Therapeutic Fostering - Multi-disciplinary Assessment Treatment & Therapy Service (MATTS)

We know that each child comes into foster care with complex and different needs and we strive to help these vulnerable, traumatised children and young people to grow and develop their individual potential.

A great deal of time and effort is put into finding ways to achieve this.

If you consider the circumstances of the child or young person’s life that led him or her to being placed in care, it is easy to understand any emotional turmoil or difficult behaviour that the young person might have.

In the past, the local Child and Adolescent Mental Health Services (CAMHS) provided specialist therapeutic assessments and interventions. This was a service of great value to young people in care. For economic reasons, this system has been faltering. Not enough economic support causes a decline in the availability of resources. The fostering community, specifically the local authorities and independent fostering providers, acknowledge the damage this lack of resources can do to the future of children in care.

The NHS website states that “Parents and carers may also need help and advice to deal with behavioural or other problems their child is experiencing. Parents, carers and young people can receive direct support through CAMHS.”

They can, but do they? Without the funding to provide the personnel to deliver the services, a helping agency is hog-tied. The supply cannot meet the demand despite the best intentions.

CAMHS does not have the capacity to respond to the therapeutic needs of children and adolescents anymore. Figures from 2015 indicated that nearly two-thirds of children and young people referred to CAMHS for help never got any treatment.

Capstone Foster Care’s initiative

Capstone Foster Care is proud of its safe, high-quality foster placements. Being aware of the need to open bright futures for the children in our care, we took action. As usual, we chose to be proactive, not reactive.

What is needed is an adaptive, timely, responsive clinical service that can respond to the needs of children in our care at any point in their placement. Our solution, our proactive response to this need, is the Multi-disciplinary Assessment Treatment & Therapy Service (MATTS).

Our journey into our therapeutic outreach began in the South West. In our early days there, we acquired an agency that specialised in providing therapeutic training and support to staff and carers. This was, and still is, a successful programme. Capstone has continued with this programme throughout the South West and is now rolling it out across the UK.

Our carers all participate in our Skills to Foster course and now the four days pre-panel therapeutic training is being provided as well. The therapeutic training gives carers and social workers a therapeutic toolkit that is a double benefit to them. They learn the skills they need to support and enhance the development of any child or young person in their care. They also learn methods to enhance how they care for themselves.

What MATTS offers

With MATTS, we can provide an extra layer of support that sustains and develops educational progress for looked after children. With an in-house psychological assessment, the team charged with caring for the child and his or her future development receives guidance on the child’s needs. Having a deeper understanding of what additional therapy and or strategies will best help the young person thrive in life, our team is better equipped to do what must be done.

The support is dynamic and multi-talented, and is led by a clinical psychologist or consultant child and adolescent psychotherapist. The type of leader depends on the geographical region.

The service includes social workers, child psychotherapists, play therapists, dyadic developmental psychotherapists, social pedagogues, support workers, and educational specialists. This gamut of experts is completely available to our children and young people and carers.

The specialists are all professionally accredited, highly qualified and skilled with extensive experience working in CAMHS, the NHS, education, and the private sector. In addition, they all have their own regular peer group supervision.

The clinical lead is actively involved in the referral process and works with the registered manager to discuss the suitability of each child or young person’s placement to be accepted into the Therapeutic Fostering Service. There are numerous reasons for recommending therapeutic services for children in care.

These are the most common – challenging behaviour, inability to regulate emotion, barriers to educational engagement, enuresis/encopresis (bedwetting/soiling), tics, inability to socialise, fears, phobias and anxieties, low self-esteem and self-worth, generalised or specific learning difficulties, speech and language difficulties, suicidal ideation and or suicidal intent, self-harming behaviours, child sexual exploitation (CSE), drug and alcohol misuse, eating difficulties, and sexually harmful behaviours.

It’s a long – and sad – list of problems children coming into care might have. However, it is an understandable list. Most children in care have come from homes where they were subjected to violence and abuse. Living in fear, without the emotional care and safety, so essential to healthy development, these children and young people need a lot of extra help so that they can have positive and happy outcomes in life.

This is what MATTS is hoping to provide. The service offers a wide range of therapies.

The therapies offered

Because each child and each family situation is different, we want to have the right response to each situation. Take a peek at some of the types of therapy we offer: dyadic developmental psychotherapy (DDP), informed practice, theraplay, life story work, pace (Dan Hughes) therapeutic parenting, trauma-focussed CBT, specialist support for the foster carers, mindfulness, timely comprehensive mental health assessments, identification of the necessity for appropriate treatment interventions, therapeutic interventions, assessment and intervention of sexually harmful behaviours, including offence specific work, clinical assessments, psychotherapy, forensic assessment, and art therapy.

The skilled and accredited team has specialised training in anxiety, attention deficit hyperactivity disorder, autism spectrum disorder, child sexual abuse, deliberate self-harm, eating disorders, education attainment, mood disorders, psychosis, sexually harmful behaviours, and social communication disorders.

What is the MATTS process?

If a child or young person taken into care seems to have problems and there are mental health concerns, a comprehensive assessment is offered. This happens within 6 to 12 weeks of placement.

The assessment usually takes place in a private room in one of Capstone Foster Care’s centres with both the foster carer and young person. Their social worker is also invited and so is any other involved professional if it is deemed appropriate.

At the first assessment meeting, the current situation is discussed. The carer and the child, and social worker if he or she is there, talk about the situation prior to young people being seen on their own. If the young person prefers for the carer or social worker to stay for the whole time, they will stay. It is up to the child.

The initial assessment gathers information on current and historical concerns, including developmental and family history, family relationships, and education and social performance. Any previous interventions, medical history, and medications are included. Substance misuse and any forensic and legal history are also included.

There may also be screenings for depression, anxiety, social communication disorder (ASD), attention deficit hyperactive disorder (ADHD), and eating disorders.

This is a very intense assessment, but it needs to be so that the child can be given the attention and treatment best able to overcome the damage that life has already done.

After the assessment, the clinician writes a report within 5 working days. There is no time-wasting here. When the lead clinician signs off on the report, any recommendations are provided to the Capstone team. This includes the foster carer, supervising social worker, registered manager, centre manager, and local authority social worker. This is done within a further 10 working days.

What happens after the report?

There are several routes that can follow the assessment and the report.

1. No further intervention – The report might state that there is no need for further therapeutic intervention. Although the clinical team’s involvement ends at this point, it is available to provide advice and consultation if and when needed.
2. Further specialist assessment – If further specialist assessments are recommended, another meeting is scheduled with the child or young person, the assessing clinician, and the network. This meeting will take place within one month of the completion of the assessment.
3. Therapeutic intervention recommended – If therapeutic intervention is recommended, a treatment plan is completed. If ongoing therapy is part of the plan, the therapist arranges a Team Around the Child review meeting at the conclusion of treatment. If the therapy is long-term, there will be termly reviews.

At these review meetings, a written description of progress is reviewed. This allows those involved to present their insights and agree on the way forward. After the meeting, within a week, a letter confirming the agreement is sent to all present. The letter also includes the date of the next review, if one is required.

Therapeutic interventions take place in the most appropriate place for the young person’s needs. Usually, these happen at schools, colleges, the foster carer’s home, or at a community children’s centre.

What does MATTS do for carers?

When a child is placed with carers, the carers’ receive support from a member of MATTS. This begins in the first week of the placement. A supportive supervision group is available on an eight-weekly basis to carers who have a child in clinical treatment. The supportive group is facilitated by a clinical team member who has experience in supervision and team support.

This is above and beyond the training and personal development programme offered to all foster carers. It is prioritised for foster carers working on the Therapeutic Fostering Framework. Aside from the training courses, the MATTS team works with the carer from the day of the placement to the initial comprehensive assessment.

A member of the clinical team is available for weekly telephone support to carers until they are assessed as no longer needing support for that placement. If the young person in care has complex needs, the foster carer may require more intensive support.

If this is the case, the appropriate clinical team therapist will arrange for monthly home visits as well as weekly telephone support. Foster carers deserve as much support as possible so they can sustain the young person’s therapy in a way that furthers the child’s development and eases the pressure on the carer.

How is success measured?

All children and young people placed at Capstone Foster Care have an assessment using an Outcome Tracker every calendar month. The assessment uses a standard of 44 nationally agreed outcomes for all children and young people in care. Their achievements and progress against each outcome are recorded and shared with the placing social worker.

If the child or young person is receiving a MATTS intervention, his or her progress is measured in relation to goal-based outcomes, aspirations of the child or young person, and standardised measures. SMART targets would have been set with them at the beginning of the intervention. These targets vary according to the child’s situation.

Progress is recorded at the termly review meetings, using the SMART targets. The progress is rated by the combined agreement between the young person and the clinician if this is appropriate. If the targets aren’t being achieved, a new action plan is created. It’s not an arbitrary action plan. It is discussed at the Team Around the Child Meetings where the therapist may contribute his or her input.

It’s an ambitious programme but it needs to be because it is fulfilling a recognised gap in the system where therapeutic services have not been available in a consistent manner to vulnerable young people. One of the strengths of MATTS is that it begins with a broad approach to all children as they enter care.

From the initial placement, the child’s needs are channelled toward the best therapeutic solution. During that process, a consistent team monitors their progress very closely – no child falls through the cracks in the system with MATTS.