Barnardo’s: Evaluation of Children’s Mental Health Service
Barnardo’s commissioned M·E·L Research to carry out an independent evaluation of the Children that We Care For (CtWCF) Mental Health and Wellbeing (MHWB) pilot service in Sandwell. The service was delivered in partnership with Sandwell Children’s Trust and aimed to address a clear gap in emotional and mental health support for children that are cared for and care experienced young people.
Nationally, demand for children and young people’s mental health support has grown, with a higher proportion of children and young people living with probable mental disorders. Children in care and care leavers face particularly stark inequalities, including higher exposure to adverse childhood experiences (ACEs) and poorer long-term health and wellbeing outcomes. Locally, Sandwell has a relatively young and diverse population, higher levels of socio-economic disadvantage, and a sizeable cohort of Children that We Care For and care leavers, many of whom experience multiple disadvantages and instability in placements.
Barnardo’s MHWB service was designed to offer an early intervention and prevention model, acting as a buffer before children reach clinical crisis and need statutory CAMHS provision. The overall goal was to:
Provide an emotional mental health and wellbeing service for children in care (5–18) and care experienced young people (up to 25, including young people with disabilities).
Ensure children with mild to moderate MHWB needs could access high-quality support.
Equip children and young people with the knowledge, skills and strategies to become safe, happy young adults.
Support foster carers’ emotional wellbeing so they can better support the children they care for.
Put children and young people’s voices at the centre of their recovery journey, shifting away from a purely medical model to a social, strengths-based model of care.
The pilot focused on three core pathways for children and care leavers, with an additional pathway developed to support parents and carers:
Pathway 1: Children entering care. Pathway 2: Placement support for those at risk of breakdown. Pathway 3: Care experienced young people not currently in receipt of Adult Mental Health Services. Pathway 4 (added later): Parenting support for parents and carers.
Between the start of the pilot and the end of monitoring, 118 children, young people, parents and carers were supported across the four pathways, demonstrating strong reach for a targeted, preventative model.
Approach
M·E·L Research worked closely with Barnardo’s to co-design the evaluation approach, research questions and Theory of Change. The evaluation explored both implementation (how the service was delivered) and impact (what changed for children, young people, parents/carers and the wider system).
Evaluation design
The evaluation used a mixed-methods approach, combining primary qualitative data with secondary quantitative monitoring data provided by Barnardo’s. All tools were developed by M·E·L in collaboration with the delivery team and were subject to ethics approval.
Methodologies and samples
Secondary quantitative analysis
Anonymised monitoring data for 118 unique service users across all pathways.
Included demographic profile, referral reason, pathway, case status, contact type, CORS/ORS scores across sessions,
Outcome Star data for Pathway 1, and qualitative feedback collected by Barnardo’s.
Data was cleaned, merged via unique IDs, and analysed to explore patterns in referrals, waiting times, duration of support and outcome trajectories.
Children and young people – qualitative engagement (primarily Pathway 3)
In-person session with Participation Team (n=5 young people) with lived experience of care, to explore views on service design and impact.
In-depth WhatsApp conversations (n=8 young people), providing a flexible, youth-friendly route for reflection on experiences and outcomes.
Self-completed feedback worksheets (n=2 completed) sent out via parents/carers to younger children.
Parents, foster carers and hosts
Three in-depth conversations with parents/foster carers/hosts whose children had been supported on Pathways 1 and 2; one had also accessed Pathway 4. These interviews explored their understanding of the service, perceived changes for children, placement stability and support for carers themselves.
Barnardo’s delivery team and wider stakeholders
In-depth interviews with 9 Barnardo’s and Sandwell Children’s Trust staff, including strategic leads, service managers, wellbeing workers and parenting workers.
In-depth interviews with 2 external partners, including CAMHS and other professionals within the wider care and health ecosystem.
Topics included service set-up, the CSSO framework in practice, referral pathways, inter-agency working, perceived outcomes and lessons learned.
Reflective workshop with delivery team
A mid-point reflective workshop with wellbeing workers, parenting worker, Team Manager and Strategic Children’s Services Manager.
Used to explore what was working well, emerging challenges, partnership dynamics and how learning was being shared across the system.
Quantitative analysis
Descriptive analysis of referral volumes, pathway mix, waiting times and profile of service users.
Analysis of Session Rating Scale (SRS) data to understand the quality of therapeutic alliance over time.
Analysis of Child Outcome Rating Scale/Outcome Rating Scale (CORS/ORS) to track changes in wellbeing and movement across clinical distress cut-offs.
Analysis of Outcome Star scores for Pathway 1 to understand patterns across domains such as feelings and emotions, relationships, school and self-esteem.
Qualitative analysis
All interviews and group discussions (in-person and via Microsoft Teams/WhatsApp) were conducted with consent and, where applicable, digitally recorded.
Data was entered into a thematic analysis grid and coded against the evaluation aims and research questions.
Quantitative and qualitative findings were then triangulated, with mini case studies developed to illustrate individual journeys and outcomes.
Limitations (e.g. small numbers for some groups, no control group, and reliance on self-reported outcomes) were explicitly documented to ensure balanced and transparent reporting.
Outputs and how they were used
M·E·L Research delivered a comprehensive evaluation package, including a full written report setting out:
National and local context.
Detailed description of the MHWB service and its four pathways.
Evaluation objectives, methodology and limitations.
Findings on implementation and delivery, partnership working and communication.
Outcomes for children and young people, parents and carers, and the wider system.
Conclusions and practical recommendations for future delivery and scaling.
Data tables and visual outputs in appendices, including:
Referral and pathway breakdowns.
Trends in waiting lists and duration of support.
SRS and CORS/ORS trajectories over time, including movement across clinical distress thresholds.
Outcome Star summary data.
Illustrative qualitative material, such as:
Mini case studies (e.g. “Sarah’s story” for a care experienced young person on Pathway 3).
Direct quotations from children, young people, carers and professionals, evidencing perceived impact and the relational nature of the support.
Key findings the client could use: The evaluation evidenced a number of positive outcomes that Barnardo’s and partners can draw on when planning and advocating for the model:
Reach and engagement
118 referrals across four pathways, including children entering care, those at risk of placement breakdown, care leavers and a small but important cohort of parents/carers accessing the parenting pathway.
Strong engagement with care experienced young people, reflecting a previously unmet need for ‘getting help’ support in this group.
Strong therapeutic relationships
Average SRS score of 37.2 out of 40 across 40 children and young people.
78% of sessions scored above the therapeutic alliance cut-off (36), with many young people demonstrating gradually increasing scores as trust built over time.
Improved emotional wellbeing
For 28 children and young people who had completed support, average CORS/ORS scores increased by seven points, from 26.1 to 32.9.
22 of these 28 were scoring above the clinical distress cut-off by their final session, and some showed very large gains (over 20 points), indicating substantial self-reported improvements in wellbeing.
Positive qualitative outcomes for children and young people
Increased emotional regulation and better coping mechanisms. Improved self-confidence, self-esteem and reduced self-blame. Safer, more trusting relationships – particularly with Wellbeing Workers seen as non-judgemental and independent from statutory services. Greater confidence in social situations, education, work and independent living.
Benefits for parents and carers
Feeling heard and validated, and more confident in responding to children’s emotional needs.
Reports of improved placement stability, with children more settled and better able to communicate.
Access to signposting and practical advice (e.g. family hubs, parenting support, SENDIAS).
System-level changes
A new “middle tier” of MHWB support for children in care and care leavers, filling a known gap between universal services and CAMHS.
Improved partnership working and communication between Barnardo’s, Sandwell Children’s Trust and CAMHS, including clearer pathways and joint working around individual children.
Growing adoption of the CSSO framework as a shared language for relational, strengths-based practice across agencies.
Actionable recommendations
Extending or tapering support for children and young people with ongoing or complex needs.
Strengthening post-intervention check-ins and onward referral pathways.
Continuing to refine timing and consistency of referrals, particularly for children entering care.
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