A history of neglect and abuse led a girl's behaviour to be difficult to contain. After a series of failed foster placements, three years at a therapeutic school directed by John Diamond introduced stability. Graham Hopkins reports
The name of the young person has been changed
PRACTITIONER: John Diamond, director Mulberry Bush School.
FIELD: Therapeutic care and education for children with severe emotional and behavioural difficulties.
CLIENT: Lucy Johnson, now 10, but aged seven at the time of her referral, has been in care since she was three.
CASE HISTORY: Lucy was found living in a derelict house, which was used as a base for trading in drugs and sex. In this environment Lucy had experienced emotional neglect as well as physical and sexual abuse from her mother and her mother’s partners. Lucy’s behaviour had become so disturbed and feral that she was found to be eating off the floor with several dogs that also inhabited the house. She had several foster care placements but her behaviour proved extremely challenging and her latest placement, the longest yet, was at great risk of breaking down. Attempts at schooling failed because Lucy’s behaviour
was so aggressive and uncontrollable. As a result, she was severely underachieving.
DILEMMA: A therapeutic placement is available but is an expensive option, but can it save money in the long-term?
RISK FACTOR: The foster carers are struggling to cope with Lucy but a placement breakdown would further damage her emotionally and make her impossible to place.
OUTCOME: Lucy is doing well and the placement remains stable. She attends a local school and, despite being demanding, is no longer “unfosterable” nor unacceptably disruptive in school or other social situations.
Lucy Johnson had an appalling start in life. She grew up in a derelict house used for selling drugs and sex. She was neglected by her mother and sexually and physically abused. Detached from any relationship, she would eat food off the floor with the dogs that lived in the house. Lucy was taken into care and finally placed with experienced foster carers. But they struggled with her. Her behaviour included wetting, smearing, self-harming, aggression, insomnia (which required one of her carers to stay up all night with her), affection to strangers, excessive masturbation, extreme controlling behaviour and cruelty to animals.
Lucy was referred to the Mulberry Bush School, which provides therapeutic residential care, education, treatment and therapy for children aged five-12, who have severe emotional and behavioural difficulties because of early trauma. “I’m sure Lucy’s foster placement would have broken down without our intervention,” says school director John Diamond. “The foster placement needed respite from her demanding and destructive behaviour.” Indeed, a play therapist previously involved with her said: “She brings chaos and destruction into everything she does.” The school uses a combined educational and nurturing process called “learning to live and living to learn”. The first part focuses on re-establishing the developmental building blocks that nurturing experiences can provide, offering children a chance to re-experience caring, positive and clear relationships with adults and their peers.
“We provide containment of behaviour and, within that, a focus on nurturing and attunement to their very complex needs,” says Diamond. “Within that attunement, we try to help the child re-attach to adults.”
Placed in one of the four care and treatment households, living with eight other children and a staff team, a reliable daily routine was set up. “The staff managed and resolved the frequent behavioural breakdowns, arguments, rivalries and the general
antisocial behaviour of the group,” says Diamond. “With time Lucy responded to this reeducation in relationships and started to understand that she could be helped to engage with normal and respectful social living.”
One particular aspect in building Lucy’s self-esteem was tackling her poor personal hygiene. “She was allowed to stay back and not attend school for the first half-hour each day so she could have those needs cared for,” says Diamond. “She was helped with bathing and hair washing and had a parental figure supporting her. This allowed her space to be looked after and fulfil a prime need: to experience a close and caring relationship.” Lucy’s education began with filling in the gaps of her early childhood. “First, she was helped to enjoy learning once more,” says Diamond. “In addition to following the national curriculum, we encourage children to play, often with pre-school equipment, listen to stories, and to sing and dress up.”
The school runs a 38-week year, allowing for home stays for “reality testing”. Initially, Diamond says, Lucy’s home stays with her foster carers remained difficult. “Inevitably, with the first few breaks from school Lucy tested boundaries. We find that it usually takes about six months or so before young people start feeling more internally content – accepting of boundaries, such as meal times and bedtimes.”
And so it was for Lucy. “Her foster carers could see she was becoming more articulate about her needs and displaying more loving and affectionate feelings,” says Diamond. Educationally, Lucy progressed from the foundation stage to a “second tier” class where expectations of behaviour, application and learning are higher. Diamond says: “She was still a noisy child, readily distracted and easily led into others’ misbehaviour but she made good progress and was able to move to the top class a year before she left the school.
During this last year she successfully participated in a weekly visit, supported by staff, to a local mainstream primary school.”
After three years – the average time required to go through the treatment process – Lucy was able to return home permanently to her foster carers. “She did tremendously well here,” says Diamond. “It wasn’t about becoming totally independent and having all her issues resolved; it was about incremental change given that her prognosis at the point of referral was so poor and she was so deprived and so mistrustful. For her to remain in the foster home was a huge achievement for her.”
ARGUMENTS FOR RISK
● It was crucial, given her early life, to re-integrate Lucy into a loving family relationship. The foster carers could do this but were struggling. The school placement offered some respite for her exhausted foster carers who were able to recharge their batteries during term time and show her that she did have people who cared for and loved her.
● The school’s strong multi-disciplinary approach, which integrates education, care, therapeutic and family work, were just the elements that Lucy needed resolving in her life.
● Lucy’s foster carer placement was at breaking point. It became clear that a breakdown was inevitable without additional expert help. Lucy’s life experience had, understandably, been hugely damaging – making her distrustful, aggressive and
behaviourally challenging. The therapeutic approach helped restore trust not least by giving Lucy her childhood back – and helping her realise she could start again.
ARGUMENTS AGAINST RISK
● Lucy did not want to be in a safe environment – her whole childhood existence had been built on resilience and self-preservation. She could never trust people – and why should she? All her instincts, learned or natural, were to hit out and keep relationships at a distance. It could be argued that Lucy and the carers were being set up to fail. All of which would have undermined further any future work with Lucy and made all those involved feel like failures.
● Given her excessive challenging behaviour, placing Lucy with foster carers was inevitably forcing a situation upon well-meaning people that would cause huge problems and probably backfire. No matter how well supported, foster carers can never be as qualified, skilled or experienced as specialised staff working in secure settings.
● Therapeutic work with children and young people is also expensive and a bit old-fashioned for modern social work.
Lucy’s story is a remarkable one, and provides a powerful reminder of how much can be achieved through intervention that is timely, skilled and driven by the needs of the child, writes Patrick Ayre.
All too often, a girl of Lucy’s age might have found herself being passed from foster home to foster home, each successive breakdown damaging not only her own self-confidence and selfesteem but also that of the foster carers, who may have perceived themselves as failing. However, though she was only seven, she was given access to the therapeutic support which she required.
Despite the increasing influence of research and professional knowledge on practice in recent years, unhelpful half-truths and misconceptions often still cloud social work thinking with respect to work with young children who have suffered severe early deprivation. In this field, excessive optimism and excessive pessimism are both common.
Many social workers seem to feel that, whatever a young child’s experiences, if you place them in an atmosphere in which they are shown warmth, affection and positive regard, all will be well. But Lucy’s life experience to date meant that she did not know what to do with love and affection and needed help to learn about what they meant from first principles.
The proponents of pessimism seem to believe that, by Lucy’s age, the damage has been done and cannot be undone. However, given good guidance and support, young people can overcome severe early disadvantage .
Patrick Ayre is an independent child care consultant and senior social work lecturer at the University of Bedfordshire
This article appeared on page 42 & 43 of the 12 October issue, under the headline She ate with the dogs