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A therapeutic placement for a troubled teenage girl has to end.But where is the best place for her now? Our panel advises

Case Study
The names of the service users have been changed

SITUATION: Amy Ashton, 14, has lived with her grandmother, Pam, on a residence order for several years. Amy’s mother, Alana, is a long-term chronic drug user, who has had spells in prison due to drug-related offences. Although she lives nearby, Alana agreed to only have minimal contact with Amy, which Pam insists must not take place at Alana’s flat because of the people who frequent it, but rather at Pam’s house.

PROBLEM: Social services became involved when Amy began to visit her mother more frequently, against Pam’s wishes. Alana agreed through multiagency child-in-need meetings not to encourage Amy to visit. However, Alana and Amy continued to meet at Alana’s flat. The situation escalated with Amy frequently going missing from home, being found by police dishevelled and under the influence of alcohol or drugs or both. Amy was also found in the company of older males, creating concern she may have been prostituting herself. Recently she went missing for a
month. Social services – against Pam’s wishes – placed Amy in an out-of-authority therapeutic placement, where Amy settled well. Pam visits weekly; Alana has not visited. However, the placement is prohibitively expensive and Amy will have to rejoin school in her GCSE year. However, the service provider and Amy want to continue with the placement. Additionally, Pam, who opposed the placement originally, does not want Amy back yet.

PRACTICE PANEL Children and families, Warrington Social Services

PANEL RESPONSES
LISA JAMIESON
If this case took place in Warrington, as the fostering team manager I would need to have several questions answered before I could decide on the best placement for Amy.

I would need to know whether Amy’s needs require her to be looked  after or whether she is ready to be returned to her grandmother’s care. I would need to know what work had been completed with Amy, what assessment of this work had been carried out and what outcomes had been achieved. I would also need to know why Amy’s grandmother is not willing to welcome her back yet and what further work or progress she is expecting.

All of this information is important as it will provide the basis upon which to make the right decision. It may also indicate that work may need to be done with Pam to help her to have realistic expectations.

After receiving answers to the questions above I would request a multiagency meeting to review Amy’s progress and her current needs. The meeting would include a representative from the  local authority education department as Amy is at a vital stage in her education and decisions would need to be made about which school she should attend. The family placement team would also be involved both from the local authority and the independent provider.

If Amy needs to remain in foster care I would look at the service provided by the independent agency, especially the therapeutic input, and would want to know whether a local foster placement could offer the same service with additional support from the local authority’s therapeutic team.

A local foster placement would enable Amy to return to school and have continuity of education after she is able to return home to her grandmother. I would expect a package of support to be arranged to address Amy’s self-esteem, as well as look at her drug and alcohol misuse.

To complete the information and to ensure that the cycle does not continue after Amy returns to live with her grandmother, I would also like to know what work was undertaken with Amy’s mother. It seems crucial that such a resumption of contact between mother and daughter is prevented.

PATRICK MELIA
Although the decision had been made to withdraw provision from the outof- borough placement, children’s services should continue its duty of care in providing a safe, secure and learning environment.

It is clear from the young person’s progress within this placement that the strategies implemented have been successful in addressing the concerns which Amy had been displaying while living at her grandmother’s. Professionals should meet to discuss strategies, timescales, resources and the options in returning to education.

This discussion should include how care and control were achieved and what strategies could be realistically employed in any future care plan, thus ensuring consistency of Amy’s future care.

Any plan should include the wishes and feelings of Amy, her mother  and grandmother. Pam is clearly attached to her granddaughter, having provided seven years’ care. The transition between placements should adhere to comments made by current placement and family members when deciding a plan of action.

Although Pam experienced difficulties in coping with Amy’s lifestyle and ensuring that boundaries and contact with Alana were monitored and managed effectively, there is no evidence that would suggest Pam received support in ensuring Amy’s welfare was maintained.

I believe an opportunity should be available for Amy to return to her grandmother, with support being available. However, there does remain a risk of Amy being influenced by her mother and other adults so a referral for an emergency placement may be needed.

The fostering service could provide this contingency in offering a family oriented placement. Future contact with Alana needs to be monitored more effectively with services taking a lead role in protecting Amy from risk of significant harm.

The agreed date of the placement with Pam should follow immediately after the therapeutic placement and before the academic year begins, so as to avoid any gap in services. The placement should be reviewed through a child-in-need meeting, preferably within four weeks of any plan being implemented.

USER VIEW
Considering what Amy has probably been through during her childhood, it is not surprising that she is facing these difficulties, writes Mark Houston.

A long-term aim should be to re-integrate Amy back into her community, and it is encouraging that Amy’s schooling is seen as a high priority. The fundamental question is when such a transition should be made.

An integral part of social work practice should be to listen to young people and act upon their views and feelings. The fact that Amy has requested to stay at the therapeutic unit indicates that, emotionally, she may not be able to cope back in her community without a high level of extra support. Her wishes need to be respected and taken seriously.

Further, Pam has said that she does not feel it appropriate to have her back, which further suggests that rehousing Amy with Pam may be unwise. It could lead to another breakdown, thus creating more disruption for Amy.

Nonetheless, it appears that staying at the therapeutic unit will not be a feasible option and another care placement will have to be arranged. The social worker should speak to Amy at length,
explaining why she will have to leave the unit and discuss other courses of action. It is also important that Pam is involved in deciding the next step.

I think there are two options: place her in foster care or one of the local residential units; or with Pam. Living with Pam again would, in many ways, seem the most sensible option, since Amy knows her well.

However, Pam has voiced concerns, and social services should find out exactly why she is reluctant to have Amy back. It is likely that more support would be needed. Social services should also look into why the therapeutic unit has been so beneficial and then consider what additional support could be provided in Pam’s home. For example, it may be worth buying in some kinds of therapy and arranging mentoring support.

While at the therapeutic unit, Amy has had no contact with Alana. But the fact that Amy had started to visit Alana regularly implies that she is keen to maintain a level of contact with her.
 
One must remember that it is very normal for children to still love and respect their parents, regardless of how they behave. Therefore, while it is crucial to protect Amy from crime and exploitation, some contact must be maintained.

Mark Houston is a care leaver