The potential for use of the Development and Well-Being Assessment (DAWBA) in adoption support assessments 1

Abstract

The Adoption Support Fund in England, which was rolled out on 1 May 2015, seeks to improve the lives of adopted children and their families by providing resources to fund therapeutic interventions for the child. Accessing the Fund requires that the needs of the child and family are fully assessed and the expected outcomes are identified. This raises questions about the use of standardised and validated assessment tools as a part of the process. This article reviews the benefits and challenges of using established instruments, such as the Common Assessment Framework (CAF) and the Strengths and Difficulties Questionnaire (SDQ), and considers the relevance of the Development and Well-Being Assessment (DAWBA) for adoption situations. It is argued that given the legal requirements to link need, services and outcomes, the importance of using validated assessment tools is strong. However, social workers need training to administer them and interpret the results. While using the SDQ should be firmly embedded in practice, the contribution of the DAWBA, although promising, requires further exploration. Social workers will also need training on how best to use it, and how to interpret the results and integrate these into a comprehensive assessment of the child and family.

Keywords

Adoption support assessments DAWBA

The national rollout of the Adoption Support Fund in England on 1 May 2015 was a significant opportunity to improve the lives and specifically the security, stability and development of adopted children and their families. This built on the experience and lessons from 10 prototyping local authorities in the previous year. The importance of ensuring the availability of adoption support services has been well recognised for many years. The view that the making of the adoption order settles all the issues for the child and family has long been discounted with a recognition of the life-long issues that are likely to present themselves. The importance of providing an effective and well-resourced adoption support service has been identified in reviews of existing services (Bonin, et al., 2013; Holmes, McDermid and Lushey, 2013; Livingstone Smith, 2014; Tarren-Sweeney, 2010).

The statutory requirement to establish and deliver an adoption support service is set out in section 2(1)(6) of the Adoption and Children Act 2002, with the detail of the services to be made available to be found in the Adoption Support Services Regulations 2005. The Act (section 4) stipulates that the local authority, upon request from an ‘eligible person’ (as defined in the Regulations), must undertake an assessment of need. Where the assessment identifies an adoption support need, the local authority must then decide whether it will make that service available (section 4(4)). The detail of the assessment process is set out in the Adoption Support Services Regulations 2005, Regulations 14–18. This includes the procedure to be followed during the assessment, the local authority’s plan to provide a service, the statutory notice and notification of the local authority’s decision about the services it proposes to make available. Finally, the local authority is required to specify the planned outcomes and timescales from any intervention or service provided. This includes identifying the person who will be responsible for monitoring those outcomes.

The Regulations make a clear and important link between assessment, intervention and outcomes. Without a clear evidence-informed and objective assessment, an evidence-informed and effective intervention cannot be delivered other than by chance. This includes the need for clarity about the outcomes identified for any child or adult who has requested an assessment. This is a skilled and professional task and may be one of some complexity from what is known about the challenges of adoptive family life. Given the relative absence of a solid and established evidence base in both assessment and intervention, it is essential that the rollout of the Fund makes good use of what is known, acknowledges what is not and remains conscious of the risks involved and how they might be mitigated (Luke, et al., 2014; Rahilly and Hendry, 2014; Smith, 2010).

The use of standardised instruments in social work assessments

Evidence-informed assessments and interventions need to make sense of and build on the descriptive and subjective perspectives of the child and adoptive family. The use of standardised and validated instruments should play a part in formulating these perspectives into a coherent description of the issues with which the family are struggling and the subsequent plan/intervention intended to help them with these. However, while social work assessments draw on a range of concepts and frameworks, these have not usually included the kinds of standardised instruments familiar in child and adolescent psychology (Basarab-Horwath, 2010; Mainstone, 2014; Turney, 2012; Turney, et al., 2011). This is not to say that assessment of risk, the identification of the focus for change, and the evaluation and sustainability of change as it impacts on the safety and welfare of children, have not been explored.

The most well-developed assessment tool in children’s services is the Assessment of Children in Need Framework (ACINF) in England. The Framework has been developed over many years and has had a significant impact on policy and practice. As a model, it has evolved as an ecological conceptual framework originating from Bronfenbrenner (1986; 2009). As such, it is constructed as a triangular model combining the domains of the child’s developmental needs, parenting capacity and family and environmental factors with a clear recognition of the complex interactions between these domains. Its use has been supported by a number of tools (Cox and Bentovim, 2000) to enable the translation of the conceptual framework into practice. It has also been used to develop and implement the Integrated Children’s System (ICS) recording protocols, although this has had a chequered history including some significant questioning of its negative impact on professional practice (Bell, et al., 2007; Seden, Sinclair and Robbins, 2001; Shaw, et al., 2009).

The ACINF is linked to the Common Assessment Framework (CAF). This is an interagency framework to be used by any professional assessing children and families with additional needs, but not those reaching the threshold for intensive involvement resulting from safeguarding or other investigations of significant harm. In an evaluation of the use and cost of the CAF in four local authorities (Holmes, et al., 2012), there were positive reports from parents where the lead professional acted as an advocate and obviated the need for ‘repeat telling of family stories’ in order to generate required services. However, it is important to note that substantial investment was needed to enable services and professionals to incorporate the use of this framework into inter-agency practice.

The ACINF informs the adoption support system framed by the Adoption and Children Act 2002 (Department for Children, Schools and Families, 2008; Miller and Bentovim, 2007). The guidance makes detailed reference to evidence-based assessment tools including the Strengths and Difficulties Questionnaire (SDQ), the Parenting Daily Hassles Scale, the Home Inventory and Family Assessment. There has been no formal evaluation of the impact of this guidance generally, or more specifically, whether the assessment tools referred to are in use in local authority assessments of adoption support needs.

The Strengths and Difficulties Questionnaire (SDQ)

The SDQ has become one of the most well-known standardised and validated tools in children’s services in England. In 2008 all local authorities were required to use it to provide information on the emotional and behavioural health of looked after children between the ages of 4 and 16. These data were to be supplied as part of the annual local authority statistical return to central government. The SDQ was required to be completed by the child’s main carer using the two-page carer section of the questionnaire. Guidance on how to use and submit the SDQ was issued by the Department for Education (2012) including a set of frequently asked questions. The guidance points to the importance of using the score in the SDQ combined with the completion of the ‘impact section’ to identify children who might be at risk of significant mental health problems. It also underlines the importance of discussing the scores with an experienced specialist through links with Child and Adolescent Mental Health Services (CAMHS) or other specialist services. Where a child is identified as being at ‘possible’ or ‘probable’ risk of significant mental health problems, the guidance recommends that the teacher and child (if over 11) version of the SDQ should be completed. The outcomes from this should be subject to an appropriate discussion between the social worker, carer, teacher and young person to identify the best next steps in addressing needs. There is no evidence of the impact of the requirement to collect information from the SDQ for those children where adoption is the plan.

The SDQ was developed as a screening measure comprising a short questionnaire (Goodman, 1997; Goodman, et al., 2000a; Stone, et al., 2010) to identify the estimated 10% of the general child population who suffer from psychiatric disorders. The questionnaire is available in multiple languages and can be accessed online (www.sdqinfo.com). It has 25 items that measure emotional symptoms, conduct problems, hyperactivity-inattention, peer problems and pro-social behaviours. Responses to the questions are subject to a computerised algorithm that predicts the likelihood of three types of disorder: conduct-oppositional, hyperactive-inattention and anxiety depressive disorders. This excludes the pro-social scale. It is important to note that in the validation study (Goodman, et al., 2000b; Goodman, et al., 2004), the SDQ identified two-thirds of the young people with psychiatric disorders in the groups named above – a high rate. However, it was poor at identifying specific phobias as well as separation and anxiety disorders. The study also notes that screening in itself is limited unless it is tied into effective, evidence-informed interventions that are readily available for those who need them. A study of the effectiveness of the SDQ used with looked after children is available (Goodman, et al., 2004) alongside other reviews and evaluations (Luke, et al., 2014; Shaffer, et al., 1983; Warnick, Bracken and Kasl, 2008).

The Development and Well-Being Assessment (DAWBA)

The government guidance notes that there are limitations in the use of the SDQ as a screening tool and suggests that where a more detailed diagnosis is needed, the DAWBA (Goodman, et al., 2000b) might be considered. This assessment tool comprises a more comprehensive set of questionnaires and rating measures that leads to the identification of a psychiatric diagnosis as formulated in ICD-10 (World Health Organization, 1992) or DSM IV.² The use of the DAWBA or other diagnostic tools to formulate the child’s difficulties and identify the most appropriate interventions from statutory or voluntary service providers is important. However, the adequacy of the DSM IV framework for looked after and adopted children has been raised as an important issue in itself (DeJong, 2010; Tarren-Sweeney, 2008).

The administration of the DAWBA involves collecting data from three sources: the parents, young people themselves where they are aged 11–17, and teachers. The interview is undertaken either in person or via a computer (see www.dawba.info/a0.html). Where an interview is conducted in person, the interviewer does not need to be a clinician. The paper version of the interview administered to parents amounts to 67 pages and on average takes 50 minutes to complete; for young people, it is 47 pages and usually done in 30 minutes. The teacher questionnaire has four pages. The questions focus on the presence of psychiatric symptomology and the impact on the child and family. If symptoms are identified through this part of the interview, then the interviewer asks supplementary open-ended questions focused on enabling the parents to describe their experiences and observations in their own words. The design of the interview allows issues to be ‘passed by’ if they appear to have little relevance. This makes the interview efficient in its length and focus.

The completed interview information is analysed by a computer algorithm that predicts any likely psychiatric diagnosis within six probability bands ranging from 0.1% to 70%. The diagnosis covers well-known disorders including pervasive developmental disorders, conduct disorders, Attention Deficit Hyperactivity Disorder (ADHD), Post-traumatic Stress Disorder, separation anxiety and eating disorders. On the basis of this, trained and experienced clinicians review the information generated and use their professional expertise to make a judgement on the acceptability of the predicted diagnosis in the context of all the available information including the transcripts. The review by the clinician is important in ensuring that:

the questions have been properly understood by the informants;

conflicting evidence is reviewed and resolved;

disorders are identified even when they do not meet diagnostic criteria;

less common disorders are identified through the clinician’s review of the transcripts.

It is important to note that the training of clinicians is an important part of the design and validity of the DAWBA. At the same time it does not require them to have any direct contact or presence. As long as there are no language restrictions, ratings can be undertaken in any part of the world.³

In a validation study comparing a community sample of 491 children and a clinic sample of 39, the DAWBA successfully identified those who had a psychiatric diagnosis from those who did not (Goodman, et al., 2000b). Children from the clinic sample were very alike in the identification of their difficulties in the DAWBA and their clinic-held notes. A similar positive use of the DAWBA was recognised in a study in diagnosing hyperkinetic disorders (Foreman, Morton and Ford, 2009).

The development and use of screening measures such as the SDQ and diagnostic measures like the DAWBA are important. However, it should be noted that they are only two among a much larger group of measures. The California Evidence-Based Clearinghouse for Child Welfare lists 20 measurement tools and rates them for their specificity, sensitivity, reliability and validity. The list includes the SDQ but not the DAWBA because one of the criteria for inclusion is the common use of the measure in California. Two reviews of effective outcome measures were undertaken explicitly focusing on mental health in the first publication and children’s social and emotional skills in the second (Deighton and Wolpert, undated; Humphrey, et al., 2011). A recent exploration of ‘What works’ in the context of school-based mental health interventions builds on this (Weare, 2015).

The potential for using the DAWBA in adoption support assessments

There is little evidence of the current use of any standardised screening or diagnostic instruments in adoption assessments. While the SDQ is required for looked after children, it is not deemed necessary for children who are adopted in their assessment. However, with both the SDQ and the DAWBA, there is an identified potential for exploring the implementation of both measures. That said, there are a number of identified issues:

Social workers are not trained as clinicians (other than where they make individual choices to do so) and would need training and support to understand the significance of and apply the diagnostic categories in ICD 10 or DSM IV.

The conceptual framework that drives social work – the ACINF – does not make any direct or explicit reference to mental health or clinical categories.

Assessment is commonly undertaken in conversation with the individuals and families being assessed and standardised tools are not in common use as a part of or supplement to this.

Recording of those conversations is essential (on computer-driven systems) but there is strong evidence that these tend to focus on the memory of what was said, especially the facts, with less and sometimes poor attention being paid to critically analysing the facts in terms of their significance or relevance, or embedding them in frameworks other than the ACINF.

There is a strong emphasis in social work on the importance of the relationship between the social worker and the individual and family in both assessment and the provision of services. That is true of other professions, although they may be more comfortable with the use and integration of categorisations of difficulties or disorders.

In addition:

The organisational culture of local authorities and the independent and voluntary sector has a significant determining effect on how assessments are undertaken, with what purpose and what effect. Commissioning adds to this in defining services and establishing output and outcome measures. This is also true of both health and education, with the former significantly influenced by commissioning and CAMHS services subject to evidence-based frameworks issued by the National Institute of Health and Care Excellence (NICE, 2015).

Clinicians themselves may have a wide range of views about what counts as significant or meaningful in any assessment they undertake, including their use of and familiarity with standardised and validated instruments.

Ofsted, as the regulator, does not take a position on the use of standardised instruments and there is nothing that suggests that this is taken into account during an inspection.

Standardised tools in mental health assessments

The questions raised above are not just confined to local authority assessments. CAMHS practitioners, especially in Tiers 1 and 2, tend to be generically trained where their originating professional backgrounds are likely to influence their competence, confidence and belief in the use of any standardised tools (Martin, et al., 2011). In a study of 100 consecutive referrals of adopted and looked after children to a Tier 4 CAMHS service (Woolgar and Baldock, 2015), an analysis was undertaken comparing the details contained in the referral letter to the outcome from the clinic’s assessment of the child or young person. It was noted that attachment disorders were far more commonly identified in the referral letter than in the clinic’s assessment. Of 16 cases where an attachment disorder diagnosis was identified in the referral, only one met the criteria from the clinic’s assessment of the child. In 31 cases where attachment problems were identified in the referral, three were confirmed in the clinic’s assessment. It was also noted that attachment disorders were more generically described with few direct references to Reactive Attachment Disorders and Disinhibited Attachment Disorders or specific symptoms.

In addition, the clinic’s assessments were far more likely to identify issues such as conduct problems, ADHD, anxiety, autism, learning disabilities and encopresis/enuresis rather than attachment difficulties. Woolgar and Baldock (2015) deduced that it was not so much the case that attachment obscured other disorders in the referral but that there was a general tendency to under-identify more common psychiatric disorders (Woolgar and Scott, 2014). O’Connor and Byrne (2007) raise similar issues in reviewing the current evidence for evaluating attachment using child-based measures: the ‘Strange Situation’ for infants and pre-school aged children, ‘Story Stems’ as developed in the Manchester Child Attachment Story Test, and the Child Attachment Interview for adolescents. Each of these tests requires substantial training for the test administrators and the facilities to complete them. Significantly, it is noted that an attachment assessment for research purposes should not be seen as a diagnostic assessment for clinical purposes. As with Woolgar and Baldock (2015), they argue that the over-use of the term attachment can have a negative impact on assessment and intervention. They contend that the implications of this are ‘not to screen for attachment per se, but instead for more objective and likely more easily obtained indicators of risk for more severe attachment problems, such as a history of trauma or parental maltreatment’ (O’Connor and Byrne, 2007: 191).

Over the years, questions of diagnostic discrepancy in assessments have been identified in other studies of children in the community (Jensen and Weisz, 2002). Where these issues are then extended to include the perspective of the parents and children, differences of view between the clinician, parent and child are common, the largest discrepancy being between the child and parent and the most agreement between the clinician and parent (Hawley and Weisz, 2005). These issues must be of concern. To specify an intervention based on a poorly formulated description and understanding of the issues is risky and may prove to be ineffective, if not dangerous. The potential for disagreement and misunderstanding between the parties is significant, resulting in lack of engagement or early disengagement and potentially heightened future risk for the child or young person.

Exploration of these issues in respect of the DAWBA was subject to a recent study (Ford, et al., 2013) of children aged five to just under 11 referred to CAMHS, but excluding children who were looked after by the local authority. Following acceptance by the CAMHS service, parents and teachers completed the DAWBA as described in the protocol above. The formulation was made available (randomly allocated) to the clinician responsible for the assessment in 151 cases and not disclosed in 148. The hypothesis of the study was that making the DAWBA information available would lead to greater agreement between the clinical and standardised diagnosis, with consequent improvement in the specification of intervention, including allocating children to practitioners with the necessary competencies to effectively deliver it. It should be noted that the practitioners were supplied with a copy of Drawing on the Evidence (Wolpert, et al., 2006), a publication that identifies possible evidence-based interventions. Subsequent analysis indicated that access to the DAWBA did not improve practitioners’ access to evidence-based interventions or that it had an impact on the need for further assessments of the child. In discussing these findings, the authors return to questions about the impact of practitioner training and the general orientation they have towards their practice, particularly the use of standardised diagnostic categories. They also raise the question of the use of instruments like the DAWBA in the referral process to CAMHS allowing the latter to triage those referrals, increasing the opportunity to engage with the family from the first visit rather than focusing on assessment alone.

Assessment in context

There is little doubt that services have a significant responsibility to develop a shared perspective with children and adopted families about issues of concern regarding an adopted child’s development, including his or her emotional, behavioural, social and cognitive health and well-being. These developmental concerns can be complex in terms of history, development over time, interaction and influence between different domains of the child's development and functioning, as well as interaction and influence between the child, the adoptive parent/s and other family members, birth parents and other important contextual experiences such as school and the community. Each of these may be a source of support but they can also be a source of constraint and challenge. The past interacts with the present and creates pathways to the future.

In enabling ‘shared perspectives’ it is essential that objectivity, responsibility and clarity play their part in allowing an evidence-informed clinical formulation, including structured observation, neuro-cognitive assessment and developmental and functional assessment. The vulnerabilities of children adopted from care are such that there may be complex interactions between various factors which need to be properly and fully explored. Narrow assumptions about what the problem is, resulting in an assumptive specification about what help to provide, are likely to be unhelpful if not dangerous (Chaffin, et al., 2006).

In a recent editorial in the Journal of Child Psychology and Psychiatry, David Coghill (2012: 815) notes that reading the papers that had been accepted via peer review, he was reminded of ‘one very basic, and on the face of it very simple, point. When you conduct an initial clinical assessment within a child and adolescent mental health setting, it needs to be broad, comprehensive, structured and non-partisan.’

Reflecting on developments in CAMHS over recent years, Coghill notes that ‘the initial appointment often seeks to shift the emphasis away from assessment towards developing a shared understanding about what the patient and their family are looking for and building a therapeutic alliance’ (p. 815). He comments that this is not an inappropriate focus, far from it, but such an approach needs to be clearly aligned with clinical effectiveness and not just service efficiency. In the Choice and Partnership Approach (CAPA) model that drives much of CAMHS, the initial appointment should feel more ‘like a conversation and not us (the clinical team) dragging them through a passive (for them) assessment interview’ (CAPA, 2013). Again, this is a view that would probably be widely shared. However, it does raise questions about the use of standardised instruments like the DAWBA to formulate a reliable and comprehensive picture of the child’s development, which avoids the experience of passive and unclear engagement of the child and family. This clearly reflects the discussion following Ford and colleagues’ study described above (Ford, et al., 2013).

Assessments as a partnership between children, parents and professionals

Professionals and families need to establish a comprehensive picture of the child and her or his circumstances and context together in a spirit of partnership. Each party will have their own experience and expertise to draw on. Objectivity, which includes drawing on the available evidence, will be essential to formulate a baseline from which interventions can be ‘prescribed’ and ‘delivered’ and against which the effectiveness and outcomes of those interventions can be measured over time. The risks of not doing so are outlined in the articles discussed above (Woolgar and Baldock, 2014; Woolgar and Scott, 2014). These issues have become subject to further discussion in child mental health services in the exploration of patient reported outcome measures (PROMs) (Wolpert, et al., 2008). PROMs should focus on asking the child or young person, as well as the parent/s or other carers, about their current views on reported symptoms and other difficulties and the impact of these on the child’s functioning or relationships and, more generally, on relevant aspects of her or his well-being. The origin of PROMs is rooted in the need to understand outcomes for research or service evaluation purposes. As such, data are combined and then analysed for the service as a whole with the intention of improving the overall quality of a health service with an explicit focus on outcomes. However, there are complexities in the routine collection and use of PROMs, especially where they are experienced as a distant, bureaucratic imposition that has little to do with direct clinical work and the patient experience, in particular its effectiveness. The argument for building in direct feedback from the family or child is strong where this leads to discussion and reflection with the clinicians with the aim of improving the child or family’s experience of the intervention/service. But that objective is different to the focus on overall service development and improvement (Wolpert, et al., 2014).

The use of PROMs as originally designed has been adapted in order to provide direct, meaningful feedback to both the patient and clinician in mental health settings (Badham, 2011; Wolpert, et al., 2012). The Child Outcomes Research Consortium (CORC; www.corc.uk.net) was created as a network for establishing, exploring and using the routine collection of outcome data from services that provide help to children and families experiencing mental health difficulties. One of CORC’s concerns has been to ensure that the use of measures in routine practice results in accurate evaluation of service impact and outcomes, which is then constructively used in service development and is equally beneficial in the direct work between the clinician, the child and the parents. A recent review (Wolpert, Cheng and Deighton, 2015) was undertaken of four measures used by CORC members who deliver the Children and Young People’s Improving Access to Psychological Therapies programme (CYP IAPT). These four measures are the SDQ, the Revised Child Anxiety and Depression Scale (RCADS), the Outcomes Ratings Scale and Child Outcomes Rating Scales (C/ORS) and Goals Based Outcomes (GBOs). Each of the measures has its own advantages and limitations. The SDQ is widely known but is limited in the feedback detail that it provides to the clinician and patient. On the other hand, C/ORS was a measure explicitly designed to become a part of the therapeutic conversation and this has been reflected in the feedback received on its utility. GBOs are specifically intended to frame the work that the therapist and young person do on a session-to-session basis, with immediate feedback on success in relation to each agreed goal. Incorporating feedback of this kind on a session-by-session basis within other therapeutic paradigms has not been straightforward and has been seen to interfere with or even undermine therapeutic effectiveness.

Wolpert, Cheng and Deighton (2015) identify the lack of research evidence that establishes the validity and effectiveness of the use of PROMs in therapeutic work and this is specifically in relation to CYP IAPT and not the other interventions or services that might be required for the range and seriousness of other disorders presented by children and young people. Continuing exploration of the place, meaning and effectiveness of PROMs is recommended and that includes the use and further development of training programmes for practitioners.

Summary and recommendations

The Adoption Support Regulations run very close to the issues identified above. They highlight the importance of an assessment in formulating an objective, helpful and appropriate description of the child’s difficulties that is shared as far as possible by the child, the adoptive parent/s and the professionals. That assessment/formulation should then become the focus for identifying evidence-informed interventions and services with a clear link being made between the interventions/services and the agreed timescales and outcomes. The common issues related to the availability of resources to enable those interventions/services to be provided will be significantly enhanced by the Adoption Support Fund, where they fall within the definition of ‘therapeutic interventions for the child’.

However, there are significant challenges to be faced in identifying the most appropriate framework that enhances assessments which draw on commonly accepted descriptions of child and adolescent developmental difficulties – including both mental health and learning difficulties. The use of standardised screening and diagnostic instruments should play a part in this. There are similar issues in identifying the meaning of evidence-informed (let alone evidence-based) interventions and it is commonly recognised that there is some considerable way to go in doing so. There are other issues in identifying how to specify evidence-based outcomes in the adoption support plan that reflect the learning from the exploration of PROMs.

Based on this, a number of recommendations can be made:

The Adoption Support Regulations 2005 and the specification of the link between assessment, intervention, monitoring and outcomes must be reinforced as the Fund continues its national rollout.

Evidence-informed assessments and interventions need to be developed that recognise the importance of both objectivity and engagement with the family.

The training, development and support of social workers need to specifically address this second recommendation as a matter of urgency.

The National Minimum Standards should be amended to include due consideration being given to evidence-informed and objective service standards.

Adoption support services, when commissioned by a local authority, should be asked to identify their current measurement of PROMs at both a service and individual client level.

The SDQ must be used in all adoption support assessments where an application is being considered in relation to the Fund. The results may be helpful in identifying baseline issues in the further work to be undertaken in the assessment. In addition, as with the SDQ for looked after children, the SDQ data collected through adoption support assessments should form part of the annual local authority return to the Department for Education. This has to be analysed for the messages it identifies for the sector in understanding the issues.

A pilot project needs to be established to explore the use of standardised diagnostic instruments including the DAWBA in adoption support assessments that may result in an application being made to the Fund. This will require training social workers in briefing applicant/s on the use of the DAWBA and what it is intended to do. In addition, an arrangement will be required to enable the completed DAWBA to be analysed by a trained person. This does not require the assessor/clinician to have any contact with the family. However, the social worker will need to be trained and supported in the use of the feedback to the family from the DAWBA in the further work on the assessment.

An evaluation should be commissioned to understand and promote the advantages of a strong link being made between assessing local authority social workers and clinicians who are expert in mental health and clinical approaches to understanding and addressing the needs of adopted children.

The potential for linking with mental health services delivered through schools should be explicitly addressed in any assessment of adoption support needs. This needs to identify the appropriate use of the Pupil Premium for adopted children.

Any Education, Health and Care Plan should identify the contribution made by the assessment of need for adopted children.

Footnotes

Notes

John Simmonds is Director of Policy, Research and Development, CoramBAAF Adoption & Fostering Academy, London, UK.

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