Foster care in the United Kingdom

Foster care in the modern sense was first introduced in the United Kingdom in 1853 when Reverend John Armistead removed children from a workhouse in Cheshire, and placed them with foster families. The local council (called unions at the time) was legally responsible for the children, and paid the foster parents a sum equal to the cost of maintaining the child in the workhouse.[1][2]

Children from a workhouse in Cheshire - similar to these children at Crumpsall workhouse.(c.1895) - were the first to be placed in foster care in the United Kingdom in 1853.

According to the Children and Family Court Advisory and Support Service – the agency for England and Wales set up to safeguard and promote the welfare of children involved in family court proceedings – the total number of new care applications between April 2011 and March 2012 was up by 10.8 per cent, rising from 9,202 over the same period the previous year, exceeding the 2008-09 tally of 6,488 by 57.2 per cent.[3]

Health and Social Care: Looked After Children and Young People

1.0 Introduction Millions of children, teenagers, and even young adults have to get into care environments annually due to various causative agents such as death of their parents, mental health illnesses, and abuse or trauma. While these children benefit from the best strategies that providers of such care can provide, there are significant risk factors that lead to problems such as abuse whilst in the care environment. Yoon et al. (2022) defined the risk factors facing children entering a care environment as both factors and individuals that may cause additional trauma, or aggravate existing and previous forms of abuse the child has faced. The first risk factor for a child going into care is caregiver-specific, which means that is the provider of care to the child is the source of risk. Such caregiver-specific risk factors include substance abuse or physical assault and abuse. The second type of risk factor facing children going into care is child-based, which means it emanates from the child itself. Such risk factors include psychological turmoil or physiological conditions such as ill-health. Consequently, other issues such as trauma, loss, separation, abuse, neglect, and the consequences of poor-quality care could be considered as part of the health and social care issues facing children and teenagers going into care. 2.0 Trauma, Loss and Separation While providing care for abuse or traumatised children, caregivers must consider separation, loss, and trauma. In this context, trauma refers to the physical and emotional injuries that result when children are exposed to violence, neglect, or other forms of maltreatment (Bloomfield, 2019). Caregivers must be aware of the potential for further trauma when caring for abused or traumatised children. They should be prepared to provide support that takes into account the child's separation from their family, loss of familiar surroundings, and exposure to new and potentially frightening situations. In addition, caregivers should be aware of the possibility of re-traumatisation and take steps to prevent it. In the context of providing care for abused or traumatised children, loss is defined as anything that has happened to the child that has resulted in them feeling overwhelmed and unable to cope. This can include physical or sexual abuse, neglect, witnessing domestic violence, being separated from their family or carers, or experiencing a traumatic event such as a natural disaster (Lewis et al., 2019). While all children experience some loss during their childhood, for children who have been abused or traumatised, these losses can be much more severe and have a lasting impact on their lives. Many of these children will go on to experience further losses in adulthood, such as relationship breakdowns, unemployment and homelessness. Additionally, separation refers to the process of removing a child from their family or carers, and can be either voluntary or involuntary. Separation can have a profound effect on a child, especially if they are already suffering from the loss of abuse or trauma (Zammit et al., 2018). Separation can also be a traumatic event in itself, and can lead to further losses such as contact with siblings or extended family members. In some cases, children may also lose their culture or identity as a result of separation. Loss, trauma, and separation are important to identify among children who are in the care system because they are often associated with serious mental health problems. Loss, trauma, and separation can lead to serious mental health problems in children as they get into the care environment further affecting the impact of care on them. It is important to identify these factors so that proper care and support can be provided (House and Owens, 2020). Loss, trauma, and separation often go hand-in-hand, and can have a profound impact on a child's mental health. If not addressed, these issues can lead to long-term problems such as anxiety, depression, and post-traumatic stress disorder (PTSD). Proper diagnosis and treatment of loss, trauma, and separation is essential in order to provide the best possible outcome for the child. 2.1 The Risks of Loss, Separation, and Trauma for Children entering Care Separation from family is a big risk for a child or teenager entering care because of the psychological impacts of leaving their family environment and interacting with unfamiliar people after enduring abuse or trauma. The effects of such risks on the quality of care for the child range from mild to severe, and in some cases can be lifelong (Alexander et al., 2020). The loss of a parent through divorce or other means is associated with poorer educational attainment, aggression issues, physical violence, and increased risk for psychiatric problems and substance abuse in adulthood. In addition, research has shown that children who have been separated from their families are more likely to experience anxiety, depression, and attachment issues. Loss is also a big risk for a child or teenager entering care because of issues such as anxiety, depression, and attachment. The child who has suffered loss through death may not benefit from care interventions because of the ongoing grief process (Zammit et al., 2018). Additionally, the child may be at increased risk for psychiatric problems and substance abuse in adulthood. Additionally, these children develop attachment issues or become withdrawn making it hard for caregivers to connect with them or even for social interaction to come naturally for them. Children who have been abused or neglected among other forms of trauma are at increased risk for a number of psychological problems. These include depression, anxiety, post-traumatic stress disorder, attachment issues, and aggression. Additionally, these children are more likely to have difficulty trusting adults and forming positive relationships (Bhui, Byrne, Goslar and Sinclair, 2019). They may also suffer from low self-esteem and poor self-image. Additionally, they may have difficulty concentrating and completing tasks, and they may act out in school or exhibit other disruptive behaviours. Finally, abused and neglected children are at increased risk for developing substance abuse problems in adulthood.

2.2 The Risks of not Dealing with Risk Factors Failure to deal with risk factors facing children and young patients who are entering care may lead to serious issues further down the road once they have grown. The first issue is crime whereby traumatised children in the care system may become juvenile delinquents while in the care system, and full-blown criminals afterwards (Bhui, Byrne, Goslar and Sinclair, 2019). Delinquency is a precursor of criminal tendencies among abused and traumatized children in the care system that must be remedied through careful interventions. Secondly, unemployment issues are common after traumatised and abused children exit the care system because of the lack of job skills they have. Many of these children and young patients have responsibility and communication problems that could be compounded by psychological and cognitive development problems making them undesirable in the job market after exiting the care system (Danese, Smith, Chitsabesan and Dubicka, 2019). The also struggle with unique skills such as teamwork and leadership because of challenges faced within the care system. Thirdly, mental health problems are rampant among children who have been in the care system because of the trauma and abuse they have suffered. These problems include depression, anxiety, post-traumatic stress disorder, and even suicide ideation (Kumari, 2020). After exiting the care system, these traumatised and abused children may have more serious psychological or psychiatric issues such as schizophrenia and dissociative disorders. Fourth, drug and alcohol abuse is also a common problem among former foster children because of the numbing effect these substances have on their emotions. Lastly, difficulty in forming attachments and trusting people are common among former foster children because of the mistrust they have developed from their previous experiences (Danese, Smith, Chitsabesan and Dubicka, 2019). Many young adults who have spent time in the UK care system also develop addictive tendencies to hard drugs such as cocaine, prescription pills, marijuana, and other dangerous drugs. Finally, social factors such as homelessness, poverty, and substance abuse are also major problems facing former child patients of the care system. These social factors make it difficult for these individuals to reintegrate into society and may lead to a life of crime or addiction (Kim et al., 2021). It is important to address these risk factors early on in order to prevent them from becoming serious issues later on in life. Unwanted pregnancies are also common among adults whose past is characterised by trauma and abuse which led to their being designed into the care system. 3.0 Abuse and Neglect Abuse is a combination of factors that affect children resulting in them entering the care system in the UK. Generally, abuse entails some form of neglect, physical, emotional, or sexual maltreatment (Ramanuj and Pincus, 2019). In the UK, it is mandatory for social service agencies and law enforcement to follow certain procedures when investigating cases of possible abuse or maltreatment. There are many reasons why children enter the care system in the UK due to abuse. One of the most common reasons is neglect. According to a study conducted by the NSPCC, nearly 60% of referrals to child protection services were due to neglect (McCrory, Gerin and Viding, 2017). Physical abuse was the second most common reason for referral at just over 20%. Emotional abuse and sexual abuse were less common, but still accounted for around 5% and 3% of referrals respectively. Neglect is the failure to meet a child's basic, emotional, and security needs causing harm and suffering or turmoil. This can include physical needs like food and shelter, or emotional needs like attention and love. Neglect can be intentional or unintentional, but either way, it can have a lasting impact on a child. Physical abuse is any form of violence against a child that involve beating and painful force (Zammit et al., 2018). Neglect takes several forms when meted out to children, which includes physical, emotional or even social neglect. Neglect causes serious psychological problems for children such as low self-esteem, anxiety and depression. 3.1 Which Risk Factors are associated with Neglect and Abuse that should be Recognized Early? The risk factors pertaining to abuse and neglect in children entering the care system in the UK include social factors such as bullying, physical assault, psychological issues such as trauma and self-esteem, and physiological factors related to the child's health (Du Rietz et al., 2020). Social risk factors associated with children entering the care system are often related to neglectful or abusive parenting, poverty, family breakdown, and domestic violence. Physiological factors can include poor physical health, developmental delays, and chronic medical conditions. Psychological risk factors associated with abuse and neglect in children entering the care system often include low self-esteem, anxiety, depression, and post-traumatic stress disorder (PTSD). Treatment for abuse and neglect in children entering the care system typically includes a combination of individual therapy, group therapy, medication, and family support. Physiological risk factors include young age and malnourishment, which could be precedented by abuse while at the child's previous home environment. 3.2 The Effects of Risk Factors associated with Abuse and Neglect Social risk factors of neglect and abuse among children entering the care environment such as abusive parenting, poverty, family breakdown, and domestic violence affect the patients through exposure to violence, trauma, and chronic stress. These risk factors are often multigenerational and have a profound impact on child development. The long-term effects of neglect and abuse can be seen in many different areas of a person's life. For example, neglected and abused children are more likely to experience difficulties in school, problems with interpersonal relationships, mental health problems, and substance abuse issues (McManus et al., 2019). These effects can last into adulthood, and may even be passed down to future generations. It is important to note that not all children who experience neglect and abuse will go on to experience these negative outcomes. Some of the short-term effects of neglect and abuse on children and young patients entering care include: feeling isolated, scared, and alone; feeling worthless and unlovable; having difficulty trusting people; acting out in anger or aggression; withdrawing from others; having difficulty concentrating or paying attention; experiencing nightmares or sleep problems; having low self-esteem; and exhibiting physical symptoms such as headaches or stomach aches. 3.3 Risks and Issues for Children entering Care from Neglected and Abusive Homes The risks facing children entering into the care system from neglect and abuse environments include constant movement from one family to another, lack of enough skilled caregivers, and family instability at new homes. These risks are major issues for children and young patients, who come from homes with abuse, trauma, seperation, neglect, and loss, can be addressed through a number of interventions (Scott, Biello and Woods, 2019). The first line of intervention is to provide a safe and secure environment for the child. This means that the child should be placed in a home where there is no risk of further abuse or neglect. The second line of intervention is to ensure that the child has a support system in place. This support system can include a number of different people, such as foster parents, case workers, therapists, and teachers. The third line of intervention is to address the underlying issues that led to the abuse or neglect in the first place. This can be done through therapy, medication, and other forms of treatment. Interventions for children entering the UK care system from families characterised by neglect and abuse include leaving care services, residential care, and fostering. There is a lack of empirical evidence on which to base decisions about the relative effectiveness of different types of interventions due to privacy and trust issues revolving abused children benefiting from interventions (Freestone, Osman and Ibrahim, 2020). However, the most effective interventions are likely to be those that provide stability and support for children, help them to develop trusting relationships with adults, and give them the opportunity to develop their own skills and abilities. There is also some evidence that intervention programmes that focus on both the child and the family may be more effective than those that focus solely on the child. 4.0 Problems Children and Young Patients may face due to Poor Care Children and young patients entering the UK care system from homes with abuse, trauma, separation, neglect, and loss face several challenges due to ineffective or poor care. The first challenge is difficulty forming and maintaining social and professional relationships. These children and young patients derive such problems from the effects of their previous living conditions. As a result, they tend to face social exclusion and emotional difficulties (McCrory, Gerin and Viding, 2017). Furthermore, they are also prone to developing psychiatric disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD). Consequently, these patients have difficulties forming emotional and social relationships because of their past experiences. In addition, they often have trouble trusting people and maintaining healthy relationships, even at workplaces where teamwork, respect, trust, and loyalty are expected. These challenges need to be addressed in order for these children and young patients to heal and progress in their lives. Single adults, or those with abusive relationships who have a history of foster care and benefiting from the UK care system is a worrying trend in the United Kingdom because it is estimated that more than 60% of individuals in the foster care system have a history of being abused (Morgan et al., 2017). This trend is especially worrying because it means that those who have already been through the trauma of abuse are more likely to end up in abusive relationships later in life. This is often due to the fact that they have not received the proper support and counselling needed to heal from their previous experiences. Without proper support, these individuals are at a higher risk of ending up in situations where they are abused again. This can lead to a cycle of abuse that is difficult to break free from. The second challenge that these children and young patients face due to poor care in the UK care system is mental health issues such as depression disorders, anxiety disorders, and even schizophrenia. Such mental health problems occur through a combination of the patient’s genes and their environment. For example, children who come from abusive homes are more likely to develop anxiety disorders and PTSD (Freestone, Osman and Ibrahim, 2020). In addition, patients with a history of trauma are also at a higher risk for developing depression and anxiety disorders. Furthermore, these mental health issues can lead to problems in school, work, and social life. As a result, it is important to address these challenges in order to help these children and young patients lead healthy and fulfilling lives. Suicide and self-harm are common evidences of mental and psychological turmoil among young adults who grew up in the UK care system without proper care. Rodway et al. (2019), reported that there was a noticeable rise in child suicides among children with a recorded history in UK care system from 20 cases per 1000 at the age of 14 years, to more than 180 per 1000 at the age of 19 years (Rodway et al., 2019). These statistics are related directly with the ineffectiveness of care that many patients get when committed into a system plagued by inadequate skilled caregivers, insufficient resources, and poor background checking of foster families. The third challenge that these children and young patients face due to poor care is engaging in criminal offences. Poor care causes children from traumatic, abusive, neglectful, and loss-oriented families to become delinquents before adopting social and emotional rebellion (Du Rietz et al., 2020). Afterwards, these problems deteriorate after the children have left the care system to become criminal behaviour and other serious offences such as robbery, burglary, and theft (Kumari, 2020). In order to prevent this from happening, it is important to address the challenges that these children and young patients face so that they can live healthy and productive lives. Children from foster homes and other UK-based care facilities are more likely to be engaged in juvenile delinquency, and even criminal activities after they exit the system. The UK witnessed 49,100 offences from this category of offenders in 2019-2020 (Ministry of Justice, 2021). The relationships between care and foster system and increased participation in crime is caused by a lack of stability and support that these children experience while in care. Without a solid support system, many of these kids feel lost and unloved, which can lead them to turn to crime as a way to cope. Statistics from the Youth Justice Statistics Report for 2019/2020 report that more than 4400 knife-related offences occurred in the UK in the year (Ministry of Justice, 2021). According to the same study, the offences were carried out by minors aged between 10years and 17 years in the year. 5.0 Conclusion Risk factors facing children entering a care environment are both factors and individuals that may cause additional trauma, or aggravate existing and previous forms of abuse the child has faced. The first risk factor for a child going into care is caregiver-specific, which means that is the provider of care to the child is the source of risk. Such caregiver-specific risk factors include substance abuse or physical assault and abuse. The second type of risk factor facing children going into care is child-based, which means it emanates from the child itself. Such risk factors include psychological turmoil or physiological conditions such as ill-health. Consequently, other issues such as trauma, loss, separation, abuse, neglect, and the consequences of poor-quality care could be considered as part of the health and social care issues facing children and teenagers going into care. The effects of neglect, loss, abuse, and trauma on the effectiveness of care in UK have been the subject of intense studies for decades. However, these factors cause major disruption because children who have already undergone abuse or neglect and other similar problems must be provided with effective and specialized care or intervention. However, the UK government through the NHS and other major stakeholders seem to be struggling based on suicide rates among children in these care environments, criminal with foster care histories, and even mental health metrics for such patients.

6.0 References Alexander, R., Langdon, P., O'Hara, J., Howell, A., Lane, T., Tharian, R. and Shankar, R., 2020. Psychiatry and neurodevelopmental disorders: experts by experience, clinical care and research. The British Journal of Psychiatry, 218(1), pp.1-3. Bhui, K., Byrne, P., Goslar, D. and Sinclair, J., 2019. Addiction care in crisis: evidence should drive progressive policy and practice. British Journal of Psychiatry, 215(6), pp.702-703. Bloomfield, M., 2019. Trauma and post-traumatic stress disorder: children should be seen and heard. The Lancet Psychiatry, 6(3), pp.193-194. Danese, A., Smith, P., Chitsabesan, P. and Dubicka, B., 2019. Child and adolescent mental health amidst emergencies and disasters. The British Journal of Psychiatry, 216(3), pp.159-162. Du Rietz, E., Pettersson, E., Brikell, I., Ghirardi, L., Chen, Q., Hartman, C., Lichtenstein, P., Larsson, H. and Kuja-Halkola, R., 2020. Overlap between attention-deficit hyperactivity disorder and neurodevelopmental, externalising and internalising disorders: separating unique from general psychopathology effects. The British Journal of Psychiatry, 218(1), pp.35-42. Freestone, M., Osman, M. and Ibrahim, Y., 2020. On the uses and abuses of narcissism as a public health issue. The British Journal of Psychiatry, 220(2), pp.54-57. House, A. and Owens, D., 2020. General hospital services in the UK for adults presenting after self-harm: little evidence of progress in the past 25 years. The British Journal of Psychiatry, 217(6), pp.661-662. Kim, J., Kim, J., Kang, H., Lee, J., Kim, S., Shin, I., Chun, B. and Stewart, R., 2021. Investigating associations of childhood abuse and serum brain-derived neurotrophic factor levels with suicidal behaviours in patients with depressive disorders. The British Journal of Psychiatry, 219(5), pp.598-605. Kumari, V., 2020. Emotional abuse and neglect: time to focus on prevention and mental health consequences. The British Journal of Psychiatry, 217(5), pp.597-599. Lewis, S., Arseneault, L., Caspi, A., Fisher, H., Matthews, T., Moffitt, T., Odgers, C., Stahl, D., Teng, J. and Danese, A., 2019. The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales. The Lancet Psychiatry, 6(3), pp.247-256. McCrory, E., Gerin, M. and Viding, E., 2017. Annual Research Review: Childhood maltreatment, latent vulnerability and the shift to preventative psychiatry - the contribution of functional brain imaging. Journal of Child Psychology and Psychiatry, 58(4), pp.338-357. McManus, S., Gunnell, D., Cooper, C., Bebbington, P., Howard, L., Brugha, T., Jenkins, R., Hassiotis, A., Weich, S. and Appleby, L., 2019. Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population. The Lancet Psychiatry, 6(7), pp.573-581. Meng, X., Fleury, M., Xiang, Y., Li, M. and D’Arcy, C., 2018. Resilience and protective factors among people with a history of child maltreatment: a systematic review. Social Psychiatry and Psychiatric Epidemiology, 53(5), pp.453-475. Ministry of Justice, 2021. Youth Justice Statistics 2019/20. [online] London: National Statistics, pp.21-68. Available at: <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/956621/youth-justice-statistics-2019-2020.pdf> [Accessed 18 April 2022]. Morgan, C., Webb, R., Carr, M., Kontopantelis, E., Green, J., Chew-Graham, C., Kapur, N. and Ashcroft, D., 2017. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care. BMJ, (359), p.j4351. Ramanuj, P. and Pincus, H., 2019. Collaborative care: enough of the why; what about the how?. British Journal of Psychiatry, 215(4), pp.573-576. Rodway, C., Tham, S., Ibrahim, S., Turnbull, P., Kapur, N. and Appleby, L., 2019. Children and Young People Who Die by Suicide: Childhood-Related Antecedents, Gender Differences and Service Contact. SSRN Electronic Journal, 6(3), pp.1-9. Scott, H., Biello, S. and Woods, H., 2019. Social media use and adolescent sleep patterns: cross-sectional findings from the UK millennium cohort study. BMJ Open, 9(9), p.e031161. Yoon, S., Pei, F., Logan, J., Helsabeck, N., Hamby, S. and Slesnick, N., 2022. Early childhood maltreatment and profiles of resilience among child welfare-involved children. Development and Psychopathology, pp.1-13. Zammit, S., Lewis, C., Dawson, S., Colley, H., McCann, H., Piekarski, A., Rockliff, H. and Bisson, J., 2018. Undetected post-traumatic stress disorder in secondary-care mental health services: systematic review. The British Journal of Psychiatry, 212(1), pp.11-18.