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'Wriggle and Roar'--an innovative approach to meeting the communication needs of looked after children under five.

Introduction

Children who are looked after have poorer educational, social and emotional outcomes as a group than other children. Many of them will have been subjected to abuse or neglect of sufficient severity to be removed from the care of their family and to become looked after by the state. In the literature review conducted by Law and Conway (1991), the following key points were highlighted:

* Child abuse and neglect have a negative impact on communication development.

* Neglect can have the most negative impact on language development.

Our experience in the London borough of Lambeth is that many of these children in the care of the local authority are likely to have several different placements, and may move between boroughs. This is due partly to the demography of Lambeth and the need to find suitable placements for a very diverse population of young children.

This situation can mean that for this group access to services can be difficult, often resulting in long waits following transfers across different Health Trusts. In many cases this can affect the long-term outcomes for an already vulnerable group of children, particularly if interventions are interrupted or uncoordinated.

In addition, the impact on foster carers caring for the communication-impaired child can be considerable. Timely assessment and support can help to prevent placement breakdown and enable foster carers to offer an environment that will promote the development of communication skills.

The purpose of the 'Wriggle and Roar' group is to provide a forum for early intervention for looked after children in Lambeth under the age of five. Regular contact with them and their foster carers can also allow for early identification of children's needs, so that they can receive the relevant support that is specifically tailored to them.

Description of the intervention model

The 'Wriggle and Roar' group is a weekly interactive group for looked after children (under five) and their foster carers. The group started in September 2008 and is an excellent example of multi-agency working, including practitioners from Guys and St Thomas's Foundation Trust Community Health Services (formally Lambeth Community Health) and Lambeth Children and Young People's Service. It was decided that an integrated approach for this client group would provide one point of contact for advice and support on all aspects of child development.

The 'Wriggle and Roar' group is run by a Speech and Language Therapist (SLT) and Early Years Literacy Development Worker, so its activities and main structure are designed to promote early language and literacy development. Support is also received from the Community Children's Service and Corporate Parenting Team, who signpost foster carers to the group. Group activities are designed to help encourage language development and positive interactions between children and their carers. Carers can receive support and advice from the practitioners as well as from other foster carers, which can help to promote successful placements and avoid placement breakdown.

The group takes the form of a two-hour weekly 'stay and play' style session. It is very structured and follows the same routine each week (free play, hello, singing, story time, craft activity, attention and listening games, song choosing and goodbye). Visual support systems, such as a visual timetable, song and story props and Makaton signs (gestures used alongside speech to give extra clues about what is being said), are used routinely to support children's learning of both routine and language. Families are given take-home packs to support generalisation of the skills learned in the group to the home environment. Children create scrapbooks to document their participation in the group. These include photos, craft activities and snippets of text capturing what the children say. This scrapbook stays with the child and can be utilised by parents, new foster or adoptive parents and social workers to support life story work during transition periods.

During the free play session, the SLT takes the opportunity to give specific advice and support to families relating to communication development. This includes information on ages and stages of development, when and how to refer to SLT and general support strategies (eg sharing books, adult child interaction).

The group runs in the local library, making the library service integral to the running of the project. The Early Years literacy development worker ensures that all children become members of the library and encourages families to share books at home. Families have access to Bookstart packs (free book packs from the Booktrust charity) and get resources to support the development of a love of books in their take-home packs.

Children generally continue to attend the group until they start nursery or school. Placement change does not affect the child's entitlement to take part. We have had experience of children attending with more than one foster carer, which has provided support and continuity at a time of transition.

Outcomes

Continual evaluations have been conducted to assess group outcomes and determine areas for future development.

Evaluation methods have included:

* observations of children and their carers within the group setting;

* feedback from carers, social workers and children regarding what they like about the group and changes they have noticed as a result of coming;

* pre- and post-questionnaires with foster carers;

* discussions with colleagues across different departments.

At the start of the group, foster carers were asked the question: 'What do you hope to gain from this group?' The responses were themed into three key areas:

1. positive outcomes for the child's interaction and communication skills;

2. opportunities for carers to access a support network;

3. friendship for children and carers.

Table 1 shows a summary of key outcomes with direct quotations from foster carers.

In addition, we have noticed the following added benefits:

* Social workers are using the group for some supervised contact between looked after children and their birth parents (agreed on a case-by-case basis). This means that the parents are able to benefit from the group and develop their confidence and skills in supporting their child's communication development.

* For children coming to the group and then referred to the speech and language therapy service, the SLT attending the 'Wriggle and Roar' group has been able to support foster carers and social workers through the referral and assessment process as well as help with therapy targets.

* Effective working relationships have been established between SLT and library services, corporate parenting and children and young people's services.

* We have had excellent attendance rates and have engaged foster carers from a range of cultural backgrounds with a variety of fostering experience.

The group has established a strong reputation for itself, with social workers continually referring new children and foster carers into the group. Foster carers return with new children coming into their care and carers are talking about our group at events and get-togethers.

The innovation and good practice in the running of this intervention has resulted in recognition through local inspections and local and national award schemes. The group was mentioned in the recent joint CQC (Care Quality Commission) and OFSTED inspection in Lambeth (April 2012) as an example of innovative practice to meet the health needs of looked after children under five. The 'Wriggle and Roar' group won the Local Health Trust 'Excellence in Practice-Partnership Working' award in 2010 and was a finalist in the National 'Health and Social Care Awards--Success in Partnership Working' in 2010.

Conclusions

Our evaluations of this innovative intervention show that this integrated way of working is providing positive outcomes for looked after children and foster carers. This is the first and only project of its kind in Lambeth (and possibly in the country), where professionals from a range of agencies have worked together to support such children and foster carers for children under five. This model of good practice could be considered by other health and local authority partnerships as a very effective way of meeting the needs of this unique group of children and carers.

References

Law J and Conway J, 'The effect on communication development: a review of the literature', Child Abuse and Neglect: AFASIC, 1991

Jane Conway, Clinical Lead Early Years, and Charlotte Godden, Specialist Speech and Language Therapist, Guys and St Thomas's Community Speech and Language Therapy Services, London, prepared these notes
Table 1

Key theme                           Quotations

* Positive outcomes for the         'My child has developed more
child's interaction and             confidence and looks forward to
communication skills                coming here on Mondays'
(Linking to Every Child Matters     'He is joining in more'
(ECM) outcome                       'She has improved in joining
Enjoy and Achieve', 'Stay Safe',    in with activities'
Make a                              'Her speech has improved, and
Positive Contribution' and 'Being   she loves singing her favourite
Healthy')                           songs' listening well, follow
                                    instructions'

* Opportunities for carers to       '... for information regarding
access a support network            fostering'
(Linking to ECM outcome 'Enjoy      'You can always learn from other
and Achieve' and 'Stay Safe')       people'

* Friendship for children and       'X became more sociable'
carers                              'It helped her to make friends
(Linking to ECM outcome 'Enjoy      and mix more ... share toys'
and Achieve',
'Make a Positive Contribution')

* Children's skills are             Excellent group, very educational
developing across all areas of      for the children ...'
the Early Years Foundation Stage    I believe the group is providing
(EYFS) curriculum                   the best for these children ...'
(Linking to ECM outcome 'Enjoy      'It helps them develop'
and Achieve',                       'It's really good, it's
Stay Safe', 'Make a Positive        stimulated X very much'
Contribution' and 'Being
Healthy')

* Foster carers are becoming more   'He smiles when I sing them at
confident and have more refined     home'
skills in supporting and            'We sing some of the songs and
discussing their child's            play roll the ball'
development, with a particular      'Sing more with my child,
emphasis on communication           read more'
development                         'We sing the songs, play the ball
(Linking to ECM outcome 'Enjoy      and do the sounds of the animals'
and Achieve', 'Stay Safe')
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Title Annotation:Health notes
Author:Conway, Jane
Publication:Adoption & Fostering
Geographic Code:4EUUK
Date:Jun 22, 2012
Words:1628
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