Abstract
Dear Editor,
The Department for Education (DfE) in the UK recently agreed funding for another year for the Adoption and Special Guardianship Support Fund (ASGSF, formerly just the Adoption Support Fund, ASF). To date, this fund has committed approximately £450 million to provide ‘essential therapy services’ for children in England who are adopted, under special guardianships or some other forms of permanency, over the 10 years since its inception in May 2015. The ASGSF funds multidisciplinary assessments and therapeutic support.
However, in the year ahead, there have been some significant reductions in the amounts available, with a new funding limit of £3,000 a year and, in particular, the removal of earmarked funding for assessments, which had previously been up to a possible £2,500 but would now have to come from within that £3,000. Overall, a £3,000 limit represents a very significant reduction from a possible £7,500 for assessment (£2,500) and treatment (£5,000) in a financial year. This raises the question of what kinds of therapeutic support are going to be feasible within these cost envelopes, and from which providers. A lot of families and providers in the sector are likely to be concerned by this dramatic reduction in the opportunities for funding, especially as there is evidence that the existence of this fund has led to some unintended consequences of blocking access to more routine child and adolescent mental health services (CAMHS) for these children. Qualitative research has highlighted families reporting that referrals to NHS CAMHS services for adopted and special guardianship order (SGO) children have been refused because of the existence of the ASGSF, apparently because it provides an alternative route to support (Selwyn and Lewis, 2021).
Providing effective support for adopted and SGO children is critical, because care-experienced children are likely to have high levels of a wide range of mental health needs (e.g., Ford et al., 2007). Supporting these children effectively also makes financial sense as a successful permanency ‘yields at least £1.3 million in net benefits’ for the child, family and society, including £1.1 million for local authorities specifically (Clifford et al., 2022: 12). But despite the likelihood of high rates of mental health needs, the ASGSF is commissioned independently of NHS CAMHS, based on assessments conducted by post-adoption social workers working in local authorities and/or regional adoption agencies, who apply for approval of funding for assessments and therapies to an external management company based in the engineering and infrastructure sector. Health professionals, and those who specialise in mental health within the NHS in particular, play a minimal role in the implementation of this fund to provide mental health support.
To understand more about where the money has been spent and with which providers, we made a Freedom of Information request (What Do They Know, 2025) because we were interested in how often young people with mental health needs accessing this fund were being seen in CAMHS services for therapeutic assessment and support. The request provided data on the 130,738 funded contracts across 4,764 different providers, delivered under the ASF/ASGSF from May 2015 to 31 January 2025. This suggests an average value of each contract over the life of the fund to have been around £3,000 (e.g., approximately £400 million over 130,738 contracts). Presumably this is the rationale for setting the new upper limit for the funding cap of £3,000, because a similar rationale was used to derive the previous limit of £5,000, i.e., based on a simplistic arithmetic of high-level numbers and not on what effective assessment and support for different families would cost.
We then categorised these providers into (a) the private and voluntary sector – 94.96%, including charities and community interest companies (10.17%), limited companies (22.84%), individuals in private practice (26.17%) and other non-statutory services (35.79%); (b) local authorities and/or regional adoption agencies – 4.04%; and (c) NHS CAMHS – 1.00%. Hence, the post-adoption social workers who initiate the commission process of the fund were almost always selecting therapeutic assessments and support from the private and voluntary sector and very rarely from the NHS. Indeed, local authority social workers appeared to be over four times more likely to commission assessment and/or therapeutic support from local authorities rather than from NHS CAMHS.
The DfE reports the most frequently commissioned interventions are creative therapies, psychotherapy and therapeutic parenting (DfE, 2022), none of which have an evidence-base for their effectiveness for the common mental health disorders most likely to be presenting in this cohort and which adopters identify as their primary concerns (Woolgar et al., 2024). The approaches offered in the private and voluntary sector are typically ‘innovative’ rather than evidence-based. Perhaps unsurprisingly, the evidence for a positive impact of the fund overall appears to be weak (Burch et al., 2022) according to research commissioned by the DfE or very limited with no overall impact according to independent evaluations (Li et al., 2023).
In conclusion, the social impact research suggests there is great opportunity to promote successful permanency solutions for children in care via options such as adoption or special guardianship. We argue that the delivery of statutory services within the NHS – providing comprehensive assessments of the wide range of mental health issues likely to present in this vulnerable cohort of children and young people and which would then lead to tailored, evidence-based interventions – would be the most appropriate way to guarantee their wellbeing, as well as value for money to the taxpayer. However, the evidence from the Freedom of Information requests shows this is very rarely happening, presumably due to the commissioning of mental health services being subcontracted to non-health agencies. While such an approach may have led to innovating a new market for adoption support in disruptive ways, it has also inadvertently blocked families from accessing NHS services for support. Over the last 10 years this will have reduced capacity within an already overstretched NHS to pick up the additional support that will likely be needed now that the funding for assessment and therapeutic support has been so dramatically reduced. The question is, what happens next for these families?