Local areas are increasingly focusing their attention on children with complex needs. This is because research suggests that: (a) need is high and growing; (b) services find it difficult to meet need; (c) the cohort experience poorer outcomes compared to their peers; (d) the way services are delivered may exacerbate challenges; and (e) there are significant resourcing challenges.

In light of this, Cordis Bright has undertaken research for four areas across the Midlands to help them understand the experiences of children with complex needs and identify strengths and areas for improvement. We have conducted:

• A needs assessment for children with complex needs who are looked after or on the edge of care in the D2N2 geographical area defined by the local areas of Derby, Derbyshire, Nottingham and Nottinghamshire, including Bassetlaw.
• A systems analysis for children with complex needs educated in Pupil Referral Units (PRUs) in the Black Country and West Birmingham, covering Dudley, Sandwell, Walsall and Wolverhampton.
• A systems analysis for children, young people and young adults with complex needs in Staffordshire and Stoke-on-Trent.
• A needs assessment for children on the edge of care with complex needs in Northamptonshire, covering West Northamptonshire and North Northamptonshire.

Following this work, NHS England commissioned Cordis Bright to draw all of these findings together into an overarching report.

Methodology

Our needs assessments draw on a wide ranging evidence base including:

• Interviews with system stakeholders across the NHS, local authorities, police, housing, and the voluntary and community sector.
• Consultation with children with complex needs and their families.
• Case chronologies and case studies.
• Evidence reviews on effective practice.
• System mapping exercises.
• Analysis of child-level datasets often drawing on metrics from multiple agencies to create a unique picture of needs.

Numbers of children with complex needs

It is hard to establish a reliable picture on the numbers of children with complex needs. There are a variety of factors for this including different definitions in use across agencies and some real technical and ethical challenges with sharing data.

Our needs assessments have used secondary data and published research to help estimate the numbers of children with complex needs and which services these children may be in contact with. We estimate that across a local area, between 0.62% and 1.48% of children and young people may have complex needs. You can read more about these calculations and download a spreadsheet for your local area in the resources section below.

Profile of need

Children with complex needs experience a wide range of need. According to our research, on average 43% of children with complex needs experience three risk factors; 20% experience four, whilst 16% experience five risk factors. As well as being multiple, our research shows that need is severe, persistent and often framed by family and social contexts. For instance, on average 67% of children with complex needs have had contact with Children in Need services, 62% had a special educational need; 61% have had contact with Child Protection teams, and 42% had low school attendance.

Areas for improvement

Our research identified a range of underlying drivers, key areas that organisations should focus on; and common barriers that are faced.

You can read more detail about these findings by downloading the resources below.

Resources

Pan Midlands needs assessment on children with complex needs

National research on children with complex needs

Children with complex needs estimates