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1 NICE/ GUIDANCE LOOKED AFTER CHILDREN AND YOUNG PEOPLE 4 th Meeting of the Programme Development Group Thursday 26 th March 2009 Royal College of Anaesthetists, London Attendees: Programme Development Group (PDG) Members: Dennis Simpson, Sue Wressell, Janet Rich, Sophie Boswell, Helen Mason, Efen Johnson, Carol Green, Helen Chambers, Caroline Cuckston, Harriet Ward, Jade Blake, Gina Gardiner, Geoffrey Skinner, Sarah Byford, Douglas Simkiss, Delma Hughes, Sue Revell, Mandy de Waal, Kim Golding, Colin Thompson, Valerie King Cooptees: Bev Curtis. : Mary Sainsbury, Amanda Edwards, Sheila Fish. NICE: Simon Ellis, Catherine Swann, Sarah Dunsdon, Alastair Fischer, Peter Shearn, Linda Sheppard. Review teams: ScHARR - Roy Jones, Alejandra Duenas, Emma Everson Eppi Centre - David Gough, Katy Sutcliffe Apologies: PDG Members: Noel Arnold, Kim Bown, Jayne Ludlam, Rhian Stone, Susan Lane, Paula Conway. Review teams: Liddy Goyder (ScHARR); Kelly Dickson (EPPI-Centre). Authors Sarah Dunsdon, Simon Ellis, Linda Sheppard File Ref LAC 4 final minutes of 26 th March 2009 Version Final minutes of 26 th March 2009 Audience PDG members, NICE team, the public (via web publication) 1

2 Item Action 1. Welcome, Introductions and focus of the Meeting The Chair welcomed the group to the 4 th meeting and outlined the objectives of the day: To consider the evidence from Effectiveness Review 1 on The effect of support services for transition / leaving care on the adult outcomes of looked after children. To develop draft based on Effectiveness Review 1 To further revise the draft from PDG meetings 1 to 3 To receive an update on progress with the qualitative review To gain an overview of the plans for health economic analyses The Chair also welcomed co-optee Bev Curtis who until recently worked in the Bromley Leaving Care Team. 2. Declarations of interests The following interests were declared: Personal pecuniary interest Susan Lane* Kim Golding* Paula Conway* Personal family interest None Non-personal pecuniary interest Harriet Ward Paula Conway* Personal non-pecuniary interest Sarah Byford Kim Golding* Paula Conway* Janet Rich Non-personal pecuniary interest Roy Jones (contractor) * absent from PDG 4 The Chair judged that none of these represented a conflict of interest and so everyone could take full part in the meeting. Bev Curtis had no interests to declare. 3. Minutes of previous meeting and matters arising The minutes were agreed with the following amendments: Pg 1, include Delma Hughes, Douglas Simkiss and Sarah Byford in attendee list. Pg 1, include Sue Revell in apologies list. 2

3 Matters arising: Social pedagogy the team are making contact with Pat Petrie who is heading up the pilot site work. All other action points were completed except for the points listed below. Actions outstanding: NICE and are obtaining the National Indicator and the Multi-Systemic information and will circulate when available. NICE are obtaining the TCRU report (that informed the revised government guidance) and will also circulate to the PDG when available. 4. Introduction to the review Catherine Swann gave an introduction to effectiveness reviews and their purpose in the development of. 5. Effectiveness review 1: The effect of support services for transition / leaving care on the adult outcomes of looked after children 6. Effectiveness review 1 The ScHARR team presented the key findings from their review on Transition to Adulthood in Looked After Children & Young People : Few formal evaluations of TSSs have been conducted TSSs appear overall to have a beneficial effect on the adult outcomes of LACYP, especially education, parenthood and housing/independent living. The PDG made the following comments: Points of clarification- Outstanding papers the ScHARR team confirmed that some papers are still outstanding and they anticipate that 3 papers of these may be included. Table 2, page 6 ScHARR agreed that they would define the terms in the table more clearly in the review. ScHARR Search strategy, pg 43, Medline database the search terms and problems with language were discussed. Studies the PDG said that the amount of US studies was a concern and something to bear in mind in terms of applicability. In addition, the studies also reflect US social policy. It was noted that there is some evidence from Scandinavia that were not captured in the review. Action point: Harriet Ward to send any recent evidence from Scandinavia to NICE. Harriet Ward Sub-groups it was noted that some transition support services may be more or less effective for particular 3

4 groups of looked after children and young people It was queried whether NICE and commission research it was noted that NICE s role is to synthesise the evidence available in order for to be made. However, have commissioned a practice survey. It was added that part of the PDG s role is to make research. 7. Effectiveness review 1: Discussion of the evidence 8. Effectiveness review 1: developing 9. Effectiveness review 1: Plenary report back from groups The PDG discussed the evidence in small groups. The PDG made preliminary in small groups. Feedback from groups Each group presented their. Four main areas for preliminary for Transition Support Services included: Access to Services TSS Service Development TSS Practitioner Training TSS Focussed Research Issues included: ensuring the importance of a holistic approach involving early and high quality transition planning skills across the life course to prepare for adulthood views of young people stability of living accommodation financial planning employment educational achievement delayed parenthood importance of self-esteem and self-efficacy continuity of relationships appropriate development & emotional needs assessment Discussion UK evidence The PDG suggested it might be useful to consider research from the UK that did not meet the criteria for the effectiveness review (ie no control or comparison group). 4

5 This might include work by Jim Wade (who undertook a review for the Department of Health). Another suggestion was Mike Stein. It was noted that the NCB report: What Makes the Difference? Researching and Evaluating Support for Care Leavers is an example of good practice. also reported that they have recently worked with the Centre for Excellence in Outcomes (C4EO) to produce a scoping review around support for children leaving care. It was noted this could be shared with the PDG. The PDG were reminded that the evidence review should be used as the starting point for making. Action point: to discuss how UK evidence might be fed into the process and to consider inviting some UK academics to give expert testimony. 10. Draft from PDG 1 3: summary of PDG feedback, key changes and outline of the task 11. Draft from PDG 1-3: Further refinement Linda Sheppard summarised the PDG comments received on the draft and explained the next stage with the. The PDG considered the draft in small groups, focusing on: Strategic development 12. Draft : plenary and reaching consensus Placement stability Out of area placements Residential care Personalised care Each of the groups reported back on their revisions to the. There was broad consensus with the draft. Action point: The terms out of area, out of authority and out of county to be defined in a glossary. Action point: to begin a glossary and ask for PDG input. Action point: NICE/ to revise the draft and circulate them to the PDG to ensure 5

6 they reflect the group discussions. The will then come back to a PDG meeting at a later date. 13. Qualitative review: update An update was provided by the EPPI team on the qualitative review. The team had found more studies than was expected and asked for feedback on how to narrow the review in order for there to be greater synthesis of the evidence. It was agreed that the review will be limited in date and geography (UK studies / 2000 onwards). References will be provided for the Scandinavian studies so that can consider them. Action point: EPPI to provide references for the Scandinavian studies to. EPPI 14. Health economics Alastair Fischer gave a brief presentation on health economics and Alejandra Duenas gave a presentation on the economic model for this guidance. It was reported that the model is based on the effectiveness review to date and will be linked to the further reviews. A PDG member reported that Erik Knauf is doing some work on social QALYS (quality adjusted life years). Action point: Sarah Byford to send her comments on the model to Alejandra Duenas. Sarah Byford The group confirmed that they were happy for Sarah Byford, as the health economist on the group, to be provided with previews of the economic modelling work. 15. Summary of the day The next meeting will take place on 14 th May 2009, NICE Offices, London. 6