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Who are "children with complex needs"?

Children and young people who have been through adversity, abuse or neglect (including most Looked After Children and Care Leavers) often have a variety of complex needs including a mixture of trauma, attachment, mental health, neurodevelopment, educational and social needs. Research shows that over half have a diagnosable mental health condition, and half of the remainder have mental health needs that are below diagnostic thresholds or don't fit neatly into a diagnostic category.
We are becoming more aware of the powerful impact of Adverse Childhood Experiences (ACES), and the vulnerability they confer on people's physical and mental health, as well as a variety of social outcomes over the life course.
Children and young people who have experienced trauma and/or poor early care are often a challenge to multiple agencies, and are often viewed as a "troubled family", a "child in need" or are on a child protection plan, in or on the edge of Care. Their needs often remain as they leave the Care system and move towards independence.
Yet the needs of these children are often very poorly understood. This could be because they are often not easy to engage in traditional services, or because professionals tend to see them either through the lens of their behaviour, or their trauma, and don’t often get a holistic picture.

Despite this level of complexity, when children are placed into Care, their needs are not prioritised. The system is very under resourced, crisis-driven and influenced by supply and demand. The most complex children are the hardest to place and often end up placed far from their home and originating authority. There are then additional barriers towards recognising their psychological needs:

  • Variety of placement types, with little clinical governance
  • Multi-agency context, often out of area
  • Carers doing most of day to day work are often unqualified, disconnected from evidence-based interventions
  • Limited CAMHS resources (perceived as inaccessible)

There is very little access to psychological assessments, and demand exceeds supply. So we have designed BERRI to be a tool that can help identify needs in a pragmatic way, and give advice about strategies that might help these children to make progress. BERRI can also help to identify and quantify need, allowing professionals to prioritise those that require services, and to measure whether children and young people make progress when provided with specialist services.

The risks of poor outcomes are particularly evident for young people leaving Care, where they often feel abandoned by professionals. Care Leavers face multiple adversities. They are 4 times more likely to have mental health problems than the general population, only 14% gain 5 GCSEs at A-C grades (compared to 55% in the general population), and 40% of those aged 19 to 21 are not in employment education or training (NEET). Looked After Children are four times more likely to be involved with the criminal justice system, and children who have been in care reoffend at roughly twice the rate of children who have never been Looked After. As a result, 39% of the children in secure training centres had been in Care, and nearly 25% of the prison population previously spent time in Care. One in three Care Leavers will spend some time homeless during the subsequent two years. According to a recent report by the Social Market Foundation (Looked-after Children: The Silent Crisis) "children in care are more likely to experience a subsequent lifetime of disadvantage". However, if we identify and meet their needs effectively we can support young people to achieve more positive outcomes, so BERRI is validated for use with young people up to the age of 25.