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Children in care constitute a deprived and needy group of young people, who are at high risk of developing mental-health problems and disorders. This article describes the development of a direct access child and adolescent mental-health service for children living in residential units or with foster families, with data on the pattern and characteristics of referrals, and discussion on the arising difficulties. The main aims of this service are, to be responsive and flexible, to provide mentalhealth assessment and treatment, and to work with residential care staff, foster parents and field social workers. Young people referred to the mental-health service had high rates of abuse, history of offending behaviour, poor school attendance and frequent previous contacts with child mental-health services. There were also high rates of child mental-health disorders, particularly mixed conduct and depressive disorders, and history of self-harm. Anticipated benefits include a coordinated and cost-effective assessment, improved mental-health outcome, contribution to the care plan and prevention of further difficulties. Joint commissioning between health and local authorities should prioritize children in care. Different models of mental-health provision may be appropriate and require evaluation. K E Y W O R D S care, children, mental health, young people Children in care A B O U T 5 1 , 2 0 0 C H I L D R E N are looked after by social services departments in England and Wales at any time (Department of Health, 1997). This is a substantial young population (5.5 per 1000 of the population under 18 years), despite its steady decrease of 35% during the last decade. There is a trend of increasing placements with foster families rather than in children's homes, although the rates vary across the country. Accommodation of children has increased in recent years, in contrast with emergency orders made in the UK. This population is heterogeneous, and entry into accommodation may occur

Mental health interventions for victims of domestic and neighbourhood violence should be integrated with community programmes of social reintegration. Mental health professionals should work in close collaboration with Housing Departments, Social Services, Education and the Police.

Aims and MethodDescription of the development of an outreach mental health service for homeless children and families, and presentation of referrals characteristics and management of 40 families.ResultsFamilies became homeless predominantly because of domestic and neighbourhood violence. They were usually referred to the team for assessment of parents and children, without specific mental health concerns. A range of mental health interventions was offered, as well as liaison with other agencies.Clinical ImplicationsThe development of such services requires coordination of different agencies working with children and their parents. Also, designated staff and resources, because of the potential conflict with generic services.