear that the process enhanced the valueof the review by providing even this brief time for jointreflection. In particular, having to ‘make a judgement’on the evidence available did, in her opinion, lead toclearer thinking about work to be undertaken in thefollowing months.

As was noted earlier, there has been far less progressin the UK in the use of the detailed Assessment andAction Records to collect aggregate data on groups ofchildren than in integrating them into the case reviewand planning processes for individual children. Thestudy reported earlier of Ward & Skuse (2001) usedresearchers to collect data from records, mainly usingthe LAC documentation but filling in the blanks fromelsewhere in the file when Assessment and ActionRecords were not fully completed. Ward & Skuse(2002) provide information on plans to publish infor-mation on cohorts of children looked after in 12English authorities, but the problems (already notedby Scott 1999) remain of poor completion rates for

much of the Assessment and Action Record data.Kufeldt et al. (2000) and Kufeldt (2002) report onalternative approaches to aggregating the moredetailed data from the Assessment and ActionRecords, which were more fully completed in theirCanadian action research project than has been thecase when they were incorporated into routine prac-tice in the UK. More detailed data are available fromthe Canadian study than from the approach reportedin this paper. However, the elements of professionaljudgement of the case worker and review manager,together with a degree of standardization (achieved byusing the same reviewing officer), are lacking in theCanadian approach based on assessments made by agreater number of individual social workers andyoung people completing the records.

Discussions with senior managers on the aggregatedata provided led to agreement that this method was acost-effective way of providing useful aggregate data,and its value would increase as longitudinal databecame available.Whilst recognizing the potential risksto planning for individual children of collapsing a widerange of data on a particular dimension into a singlerating, they saw value in this broad-brush approach tothe collection of aggregate data for monitoring andplanning children’s services at local and departmentallevel. It was also recognized that such a system couldwork only if there were an element of consistency,made possible in this agency by reviews being conducted by a small number of experienced and specialist reviewing officers. In short, there was thepotential in this process for achieving what Grimshaw& Sinclair (1997, p. 242) recommend:

There is a case for uniting the monitoring and the aggregate

co-ordinating functions by insisting that information is not

only collected but regularly scrutinised by those responsible

for strategy development, so that procedures and services are

constantly updated to meet new needs.

That the planned development did not happen wouldbe the subject of another paper on why some promis-ing initiatives are incorporated into practice andothers not. In this case, the main explanation was thatthe reviewing officer (the ‘product champion’) wasunavoidably away from the reviewing role at a crucialtime, but more importantly the department was goingthrough a period of organizational change and thisparticular initiative got lost. An improvement in thedata routinely collected by the Department of Health(Department of Health 2000b; Dickens & Howell2001) has meant that some of the data reported here,on age, sex, placement type and moves, is now

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routinely collected. However, despite attempts to useelectronic versions of the Assessment and ActionRecords, the collection of aggregate data on the moredetailed well-being of looked after children is still inits infancy in the UK.

The relevance of the study to our understanding oflooked after children

Whilst the small numbers necessitate caution in inter-preting the findings, they provide insights into thewell-being and placement patterns of a full cohort ofchildren cared for by one area for at least six months.It is particularly interesting to look more closely at theage of the children, placement type, and stability ofplacements.

Two measures of stability were used: duration ofcurrent placement (Table 3) and number of place-

ment changes in the previous 12 months (Table 6).Table 13 shows that, as with educational attainmentand emotional and behavioural development, stabilityof placement appears, to a greater or lesser extent, tobe associated with higher well-being on each of thedimensions. One slight exception is that amongstthose with a poor sense of personal identity and prob-lematic family relationships were children who hadbeen in placement for over 24 months.This may pointto the need for additional work on parent/childcontact or life story work. Again, as discussed above,care should be taken in interpreting this finding. Alack of placement stability may lead to the child’sdevelopment being adjudged to be poor; however, analternative interpretation is that a child with many dif-ficulties may, as a result, be subject to frequent moves.

In view of the current drive, mirrored in govern-ment targets and performance indicators, to reduce

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Table 13 Placement stability and well-being

Measure Rating Average length of current placement

Education Average or above 34 monthsProblems 16 months

Sense of personal identity Good understanding 39 monthsRealistic 28 monthsSome problems 17 monthsPoor 22 months

Ethnic/cultural identity Good understanding 24 monthsSome confusion 17 monthsPoor understanding/ 15 months

negative views

Family relationships Good 23 monthsProblematic with either 39 months

birth family or carerProblems with both birth 11 months

family and carer

Social relationships Average 27 monthsProblems with peers 24 monthsProblems with adults 11 monthsPoor with peers and adults 12 months

Social presentation Above average 81 monthsAverage 25 monthsSome problems 19 monthsPoor 11 months

Emotional and behavioural Average 35 monthsdevelopment Some problems 21 months

Many difficulties 9 months

Self-care Good 28 monthsSome deficits 16 monthsSerious deficits 12 months

Health Rare or minor problems 25 monthsSome problems 18 months



placement instability for looked after children, theareas taking part in this study can take some pride in a placement stability rate of 90% having no morethan two placements during the year, compared with81% for all children looked after in England in 1999(Department of Health 2000b). A proportion of thesechildren began to be looked after during the year andwere placed in an emergency in a very short-termplacement. A speedy move at this stage, whilst dis-tressing, is less likely to cause harm than a move froma placement in which the child is starting to put downroots. However, it should be a cause for concern thatalmost half in the youngest group had had at least one change of placement. It may be that for some thesingle move is into an adoptive placement. A scrutinyof these six cases could prove helpful in suggestingpolicy changes that could avoid unnecessary movesfor this most vulnerable group. This point is lentweight by the finding of Ward & Skuse (2001, p. 343)that, during the first year of their care episodes, a muchsmaller proportion (70%) of the children had onlyone or no change of placement. Of the placementchanges in that study, 54% (66% for those enteringcare when under 1) were planned and only 22% (7% for the under 1s) resulted from a placementbreakdown.

Turning to placement type, whilst foster care wasused for all age groups, group care was predominantlyused for those aged 10–15. All except one of the children placed with a relative were aged 10–15.However, all eight of the young people aged 16 or overwere in foster care. A probable explanation for this isthat those who reach 16 in other settings (placed withparents or relatives or in group care) tend to leavebehind their ‘looked after’ status before their 17thbirthday.This is a further indication (to which weightis also added by our data on age and placement sta-bility) that those who ‘age out’ of their ‘looked after’status at 18 usually do so from foster families withwhom they are well settled. They then have a betterchance of reaping the benefits, of which the UttingReport (Department of Health 1997) writes, ofretaining the support of their carers as they move intoadult life. This is congruent with positive reports ofgrowing up in care from qualitative studies of youngadults who spent substantial periods in long-termfoster care (Stein 1998;Thoburn et al. 2000a; Jackson& Martin 2002; Schofield 2002) and contributes tothe argument that long-term foster care may havebeen undervalued in recent years. Drawing on herLAC data, Kufeldt (2002) concludes similarly.

There are indications from this study that, for a

proportion of children who remain long in care (someeventually adopted by their foster parents, someremaining in foster care), the placement instabilitywhich is so damaging to their prospects tends tohappen early in their care careers. Those who forwhatever reason cannot return to parents or relativesor be adopted, but who are placed early enough inlong-term foster homes, appear to have a reasonablechance of finding stability and ‘a family for life’ withtheir foster families. This hypothesis can be looked atin subsequent years if the routine collection of aggre-gate data at national and local level allows for cohortsof children to be ‘tracked’ through their care careers.It may be that an unduly pessimistic picture hasemerged of the ‘looking after children’ servicesbecause attention tends to focus on the minority whoexperience multiple placements and placement break-down, rather than those for whom placement stabil-ity is achieved.

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