The names of the young person and her family have been changed.

CASE NOTES
PRACTITIONER: Kath Smith, manager, intensive support service.
FIELD: Children and families.
LOCATION: Isle of Wight.
CLIENT: Abigail Adamson is a 10-year-old girl. Her mother, Chloe, has been involved in alcohol misuse from an early age. 
CASE HISTORY: Chloe had Abigail when she was 16 but split up with the baby's father, Jack Smithson, shortly afterwards. She had a few other relationships before getting back together with Smithson, and with him had another baby, Tom (now seven years old).
Chloe's father - who they lived with - tried to be involved and support the family situation but had his own alcohol and occasional substance misuse problems. The children were cared for reasonably well in the early days, but when Chloe and Smithson again split up the situation deteriorated, and both children were taken into care by the local authority. 
DILEMMA: With Abigail sabotaging foster placements, the possibility of a mainland placement in a secure unit would only heighten her  levels of anxiety.
RISK FACTOR: Placing Abigail back home with Chloe, who was still drinking, exposed her to risk of harm or neglect.
OUTCOME: Chloe is managing well. She is controlling her alcohol intake, has separated herself from the drinking lifestyle and is considering college. She is now working with social services in an attempt to have Tom come home as well. For her part, Abigail is, at last, enjoying her childhood.

Some individuals and some societies believe that children are merely adults in waiting, an unfinished product that a pre-packed education can complete. It is a mindset that belies the capability of children to learn for themselves and devalues life as experienced through a child's eyes. The opposing view is that children should be encouraged to have a childhood.

Family circumstances play a pivotal role in shaping childhood experience. We hear a lot about the extraordinary resilience that children draw on to adapt, function and survive.

The anxiety experienced by the then nine-year-old Abigail Adamson over the safety of her mother, Chloe, and grandfather, Bryan, who both have alcohol addictions, proved overpowering. She and her younger brother Tom, then six, were placed in foster care following her parents' break-up.

"Abigail developed an overriding concern for her mother and was anxious to know that she and her grandfather were managing OK," says intensive support service manager, Kath Smith. "She needed to know her mother wasn't getting into alcohol misuse. All she could think about was: Is mummy safe? Is mummy coming home tonight?"

But Abigail was sabotaging each placement because she wanted to go home and live with her mother and grandfather. So about a year ago the family was referred to the intensive support service.

This service was set up because emotionally or psychologically damaged young people with resultant testing behaviours and characteristics all too often ended up in specialised residential units rather than receiving local services. Such placements also took young people away from their homes, peers and communities, which risked adding to their sense of rejection and isolation.

The Isle of Wight's intensive support service consists of four agencies (health, education, social services and substance misuse) and works with children, says Smith, "who are struggling with their social environment, are not be able to sustain a placement, are excluded from school and have mental health problems in the broadest sense".

At the first meeting with the team, Abigail made clear she was not going to go to school. "If the subject was raised, it was met with a rude comment," says Smith. "We embarked on creating a care plan alongside the work being carried out with mother, who was working with the island's alcohol support service. We put together an educational programme which could be delivered at home or in an appropriate community facility." The intensive support service now has its own classrooms for such programmes.

While looking at Abigail's mental health needs and improving Chloe's parenting skills, the team put together a care package with social services to allow Abigail to return home. Smith says: "Over the year Abigail has developed a confidence in her mother's ability to reduce her alcohol consumption. Knowing that someone else was caring for her mother freed her up to engage with us and become a little girl again."

Children referred to the service may be, say, 12 years old, but have an educational attainment age of eight and an emotional age of four. "We measure where they are educationally and emotionally. We then create a plan to help the child engage in play activities - maybe to take them down to the beach to feed the birds, or take them on a nature walk. During these times children can begin to engage in conversations which can help them make sense of their world.

"We also take our children to the Cats Protection League. They enjoy that and often gravitate towards the animals that have been rejected. We walk the dogs at the RSPCA. And the young people love cooking: so part of their programme is spent in the kitchen."

The team's work with Chloe and Abigail centred on early childhood intervention. "We looked at working in a pre-school play environment, so they could learn to play together and learn to communicate in a different way. This helped bring the caring role back from the little girl and place it in its rightful position - with the mother," says Smith.

This work progressed so well that Abigail has now said she is ready to go back to school. "That was a huge step forward," smiles Smith. "We're liaising with the local education authority and a local school about her future."

With stability slowly returning, Chloe's hope now is to get Tom, who is still in foster care, back home as well.

Arguments for risk

• If a positive outcome was to be achieved it was crucial to understand that Abigail could not be away from her mother. She sabotaged all foster care placements to this end. A secure placement on the mainland would have only served to raise Abigail's anxiety about her mother's safety.
• A mainland placement would also prove expensive and isolating.
• Chloe was making enough progress on her alcohol addiction and parenting skills to warrant confidence that she wanted to change. With support from social services and the intensive support service team, Abigail could be helped to move back home.
• The team built up a relationship that would benefit Abigail educationally. She had an individual programme with a teacher from the intensive support service. Also the team's ability to work therapeutically with children with challenging behaviours, including verbal and abusive language, meant they could show Abigail how to develop different ways of managing trauma and conflict.  
  
  Arguments against risk
  
• While Chloe did seemingly provide reasonable parenting to her children at first, the break-up of her relationship with the children's father meant that her ability to cope quickly deteriorated, resulting in the children being placed in care. This outcome suggests that when the going gets tough, Chloe lacks the responsibility and conviction to work things through to resolution. 
• The children were placed with separate foster carers. Being apart from her brother may have contributed to Abigail's challenging and disruptive behaviour. Perhaps if they had been placed together Tom would have had a calming influence on his sister, resulting in a stable placement. The children may then be returned home once Chloe proved herself able to cope and to take parental responsibility once again.
• Tom is still with foster carers. This suggests that Chloe is not yet ready to cope with him, but she has been thought capable, albeit with support, of caring for Abigail. Surely, either she is or is not a competent parent.
  
  Independent comment 
  This case provides a shining example of what can be achieved if resources are used creatively,  writes Patrick Ayre.
  
  Specialist out-of-county provision is almost inconceivably expensive, yet few authorities have a flexible, responsive in-house alternative. But it's not about replicating institutional provision on a small scale locally; it's about staff who have the confidence and competence to assess what is required in each case and the resources to implement it.
  
  The introduction of intensive support services can prove disastrous if a department does not appreciate that although often cheaper, they are not cheap. In placing Abigail at home, the team accepted the onerous responsibility of ensuring her safety, both physically and psychologically. Her emotional development has been severely affected by her topsy-turvy relationship with her mother and she clearly needs a great deal of help in realigning her ideas about what being a child means. 
  
  The team's sensitive and person-centred approach is crucial to this. For them, there is no comforting standard procedure to follow, no off-the-shelf set of rules; there is just a vulnerable and damaged mother trying to make a life for her vulnerable and damaged child. Smith and her team give hope to those of us who had begun to fear that, in our obsession with procedures and process, we had all started to forget why we are doing this job in the first place.
  
  Patrick Ayre is senior lecturer at the University of Luton and an independent child welfare consultant