CTC Psychological Services

CTC Psychological Services Inspection report for adoption support agency

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Unique reference number SC478850 Inspection date 09/06/2015 Inspector Mrs Lloyd Type of inspection Full

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Setting address 20 WALPOLE STREET, CHESTER, CH1 4HG

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Telephone number 01224390121 Email admin@ctcps.co.uk Registered person The Partnership of CTC Psychological Services Registered manager Other Jeanie McIntee Responsible individual Mr Julian Long Date of last inspection N/A Website: www.gov.uk/ofsted

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This document may be reproduced in whole or in part for non-commercial educational purposes, provided that the information quoted is reproduced without adaptation and the source and date of publication are stated.

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Brief description of the service

CTC Psychological Services is a non-profit, private limited liability partnership. It provides a range of psychological services in addition to adoption support. Only the adoption support work is the subject of this inspection.

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Brief description of the service

To undertake adoption support work, CTC employs a registered manager, two therapists and a part-time administrative assistant. It provides psychological assessments and therapeutic interventions commissioned by a local authority and currently support 23 adopted children and their families. In addition, it provides guidance and training to local authority social workers involved in adoption.

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The inspection judgements and what they mean

Outstanding : a service of exceptional quality that significantly exceeds minimum requirements Good : a service of high quality that exceeds minimum requirements Adequate : a service that only meets minimum requirements Inadequate : a service that does not meet minimum requirements

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Overall effectiveness

The overall effectiveness is judged to be Good

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Overall effectiveness

The agency carries out psychological assessments and therapeutic interventions with adoptive families in crisis and at risk of adoption breakdown.

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Overall effectiveness

The quality of the agency’s psychological assessments is a key strength of the service. Parents, teachers and social workers value them enormously. Children who have highly complex emotional and psychological needs respond well to the therapy provided. The agency specialises in helping parents to understand their children better and develop supportive relationships that promote healing. This makes a real difference to family life because parents change the way they parent their children. Parents and social workers report that the agency’s involvement has prevented family breakdown and that children in crisis have been very well supported.

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Overall effectiveness

Therapists are fully aware of the life-long impact of early trauma and neglect on children and their adoptive families. Children’s safety is paramount within the agency and staff recognise that adopted children are extremely vulnerable to sexual exploitation, self-harm, bullying and assault. The agency has clear policies about how to respond to a disclosure or allegation of abuse. However, not all disclosures have been notified to the children’s services safeguarding team without delay. This has been addressed within the agency so that all staff fully understand their responsibilities. No children have been harmed as a result of this delay.

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Overall effectiveness

The service is very well led and monitored by a competent and highly acclaimed therapist whose work is widely published. Equally, the therapist who carries out the vast majority of the assessments and therapy is an expert in her field and is widely published. Children and parents report she is a warm and caring individual who communicates and listens very well and goes the extra mile in providing support.

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Overall effectiveness

Therapists keep up to date with research and learning that promotes their continuing professional development and supports them to provide a high quality service. Staff are very well supported and supervised by the registered manager. However, the formal arrangements for supervision are not always adhered to and as a result not all supervision sessions are recorded. Additionally, the arrangements for the registered manager’s professional supervision have broken down.

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Overall effectiveness

The agency has produced three leaflets for children that make up the children’s guide. They explain CTC’s work and how to make a complaint. These leaflets are aimed at children who can read. They are not suitable for all the children supported by the agency.

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Overall effectiveness

Confidential information is stored securely. Children’s records are not kept in a standardised format, which makes it difficult to monitor and review them to ensure they meet the agency’s standard.

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Overall effectiveness

The agency does not have a whistle-blowing procedure to guide staff on how to address concerns about colleagues.

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Recommendations

To improve the quality and standards of care further the service should take account of the following recommendation(s):

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Recommendations

 ensure that the Children’s Guide to adoption support services is appropriate to the child’s age and understanding (NMS 18.6)  ensure there is a whistle-blowing policy which is made known to all staff, volunteers and persons on the central list. This makes it a clear duty for such people to report to an appropriate authority any circumstances within the agency which they consider likely to significantly harm the safety, rights or welfare of any child placed by the service (NMS 21.6)  ensure that suitable arrangements exist for professional supervision of managers and the registered person of the agency (NMS 24.3)

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Recommendations

 ensure that a written record is kept by the agency detailing the time and date and length of each supervision held for each member of staff, including the registered person. The record is signed by the supervisor and the member of staff at the end of the supervision (NMS 24.5)

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Recommendations

 ensure that the agency has and implements a written policy that clarifies the purpose, format and content of information to be kept on the agency’s files, on the child’s and prospective adopters’ case records (NMS 27.1)  ensure that all adoption support agency staff and volunteers understand what they must do if the receive an allegation or have suspicions that a person may have: a. behaved in a way that has, or may have, harmed a child; b. possibly committed a criminal offence against or related to a child; or c. behaved towards a child in a way that indicates they are unsuitable to work with children and ensure that the required action is taken in any relevant situations of which it is aware. (NMS 22.1)

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users

Outcome for service users are outstanding

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users

Children’s lives improve because the agency helps parents to gain confidence and understanding so they respond to their children more effectively. Both parents and social workers say CTC’s interventions prevent adoption breakdowns. Many families are at crisis point when they are referred to the agency and the agency has been successful in helping families stay together and address their problems. A social worker commented, ‘Parents are much more hopeful and they keep the children safer and happier.’

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users

Parents report that the agency makes a huge difference to their lives by providing good advice, modelling and teaching. For example, one parent said, ‘CTC helped us to do better parenting. We react differently now so he is more relaxed and less challenging; less angry. We can spot things earlier and intervene faster so things don’t escalate as far. We focus on how he is feeling and not just on the behaviour. We’ve developed stronger bonds.’

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users

Commissioning social workers recognise the value of the service and the positive impact the interventions have on adoptive families. For example, one said, ‘I hear about children who are very challenging making good progress following their involvement.’

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users

Children and parents make effective contributions to their psychological assessments and give feedback to the agency at the end of every session and intervention. They feel listened to and understood by the therapist. For example, one said, ‘CTC always listen and help us sort things out. They’re supporting our whole family. The children give Nici feedback after every session and so do we. I’m massively relieved they are helping us.’ This viewpoint was echoed by all the families who contributed to the inspection. A child said, ‘Nici’s kind. She helps me with anger and teaches me how to control it…I like seeing her.’

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users

A teacher explained how the agency has supported a child to be more settled and make better progress in school by providing expert advice to teachers about how to manage and support the child. She said, ‘They came out to school and gave us advice. We’ve introduced new strategies for managing the child and they’re working. It’s had a positive impact on all the children in school.’ The parent of another child was extremely pleased that her child has made great progress in school following the agency’s interventions: ‘My child has caught up 10 months’ work in six months and school can really see the difference.’ This demonstrates that the agency’s interventions support children’s cognitive development as well as their psychological and emotional development.

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users

Many of the children accessing the service have had extensive support over a number of years from other agencies. However, their emotional distress and challenging behaviour has continued to increase and for some adolescents, their dangerous behaviour puts them at risk of sexual exploitation and self-harm and puts family members at risk of assault. Parents feel the therapists at CTC understand their children and are confident in the diagnoses given. They say that this agency is helping them to understand and respond better to their children where other agencies have not managed to do so.

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users

Social workers and families clearly understand the remit and limitations of the service. Professionals and parents recognise that many of the children assessed by CTC need long-term therapeutic support. Their assessments have enabled a number of families to secure Adoption Support Funding in recent weeks. Consequently, children can now begin to access the therapy they need.

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Quality of service provision

The quality of the service is outstanding

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Quality of service provision

Parents accessing the service are often anxious, deflated and filled with feelings of guilt. They benefit immensely from the non-judgemental, caring approach of the therapists who recognise the enormity of their struggles and their commitment to their children. One parent described the therapists as ‘professional with humanity’, and others comment on their warm and welcoming approach that engenders trust and instils confidence.

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Quality of service provision

Parents report that the therapists know them and their children well and are very responsive and sensitive, putting them at their ease and providing a welcoming environment. ‘Nici is very warm. My child was resistant at first but Nici was gently persistent and she’s come round now and has started seeing her’. Another said, ‘Nici and Jeanie are always there for us, at the end of a text or a phone call away. They don’t just tell us everything is ok. Nici can hear the worst and see the good in everything.’

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Quality of service provision

Therapists model a different way of parenting and teach parents both through individual work and through the parenting support group to understand their children better. This enables parents to respond more effectively to children’s emotional needs and presenting behaviour and to recognise the impact of early trauma and neglect on their development and ability to form attachments. A parent explained, ‘They help you to understand where your child is coming from and how to help them’.

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Quality of service provision

The agency has expertise in a range of counselling and psychotherapies with children and families. Its work is underpinned by extensive, evidence-based research. Therapists successfully promote more nurturing and relaxed family life where children can grow emotionally and psychologically, benefitting from greater acceptance and more positive experiences. They successfully use a variety of therapies including developmental attachment therapy to support children to bond with their adoptive families. Therapists skilfully support children with a wide range of presenting problems, including anger and aggression, depression, suicidal thoughts and sexual and physical abuse. They tailor their interventions to meet the needs of individual children and families. One parent explained, ‘It’s a slow process but things are improving’.

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Quality of service provision

Referrals to the service come through the commissioning local authority’s therapeutic adoption support service. A therapist from the agency meets regularly with the adoption support social work team and other professionals to review children in need of adoption support and advise on the best way of meeting that need. Social workers are extremely pleased with the ‘excellent’ partnership working, which supports them to deliver a better adoption service. They say, ‘We refer the most challenging young people that we’re really worried about,’ and, ‘They do fantastic assessments on the most complex children.’

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Quality of service provision

Commissioners recognise that the agency has enhanced the local authority’s adoption service through the level of expertise and training they give to social work staff. This has helped develop social workers’ assessment skills so that adopter assessments are now more in-depth and securely grounded in evidence. Social workers report that CTC’s training has helped them to improve their matching processes so that children’s needs are more closely matched to adopter skills. Additionally, social workers now support children and families more effectively because they understand better how to support children who have suffered trauma and neglect. This means that social work interventions are more successful and families in crisis receive better help.

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Quality of service provision

The agency provides regular case studies, feedback, advice and training to the local authority adoption social work team. This service is a valued resource which supports better and more successful working practices. A social worker explained, ‘They helped me really understand about the impact of trauma and supported me to work with a traumatised family through a difficult period. The child began to release her distress. I held the family and Nici held me. We put in extra support as things started to come out. I’ve had good feedback from the family and things are going well. CTC’s input really helped.’

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Quality of service provision

Therapists are extremely committed to providing a high quality service and place children at the heart of all their work. They carry out assessments and deliver therapy at a child-friendly venue that is close to the adoptive families’ home area so that it is easily accessible for families.

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Quality of service provision

Assessment reports are of very high quality and provide helpful recommendations for parenting individual children more effectively to meet their individual emotional and psychological needs. A social worker from the commissioning authority said, ‘It’s phenomenal what they provide; we would not have been able to do the in-depth quality of assessments ourselves as we don’t have that level of skill.’

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Quality of service provision

Commissioners don’t always take up the recommendations CTC make because of funding limitations and the very high demand on the local authority adoption service; but the assessment process in itself helps families to identify and talk about their feelings. The short term therapy that has been provided has enabled families to build stronger bonds and many children reduce their dangerous and aggressive behaviour. A parent explained, ‘Our family is calmer and more able to deal with anger and express things openly’. Other families recognise that children’s anger may be expressed more openly as they begin to heal and parents’ greater understanding of their children’s needs gives them the strength to deal with it more effectively and removes the burden of guilt.

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families

The service is good at keeping children and young people safe and feeling safe

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families

Therapists are acutely aware of the devastating impact of early neglect, abuse and trauma on adopted children. They have a very good understanding of the long-term effects of poor and broken attachments and multiple placement moves. They recognise that adolescence is a challenging time for many adopted children and know the indicators that may suggest children are suffering harm or are at risk of harm. Children disclose things to their therapist because they trust her. For example, some have disclosed incidents in which they’ve been hurt by a parent struggling to cope; others have disclosed self-injurious behaviour. This enables the therapist to help the children and families deal with dangerous situations more effectively. A parent said, ‘She’s very ethical and we feel safe with her’.

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families

Another parent explained, ‘She’s shown me how to recognise and de-escalate the rage inside my child, which can be overwhelming. Both my children can be violent and one has been excluded from school because of it. CTC have been into school and helped the teachers deal with things better. They’ve been enormously helpful and make me feel it’s not my fault. I feel we’re getting the right sort of support from the right people after many years and loads of support from different professionals.’

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families

CTC goes the extra mile to support children and families at times of crisis. For example, a parent explained, ‘Nici is very astute and can see what’s going on. My child ended up in hospital after a suicide attempt and Nici visited and used dolls to help explain things. I could see in my child’s face that Nicci had got through and had understood what she was going through. She knew she was being listened to’.

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families

CTC has clear safeguarding policies, agreed with the local authority, which it usually follows. Despite this, on one occasion, the therapist did not notify the local authority safeguarding team of concerns about a child’s safety and welfare in good time. Indeed, it was several days before the therapist notified them of an allegation made by a child and confirmed by a parent about a trusted adult. The impact on the child on this occasion was minimal; however, the reason for the delay in notifying the local authority was thoroughly explored and reviewed by the registered manager and the therapist revisited safeguarding training. Further safeguarding training with the local authority has also been arranged. All agency staff are now fully aware of their responsibilities.

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families

The agency does not have a formal whistle-blowing procedure. However, all staff clearly state that they would have no hesitation in whistle-blowing should they have concerns about another member of staff’s practice. The staff team show a strong commitment to putting children’s and families’ needs first in all aspects of their work.

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Leadership and management

The leadership and management of the adoption support agency need

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improvement

The registered manager of the service is a very well qualified psychotherapist and forensic psychologist /counsellor who has extensive experience in working in the field of trauma with children and families over many years. She provides clinical supervision to a number of consultant clinical and counselling psychologists and is involved in cutting-edge research in the field of dissociative disorders. Additionally, she has been involved in training doctorate students at several universities and currently supervises psychology and clinical counselling trainees at the University of Chester.

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improvement

The responsible individual and the registered manager demonstrate a very strong commitment to providing high quality adoption support and strive for excellence in all that they do. Equally, a commitment and dedication to improving the lives of vulnerable children permeates the whole staff team. CTC know the value of their work and the positive impact it has on children and families and they go the extra mile to ensure they deliver the best possible service. This includes working additional hours and supporting families who are in crisis during evenings and weekends.

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improvement

The agency has highly effective relationships with partner agencies, other professionals and parents. This leads to improved experiences for children who reduce their anxieties, make developmental progress, and begin to build attachments as a result of the agency’s interventions. A course on the traumatised brain and dissociative disorders was extremely well received by other professionals, who also value the agency’s expert advice with supporting individual children and families.

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improvement

The registered manager continuously reviews the service and provides valuable feedback to the commissioning authority about particular children’s progress and the overall impact of the service. She has carried out the first six-monthly service review which demonstrates that the agency is providing a range of effective interventions. Her review has highlighted what the service does well and what the barriers are to greater success. It identifies the best way to help the most children and families and recognises that early intervention is more successful in helping children overcome trauma and forge meaningful bonds that will enhance their lives, reducing the likelihood of long-term mental illness. CTC have shared this with commissioners.

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improvement

Training and personnel records are well maintained and demonstrate that therapists are suitable qualified and keep up to date with research and learning that promotes their continuous professional development and assists them to provide a high quality service.

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improvement

Staff are very well supported by the registered manager and her open-door policy provides them with on-going access to expert advice on a daily basis. Formal weekly supervision arrangements are in place for therapists and the quality of these records is good, demonstrating useful reflection, professional challenge and sound advice. Formal supervision takes place most weeks for most staff but records are not always completed so the agency cannot demonstrate that all staff are receiving the high levels of supervision outlined in its own policies.

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improvement

The arrangements for the registered manager’s professional supervision have broken down due to unforeseen circumstances. She is currently seeking an alternative arrangement but is fining it a challenge to find a professional who has sufficient commitment, knowledge and expertise in this specialised area who can meet the requirements of this important role.

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improvement

The Statement of Purpose succinctly illustrates the aims of the agency and reflects the service provided. The children’s guide is made up of three separate, informative leaflets which are shared with children and families by the local authority that commissions the service. The guide explains CTC’s work and how to make a complaint. These leaflets are written for children who know how to read. They are not suitable for all the children supported by the agency, particularly for young children and pre-readers. The impact of this shortfall is minimal as the therapist explains her role to parents and children at the start of her involvement and makes sure children have an on-going say in the delivery of the service, giving regular feedback at the end of each session. This ensures they have a clear understanding of the aims of the specific work undertaken with them and enables their views to be captured and any concerns raised immediately.

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improvement

Good security arrangements are in place for the safe transfer of electronic information and all confidential records are stored securely. Hand-written records are held safely by the therapist until they are transferred to the head office in Chester. The arrangements for their safe storage by the therapist are not specified in CTC’s policies, and are not supported by an agency risk assessment. This means that possible risks to the safety of confidential information have not been explored.

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improvement

Children’s records are not kept in a standardised format, which makes it difficult for the registered manager to monitor and review them to ensure they meet the agency’s standard.

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About this inspection

The purpose of this inspection is to assure children and young people, parents, the public, local authorities and government of the quality and standard of the service provided. The inspection was carried out under the Care Standards Act 2000 to assess the effectiveness of the service and to consider how well it complies with the relevant regulations and meets the national minimum standards.

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About this inspection

The report details the main strengths, any areas for improvement, including any breaches of regulation, and any failure to meet national minimum standards. The judgements included in the report are made against the inspection framework and the evaluation schedule for the inspection of adoption support agencies.

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