National Assembly for Wales
Children, Young People and Education Committee

CAM 55

Inquiry into Child and Adolescent Mental Health Services (CAMHS)
Evidence from : Adoption UK

Ann Bell (Development Manager for Wales)    

Ann@adoptionuk.org.uk

What is Adoption UK?

1. Adoption UK is a national adoption support charity, empowering families to build bright futures for vulnerable children who are unable to live with their birth parents.  All children separated from their birth parents have experienced loss and many will have experienced abuse and or neglect.  Finding a permanent family will not overcome these experiences alone.
2. With more than 9,000 individual members and over 40 years experience supporting families Adoption UK understands the challenges faced.  We provide a range of services for families and professionals which include peer-to-peer support groups, family days, specialist training and publications, online support and information and advice through our helpline. 
3. There are at least 4,000 adoptive families with children currently living in Wales.  Adoption UK supported 359 families in Wales last year.  Many of these children will experience mental health problems as a result of early loss and trauma.  Consequently many adoptive families are in contact with their local CAMHS seeking support for their children.   
4. Adoption UK welcomes the opportunity to respond to this consultation and will respond with reference to adoption support services throughout this document.

Research and consultation with adoptive families

5. We have undertaken a number of research studies of adoptive parents across Wales and the rest of the UK over recent years.  Our report Support Needs of Adoptive Families in Wales was published in 2010.  Based on information collected from 67 adoptive families in Wales it contains two recommendations for CAMHS in Wales aimed at improving the service they are able to give to adopted children.

Recommendation 1

6. Adoption UK believes that the mental health needs of adopted children could be better supported if they received the same priority access in education and health as Looked After Children.  The challenges adopted children face due to their early experiences are not overcome by simply finding a permanent family.  Often their experiences have been the most traumatic of the care population, indicated by the fact they have been permanently removed from their birth families.  Therefore, in order to address mental health needs arising from these experiences adopted children require the same priority access to CAMHS as Looked After Children.  This principle is supported by the Children’s Commissioner for Wales, and could significantly improve outcomes for adopted children and reduce adoption disruption.

Recommendation 2

7. CAMHS support for adopted children could be significantly improved if staff teams received specialist adoption training.  Many CAMHS teams recognise that they work on a heavily  medical model.  Our experience shows thatCAMHS medical staff largely screen for conditions which can be diagnosed and treated with medication.
8. Abuse and trauma have an emotional and developmental impact on many adopted children, particularly on their ability to form secure attachments. CAMHS support could be more effective and targeted if clinicians had a greater awareness of the impact of early experiences on adopted children and young people.
9. CAMHS teams could be more effective if there was more frequent involvement of family therapists who have skills and knowledge of attachment disorders and developmental delay caused by early trauma and abuse.  Adoption UK has been working with other organisations in Wales to establish an All Wales Attachment Network.  This network aims to increase undertanding of attachment based therapies and share expertise and examples of good practice amongst professionals and parents in Wales. Adoption UK could support CAMHS to devise specialist training to improve efficiency of services and reduce long term need of adoptive families.

The situation in 2014

10. In order to provide up to date evidence for this inquiry Adoption UK undertook a new survey of adoptive families across Wales which asked them about their recent experiences of CAMHS.
11. We received 13 responses covering 11 different local authority areas. In addition we have drawn on case studies from adoptive families who have called our helpline over the past 12 months.  These responses suggest that the recommendations made in 2010 still apply.
12. The majority of adopted children accessing CAMHS were at tier 2 with a smaller number accessing a service being at tier 1 and tier 3. 

Referrals

• 30% of those completing the survey were referred by the GP,
• 30% by the social services front line team
• 15% by the adoption team
• 15% by the community paediatrician.

Waiting times  

• 50% of those completing the survey recieved an appointment between 1 and 3 months after referral,
• 33% waited  between 3 and 6 months
• 15% waited between six months and a year.
• No respondents received an appointment in less than one month.

13. The length of waiting time for an intial appointment with CAMHS implies that emergency services for adoptive families are not responsive enough and leave families in crisis for too long.

Postcode lottery

14. Respondents highlighted that services vary significantly across Local Authorities in Wales.

Extract comment:

15. ‘I am very frustrated that Y CAMHS can’t even see us because of their staffing level and that they don’t work with long term complex children !!!  X CAMHS team on the other hand were very helpful.’

Specialist support

16. A number of respondents  found the service excellent and others noted that they felt that there was a lack of specialised understanding about attachment and the impact of early trauma.Where support was more specialist it was effective.

Extract comments:

17. 'Appaling.  It wasted 2 years of our daughters life when appropriate support might have helped her.’
18. Our local CAMHS only see children with a diagnosed mental health problem so children with trauma based behaviours who require a therapeutic service in order to prevent them developing a mental health problem do not qualify. Early intervention and joined up services between LAC/Adoption/Paediatrics/ CAMHS is what is needed’
19. ‘We cancelled further appointments as we felt we were just going around in circles. Suggestions like ‘buying a punch bag’ to stop X from trashing the house didn’t seem very helpful and we seemed to be going back to the days of the naughty step and reward charts which again we did not think would serve any purpose.  At our last appointment we completely gave up when I was asked by a new consultant if there had been any complications during the birth – he hadn’t read the notes and didn’t know X was adopted!’

Whole family approach

20. The survey highlighted that services are more effective when professionals work with parents and children in partnership.  Some services focus solely on the child and parents are not fully informed about the child's case and treatment.  This disempowers parents from building on the work of CAMHS with their children outside of formal sessions.  What's more, this can put families at risk if they are not aware of issues which have been raised in sessions.
21. Extract comment:
22. 'We receive support from a psychologist based in the LAC team who has used DDP (Dyadic Developmental Psycotherapy) with us as a family – we accessed this support prior to the formal adoption and so it remains ongoing – without it the adoption would have undoubteldy broken down’.

Joined up working

23. Respondents were asked to what extent they felt their CAMHS team is connected to and understood by the other services such as education, health and social services. 
24. 55% of respondents said that joined up working is patchy in their area, with some services  communiciating and others not.
25. 45% of respondents said that communication and understanding between CAMHS and other services was very poor in their area.
26. This highlights that awareness of CAMHS in other services is not as strong as it should be and a joined-up, targeted approach is not used frequently enough across Wales. 

Conclusions

27. Early trauma and neglect in infancy have a major impact on mental health development.In order for vulnerable children placed with adoptive or long term foster parents to thrive they will usually require a style of parenting which is often described as ‘therapeutic’ parenting.  That is one which recognises and addresses the impact of the early trauma.  In order for parents to develop these additional therapeutic skills they will need support from professionals with skills in clinical psychology, family therapy and attachment based therapies.
28. The Welsh Government is currently working with partners in local government and in the third sector to create a new National Adoption Service for Wales which has the aim of increasing the number and success of adoptions in Wales.  If these goals are to be achieved it will be essential that adoptive families are able to access appropriate professional support from their local CAMHS team.  Adoption UK therefore believes that at least one CAMHS in each of the five regional adoption collaboration will need to develop the expertise described above and work closely with those families who need this support.