Summary: Mrs B complained about how the Council dealt with the assessment and support of her daughter. The Council has completed the statutory children’s complaints process, which means the issues have been independently investigated, and a Panel has reviewed the investigation. The Council has acknowledged there was fault and agreed a means to remedy this. There is no fault in the investigation and no basis for me to recommend that the Council take further action.

The complaint

1. Mrs B says that the Council failed to assess her family properly, failed to provide support and delayed in referring them for a clinical diagnostic assessment.
2. Mrs B says as a result of the Council’s failures, her daughter, K was put to further risk of harm and her situation deteriorated.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

5. I considered the information provided by Mrs B. I considered the information provided by the Council including its file documents. I also considered the law and guidance set out below. Both parties had the opportunity to comment on a draft of this statement.

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What I found

The law and guidance

The Children’s social care services statutory complaints process

6. The law sets out a three-stage procedure for councils to follow when looking at complaints about children’s social care services. The accompanying statutory guidance, ‘Getting the Best from Complaints’, explains councils’ responsibilities in more detail.
7. The first stage of the procedure is local resolution. If a complainant is not happy with a council’s stage one response, they can ask that it is considered at stage two. At this stage of the procedure, councils appoint an investigator and an independent person who is responsible for overseeing the investigation. If a complainant is unhappy with the outcome of the stage two investigation, they can ask for a stage three review by an independent panel.

Child protection

8. Councils have a duty to investigate if there is reasonable cause to suspect that a child in their area is suffering, or is likely to suffer, significant harm. They must decide whether they should take any action to safeguard or promote the child’s welfare. (Children Act 1989, section 47)
9. If, following a referral and an assessment by a social worker, a multi-agency strategy meeting decides the concerns are substantiated and the child is likely to suffer significant harm, the council convenes a Child Protection Conference. This decides what action is needed to safeguard the child.
10. The Child Protection Conference is a multi-agency body and is not in itself a body in the Ombudsman's jurisdiction. We would generally consider it appropriate for a council to follow the recommendations of the Child Protection Conference unless there was good reason not to.

Child in Need

11. Under the Children Act 1989, councils are required to provide services for children in need for the purposes of safeguarding and promoting their welfare. When a council assesses a child as being in need, it supports them through a child in need plan. This should set clear, measurable outcomes for the child and expectations for their parent. Councils should review child in need plans regularly.

Adoption Support

12. An adopted person or adoptive parents can request the Council assess their needs and arrange for these to be met. The services offered must be in a draft plan and include counselling, mediation, therapeutic support, respite care and financial support. The adopted person and the adoptive parents can make representations about the plan.

What happened

13. Mrs B adopted her daughter K, now a teenager. K and the family started experiencing difficulties at around age 10. Mrs B was concerned she had developmental trauma and asked the Council’s adoption service for help, initially in September 2018. The Council’s adoption service is run by an agency on behalf of the Council. The Council remains responsible for the agency’s actions, and in this statement I have referred to the agency as the Council. It worked with Mrs B but the SW did not meet with K.
14. In July 2019, the family was referred to the Council’s child protection team. K had repeatedly gone missing and there was concerns about child sexual exploitation, self-harm and attempted overdoses
15. The Council decided that K was at risk of significant harm. In August 2019, the Council held a young person’s risk management conference (this is similar to a Child Protection Conference) and Mrs B attended. The conference acknowledged that K has complex needs following a Child and Adolescent Mental Health Service (CAMHS) assessment. The conference decided that K was at risk of harm outside the home and on its recommendation, the Council made a child protection plan.
16. The plan included therapeutic life story work for K and a therapeutic parenting course for Mrs B and her husband. The core group reviewed the child protection plan in August, September and October. Mrs B asked the Council to arrange a clinical assessment of K instead so that she could get the most appropriate therapy. Mrs B had identified an organisation that could do the assessment.
17. The Council took advice from the CAMHS and decided to fund creative arts therapy for K. The therapist would assess her needs alongside the therapy. The therapy stalled in March 2020 due to COIVD-19 restrictions and K was having a telephone check-in with the therapist instead of therapy sessions.
18. In October 2019, the conference recommended the Child Protection Plan end and the Council made a Child in Need plan in its place, based on a risk assessment detailing the risks to K and her family. In February 2020, the Council ended the Child in Need plan.
19. In August 2020, Mrs B asked the Council to reconsider a clinical assessment so that more appropriate therapy could be found. She said the creative therapy provider’s report had been brief with no new recommendations of support for K, and that she doubted the therapy was helping her.
20. The Council referred K to a clinical team at Great Ormond Street Hospital (GOSH) and in January 2021 she was diagnosed with Post Traumatic Stress Disorder and Attention Deficit Hyperactivity Disorder. The GOSH report made 14 recommendations including therapy, medication, a safety plan and active case coordination with CAMHS.
21. Mrs B complained to the Council. She said:
• the Council should have referred K for a trauma based clinical assessment when she raised this in August 2019. Had it done so the Council would have had a proper assessment and diagnosis on which to base K’s therapy.
• Instead it had relied on CAMHS that did not have the specialist knowledge to assess K’s needs, and as a result the creative arts therapy was not appropriate.
• In the meantime, K had suffered significant harm. Mrs B said K had been depressed and spending hours in bed. She had taken a further overdose and been reported missing a further six times, she had flashbacks, had witnessed violence, been reportedly raped and her education was suffering
• The Council should have a structured approach that moves from assessment and diagnosis, to treatment and then to evaluation.
• In addition, Mrs B had for three years asked the Council for respite in her home, and for practical help with night-time continence, cleaning and shopping, and a crisis phone number. Mrs B said the family had been suffered trauma from the 26 times K had gone missing episodes in that three-year period. The Council instead offered the family training courses and respite outside the home which Mrs B said did not meet their needs.

The Council’s stage 1 complaint response

22. This is an internal review of the issues complained about. The Council said that the creative arts therapy was an appropriate means of assessing K’s needs at the time, alongside therapy. However, the Council took Mrs B’s views into account and made a referral to GOSH when she had asked for it to reconsider a trauma-based clinical assessment.
23. The Council accepted that the communication around the creative arts therapy and its aims was not good enough and this led to a misunderstanding about what kind of assessment it was. The Council also acknowledged that an earlier trauma-based assessment would have meant the recommendations would have been made and implemented sooner, but this did not lead to a deterioration in K’s health or place her at risk of harm of further trauma.

The independent investigating officers stage two investigation.

24. Mrs B asked the Council to consider the complaint at its stage two. In addition to her earlier complaints she said the Council should have given her adoption support plans that would allow her to understand what support was in place and to make representations about this.
25. The Council appointed an independent person and an independent investigating officer (IO) as per the statutory complaints procedure. The IO reviewed the case notes and interviewed the officers. The IO also interviewed Mrs B. The independent person confirmed that the investigation had adhered to the proper processes and had fully explored the issues raised through the files and interviews with staff. They were able to ask supplementary questions.
26. The IO found that in October 2019, the core group of professionals had discussed the assessment and therapy for K. CAMHS had advised that a clinical assessment was not necessarily needed, would be much more intense, and perhaps pathologizing for K.
27. Following this, the Social Worker and the creative arts therapy provider had discussed the therapy and assessment with Mrs B. This would include collaborative assessment, creative arts therapy sessions; an opportunity to bring in Mr and Mrs B when K was ready; and review meetings with them. The referral was agreed with Mrs B, and K chose the therapist. A progress report said that K was engaging in the therapy and assessment.
28. The IO interviewed Council officers about why it had chosen the creative arts therapy. The Council explained that the work was urgent and in this way the assessment and the therapy could start straight away. The provider was local and so more accessible. The Council had taken advice from a CAMHS clinical supervisor that K did not at that stage need a clinical assessment. Mrs B said that she thought the referral to GOSH had been made then.
29. The IO concluded that the Council had taken advice from CAMHS at an appropriate level and was entitled to rely on this. They acknowledged that it would have been preferable if CAMHS has more detailed information about an alternative Mrs B had suggested in October 2019, but the Council did have enough information to decide on the creative arts therapy. The IO noted that Mrs B was under pressure due to the difficult family situation, but she did not raise any concerns having met with the provider.
30. However, the IO found that there had been some failings by the Council. It should have given Mrs B an adoption support plan and told her of her right to make representations about this, and a written assessment as to why she needed this service. The Council did not do this and so the IO recommended this complaint be upheld. The IO concluded that this might have meant that the referral to GOSH was made sooner.
31. The Council confirmed that this was a short period when it was not using adoption support plans, but it had since resumed this. The Council pointed out however, that it worked collaboratively with Mrs B and that the referral to the creative arts therapy was documented in the Child in Need meeting minutes. By September 2020 when the GOSH referral was made, the Council had an adoption support plan.
32. The IO could not look at the decision to end the child protection plan because this is excluded from the statutory complaints process. However, the IO did look at what was done to keep K safe.
33. The Council said that support was in place from the creative arts provider when it ended the Child in Need plan, and this would have continued had Mrs B not withdrawn K from this. It also said other measures continued to be in place to support K: there were return home interviews when K came home from being missing, but Mrs B would often refuse those; and referrals to two intensive support services. The family had a named worker at the Police service and the police had a trigger plan so that there would be an appropriate response if K went missing.
34. In June 2020, Mrs B told the Council that K had gone missing multiple times. The Council offered Mrs B an assessment of K’s needs, but Mrs B declined this.
35. The IO concluded that they could not say whether the time it took to get the GOSH assessment meant that K’s situation deteriorated. The IO also concluded that it was reasonable for the Council to close the case when the Child in Need plan ended as it understood that there was support in place and it followed the relevant legislation and guidance; between February 2020 and January 2021 there was child protection intervention where this was needed; and the Council would have taken more action in this time had Mrs B agreed to this.
36. The IO explored in detail the processes in place for post adoption-support, and whether these should be more structured as Mrs B suggested. The IO concluded that post adoption services are broad and there is no requirement that there be a clinical diagnosis before putting services in place.
37. The IO considered information from Mrs B and the Council on whether there had been a lack of support for Mrs B as parent carer. The Council had offered respite care but only in the form of a foster care placement which Mrs B said would not be workable for K. The Council said post adoption support for parents is therapeutic rather than the practical help Mrs B wanted. The IO found the Council had offered Mrs B a therapeutic parenting course and adoption psychotherapy (both of which she had not found helpful). The IO considered the case records which showed that Mrs B had frequently asked for help via crisis line or practical help. In response, the Council had offered specific support.
38. The IO concluded that Mrs B had received considerable support, mostly therapeutic but acknowledged that she had consistently asked for practical and domestic support (eg shopping and laundry). The IO concluded that the Council should have made clearer to Mrs B that following K’s diagnosis, she may have been able to access this kind of support via a parent carer assessment, and a carers grant.
39. The IO recommended that the Council should:
• review its current use of written assessments, adoption support plans and notices to ensure it complies with post adoption support legislation and guidance, and provide relevant training for their workers.
• review its written and online information about post adoption support to ensure it provides sufficient detail for families about the process of assessment, planning and notice.
• review its understanding of entitlement to parent carer needs assessments and the flexibility of direct payments as an alternative to the provision of direct services to ensure adequate and prompt information is given to parent carers.
• offer Mr and Mrs B a meeting to discuss any remaining concerns they have about the processes used by the teams and how they were applied in their family’s case, and the future relationship they may want to have with the Council.
• apologise for the shortcomings identified in this report.
40. The independent person endorsed the IO’s recommendations.

The Stage three independent panel review

41. Mrs B asked the Council to consider the complaint at a stage three review panel. in accordance with the statutory complaints process. The Panel included two independent panel members as well as the independent chair. Mrs B, the Head of Service, the manager of the adoption service, and the complaints manager, as well as the IO and independent person that had conducted the stage two investigation, all attended.
42. The Panel Chair liaised with Mrs B and the Panel Members prior to the meeting to agree the remit of the panel and what documents it would consider. The Panel considered Mrs B’s new evidence. It considered the representations made to it by the Council officers.
43. The Council accepted that Mrs B had some valid points about assessment, treatment and evaluation, but explained that adoption support is not about medical assessment but a social model undertaken by social workers. It had pursued the medical assessment from August 2020.
44. The Panel questioned the staff about the assessment process, how the Council decides on a therapy, and the advice it sought from CAMHS. The Council confirmed that it continually sought advice, and that therapy is not always evidence based because it is very personal.
45. The Panel looked at whether K had been exposed to more risk and had deteriorated as a result of not having a clinical diagnosis or assessment sooner. Again, it considered Mrs B’s views on this. The Panel said the Council could have conducted more analysis of what the creative arts therapy would offer and given more information to Mrs B.
46. The Council explained that it evaluated the usefulness of therapies by feedback from parents and behaviour changes observed. It could have requested that K be considered for more treatment within or beyond CAMHS, and that this was discussed at the child protection and child in need meetings.
47. The Panel concluded that:
• Mrs B gave some new information but it did not consider this cast doubt on the IO’s conclusion that it was not possible to determine whether K had been harmed by the time it took the Council to get a clinical assessment of K.
• It was persuaded that adoption support did not need thresholds where certain support would be given if met. However, the Panel said there was value in clarity of purpose and communication.
• In terms of assessment, the Council has to work with other agencies, and it was right for the Council to seek advice from CAMHS, but the scope of the assessment should have been explicit and clearly stated to the parents.
• it is not wrong to try courses of action without certainty as to their effectiveness and there is value in flexibility. There was not a negligent or ‘slipshod’ approach to supporting K and her family. They were involved in the approach.
48. The Panel recommended that the Council:
• considers reviewing its assessment process to ensure that the scope and limitations of the work are clearly spelt out to the adopted young person (if appropriate) and his or her parents;
• builds into its processes the obtaining of timely feedback from the young person (if appropriate) and his or her parents as to what they think of its work and any interventions provided; and
• considers sharing with its partner agencies in adoption support the main learning points from this complaint, in particular about the need for clarity of purpose and clarity of communication with the child/young person and his or her parents.
49. The Council considered the Panel’s recommendations and wrote to Mrs B with its response to these. It said:
• It will provide all families subject to an assessment with written information that clarified the scope and limitations of the work.
• As a result of this complaint, the Council has put in place feedback processes so that the young person and families can say how interventions are working. The Council will report its findings to the Regional Adoption Agency Board.
• It will share with its partners the learning from this complaint.
50. Mrs B complained to the Ombudsman.

My analysis

51. If a council has investigated something under the statutory children’s complaint process, the Ombudsman would not normally re-investigate it unless we consider the investigation was flawed.
52. The IO properly explored why it proceeded with the creative arts therapy. They took into account Mrs B’s views, and those of her daughter, as well as the Council officers. The IO’s conclusion that the Council took advice at an appropriate level and could explain its reasons for choosing the creative arts therapy, is based on the case notes and their interviews. The Panel explored this further and concluded that the IO’s reasoning was sound. There is no clear fault in the investigation and statutory complaints process.
53. The IO and the Panel acknowledged that the Council should have given clearer information about the therapy to Mrs B. It should have used an adoption support plan and notified Mrs B that she could make representations about this. The Council had already reinstated adoption plans by the time it made the GOSH referral.
54. The IO and the Panel also looked at whether the time it took to make the GOSH referral caused K harm or put her at greater risk. The IO mentioned that the statutory complaints procedure cannot usually investigate safeguarding actions and I have considered whether I could investigate whether any failings here impacted on the family. However, the IO and the Panel do consider the support that was offered or in place for the family and actions to keep them safe. This is wider than the safeguarding process and so I do not consider that an investigation by me will add to the independent investigation already done by the IO.
55. The IO and the Panel considered in detail whether a structured approach, suggested by Mrs B, of assessment, treatment and evaluation is needed. There is no fault in its consideration of the issue. It was explored with Mrs B and the Council.
56. I have considered whether the investigation adequately addressed why the Child in Need plan ended. However the IO’s conclusion that this was ended while support was in place, is sound. As is the conclusion that the Council again offered to work with Mrs B when she reported K had gone missing several times. It was open to Mrs B to refuse offers of assessment by the Council on which it could base support services. However, the IO’s conclusion that support was offered was sound.
57. Overall, Mrs B’s complaints have been properly addressed via the independent IO and the independent panel. The IO and Panel considered the views of all involved, and the IO considered the case notes. There is no fault in the complaint handling and the investigation was independent. The conclusions and recommendations of the IO and the Panel were based on careful consideration of the facts. The Council accepted the recommendations and has written to Mrs B to explain how it will implement these.

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Final decision

58. I have completed my investigation. The issues have been independently investigated and the Council has acknowledged there was fault. It has already agreed a way to remedy the complaint and no further action is necessary.

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Investigator's decision on behalf of the Ombudsman