Blog: Appropriate transitions to supported accommodation: What new evidence is telling us

A growing number of older children in care are moved from a children’s homes placement to supported accommodation before they turn 18. A recent study led by Kingston University and NCB has uncovered new evidence about why this is happening and how these adolescents’ outcomes compare to those of their peers. The study analysed national data on 40,000 care leavers and also involved interviews and focus groups with young people, parents and professionals.

Children placed in residential care are often those with the most complex needs. These children need care which is individualised, responsive and consistent. Yet, given the current context of acute insufficiency in care placement options and rising placement costs, our research findings suggest that supported accommodation may sometimes be used as a default pathway from age 16, rather than as part of a planned transition based on a young person’s readiness.

As our report on the outcomes for young people at risk of or subject to Deprivation of Liberty Orders with Research in Practice (RiP) for the Department for Education (DfE) highlighted, the reasons for the lack of sufficiency in placement options are multiple and complex. This includes significant challenges with the recruitment and retention of foster carers, changes in Tier 4 health provision reducing inpatient facilities for children and young people, and residential provision not keeping pace with demand. Increasingly, this creates dependency on the private care sector, where high rates of demand have driven up costs substantially. 

Outcomes for young people leaving supported accommodation

Analysis of data suggests that young people exiting care from supported accommodation have worse outcomes than their peers. The research examined employment and housing outcomes for 40,000 young people who aged out of care in England between 2016 and 2020. It found that 29% of care leavers whose last placement was in supported accommodation were predicted to be not in education, employment or training, compared with 18% of children whose last placement was in a children’s home or 17% of children whose last placement was in foster care. 

For commissioners, service managers and practitioners, this raises a number of questions. Are current placement pathways and commissioning decisions supporting young people to thrive, or making successful transitions to adulthood more difficult? Why is this happening? And how can transitions towards adulthood for adolescents in residential care be better managed?

Supported accommodation as default

A key theme that emerged during the qualitative research was that some young people were being moved into supported accommodation almost automatically once they turned 16. A prevailing view among participants was that such decisions were not always based on the young person’s individual needs, readiness or progress in their current placement. In some cases, managing a young person’s care was perceived as ‘high risk’, leading to a lack of placement options other than a move to supported accommodation. This aligns with similar findings in the DfE’s rapid review of evidence on supported accommodation.

“We work with the care plan… for the young person to stay [in a children’s home] until their 18th birthday. Change of social worker – the plan has changed: the child needs to go to semi-independent. They’re not even ready yet…[the local authority] do their own referral without letting us know” Children’s Home Staff A 

Those that took part in the study shared that a key consequence of using supported accommodation as a default option for adolescents is that it can lead to a 'downwards spiral' as adolescents used to a high level of care, support and oversight experienced a significant shift towards independence with significantly less supervision. For example, some teenagers who had been on a 'spend with staff' policy in terms of access to money were suddenly given a monthly budget with insufficient input into money management provided prior to this. Participants described such sudden changes as increasing young people’s risk of exploitation and other forms of extra-familial harm without having the safety net of a secure caring environment.

“Why wouldn’t they have their mates round and they smoke cannabis and they end up getting into trouble or they go missing, they’re taking risky behaviours, having sex, making babies, doing stuff. What else have they got? Because we’ve just stuck them in a flat on their own” Children’s Home Staff B

Poorly managed transitions

Readiness for transition to semi-independent living was cited as a key factor which could make or break a move. Many young people had not achieved basic independent living skills, let alone the capacity to navigate the many other complexities of life with minimal supervision and support. Other young people were able to cope independently on a superficial level but were still vulnerable in many ways, with some parents and young people saying that the relative lack of support available contributed to young people experiencing unhealthy relationships, problematic substance use, and exploitation. 

Some of the drivers of these poorly managed transitions were attributed to changes in social workers, unplanned changes as a result of a young person’s ‘risk profile’ or pressures on decision-making due to the increasing costs of residential care.

“That is frustrating for us, and it's frustrating for staff because you can have a young person and you're putting all these things in place and then [clicks fingers] social worker will just make a decision, no, let's send them to semi-independence. There's no staffing, there's no boundaries, and it's just let them do what they want. That's not nice to see when that happens” CHS C

Sufficiency and efficiency pressures

Professionals who took part in the research told us about the wider challenges facing local authorities and the children’s homes sector. There was widespread concern that there are not enough good quality children’s homes where they are needed. Some participants thought there could be pressure for local authorities to move children out of residential placements, seen as high-cost, even when children were settled and stable. 

These findings on marketisation and misalignment chime with the Children’s Commissioner’s recent report on children living in illegal children’s homes, which connects the skyrocketing costs of placements and sufficiency gaps to the inappropriate, and in some occasions, illegal, practice of placing young people in supported accommodation who are in need of care, rather than the support that these placements are registered to provide. 

What does good practice look like?

Clearly, challenges around sufficiency and costs will need whole systems solutions, resources and action at a regional and national level. There are signs that some of this action may be happening through reforms in the Children’s Wellbeing and Schools Act, including the establishment of Regional Care Cooperatives to improve planning and commissioning of children’s placements, as well as a power to cap the profits of Ofsted-registered providers if it is needed. 

What might be done at a local and individual level to make more appropriate use of supported accommodation? The findings from this research make it clear that supported accommodation can play a positive role for some young people, but only when it is used intentionally:

• Good practice starts with readiness, not age. Decisions about moving from a children’s home should be based on a holistic assessment of a young person’s emotional, relational and practical readiness for life with significantly less supervision. 
• Readiness should go beyond basic checklists. Some of the young people we spoke to thought there was too much focus on certain basic skills, such as their ability to chop up a pepper, which was not enough to develop their capacity various aspects of independent living with little to no supervision.
• Well-supported transitions should be planned and gradual and are characterised by:
• Better consultation with adults working closely with the young person by those involved in making decisions about where the young person should live
• Early and meaningful planning rather than last-minute decisions
• Step-down arrangements that reduce risk
• Shared decision-making between all of those involved in the young person’s life and including the young person themselves
• Holistic assessment of readiness 
• Levels of maturity and preparedness taken into consideration

Call to action

Supported accommodation can be an important part of the care system, but only if it is commissioned and used in ways that reflect young people’s needs rather than system pressures.

For commissioners and senior leaders, this research points to three actions:

1. Review placement pathways where supported accommodation is routinely used when a child turns 16 and ensure decisions are driven by readiness. Include all professionals working with young person in this decision-making
2. Strengthen commissioning specifications so that supported accommodation is not used as a default substitute for residential care
3. Invest in sufficiency and stability, recognising that short-term cost savings from early moves out of children’s homes can create longer-term costs in other areas

If we are serious about improving outcomes for care-experienced young people, we must remove the cliff-edge of care and support, especially for those with the most complex needs. For young people leaving care, the goal should not be independence at 16 or 17, but stability, safety and the chance to thrive into adulthood.

The research discussed in this blog is funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR205697). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.