How can we know if a child in care is happy?

Posted by Kate Maher / Wednesday 03 August 2016 / Care leavers Children in care

The Alliance for Children in Care and Care Leavers is recommending a child-centred outcomes framework to promote children’s emotional wellbeing and their recovery from traumatic past experiences.

We’ve published a new report on why this should happen and put forward some recommendations for Government. You can also read the Alliance’s A New Vision here

If you’ve been keeping up with our blogs, you’ll be aware that the vast majority of children who come into care have had to deal with neglect or abuse, as well as feelings of loss after being separated from relatives and friends. Unsurprisingly, these experiences can have a profound impact upon children’s healthy development, their relationships with others, their behaviour, and their ability to keep safe. They are also at increased risk of developing a mental health difficulty. 

Yet we are still not effectively supporting children to recover from the abuse and neglect they should never have had to suffer. 

For care to be the best it can possibly be, children must be helped to make sense of and move forward from such adverse experiences. This can be achieved through loving day-to-day emotional support with the help of specialist mental health services if needed.

But how can we know if we’re doing right by the children in our care? 

How can we know if any changes have the desired effect? 


Measuring emotional wellbeing 

One solution is to start measuring looked after children and care leavers’ emotional wellbeing. This isn’t required at the moment, so we can’t answer the question, how good is care? We don’t know whether care in one local area is better than in others, or who’s doing a really good job and so could share great practice.

By asking children and young people how they are feeling about the care they are receiving and making sure carers and social workers have a say about this too, we would have a way of assessing good quality care. It would also enable us to swiftly recognise when the care children are receiving needs to improve. 

What do we actually measure now?

Mental health difficulties through the SDQ: At the moment, local authorities use the Strengths and Difficulties Questionnaire (SDQ) as a measure for emotional and behavioural health, primarily for children between the ages of 4 and 17. Results are included in national data collection. 

Questions that need to be answered as ‘Not True’, ‘Somewhat True’ and ‘Certainly True’ include:

  • Often unhappy, down-hearted or tearful,
  • Often fights with other children or bullies them, and
  • Nervous or clingy in new situations, easily loses confidence.

However it is not strictly a ‘wellbeing measure’ – more a way of identifying when a child might need a mental health service. Factors intrinsic to a looked after child’s wellbeing are not included, for instance:

  • involvement in decision-making,
  • frequent moves,
  • and quality of relationships.

It is also not the child themselves who fills out this questionnaire and it isn’t a qualified mental health professional either; rather, a child’s primary carer is expected to do this.

Furthermore, the way in which it is used means the information it provides is not acted upon effectively. It is often not analysed, either for the benefit of the individual child or to create a picture of the needs of children in care in the local area as a whole. Child and Adolescent Mental Health Services (CAMHS) do not always receive SDQ results, preventing an effective response to looked after children’s mental health needs. 


What do we need to measure? 

Wellbeing measures are not currently being captured by national datasets, which of course shape and influence the policies which are designed to protect and nurture them. And they are vital because they tell us about children’s own experiences of being in care, and how they are feeling.

There are brilliant wellbeing measures available, such as the Outcome Rating Scale. This clinically validated tool measures children’s self-reported wellbeing, asking children to rate their own individual, interpersonal, social and overall wellbeing. 

What needs to change? 

The Government should: 

  • measure and report annually on looked after children and care leavers’ wellbeing. Children’s own views about how their lives are going need to be included in this. 
  • improve the use of the Strengths and Difficulties Questionnaire (SDQ) so that the needs of children across a local area are clearer – resulting in better service provision – and so that individual children get the right support at the right time. 


Taking children away from harmful home situations is crucial. But attention must also be paid to how those very experiences might have affected each child, and continues to affect them, even when they are now safe. 

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