osion of parents’ resilience to cope with children and young people’s behaviours in the pandemic and since, plus a lack of access to timely mental health support for both parents and children, appear to be key factors in leading children and families to the door of children’s social care, particularly where self-harm and suicidal ideation escalate and families do not feel they can keep themselves or their child safe (ADCS, 2021). Around 10% of my children in care are in what we classify as high-cost placement for high levels of complexity… They basically drive all the costs in our system and if we can offset that cost we can invest that money elsewhere... So, we are targeting our development [of new provision] on the top 25 of these placements (DCS, County, North East Region) Children with the highest level of complex needs make up a small but rising proportion of all children in care. The cost of such placements absorb a very large proportion of local authorities’ children’s services budgets. The number of children in residential care has doubled since 2011 and spending on these placements rose by 90% to £2.4bn in 2022–23, with almost half of this increase in the last two years of the period (Larkham, 2024). Many DCSs interviewed were forecasting a significant overspend in this area and shared examples of individual packages of support costing tens of thousands of pounds per week and in excess of £1 million per year. These high costs do not always mean that appropriate, therapeutic, well-boundaried care placements are being provided. The acute insufficiency of placement options, and the related use of unregistered provision is an area of intense public, political and judicial attention. The prevalence of complex mental health concerns has increased and yet the number o