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• Intervene early. Abusive, neglectful families harm children. Identify quickly those families who lack the capacity to relate to the child with warmth to a degree that the child feels constantly denigrated. This is tied with poor outcomes in children and if the situation cannot change then action is required.

• Make sure every child is in receipt of a good enough education which promotes learning through teaching but also through nurturing. This is important at the secondary level and not just for young children, so design your school so that even the average teacher can have time to attend to a vulnerable child. Schools can provide a place for relationships that help make up for those missed at home.

• Involve other agencies if problems cannot be sorted or you think there will be repercussions for the child later on in life.

• Remind health agencies, education and social services that even if there is no diagnosis, problem solving with other agencies is crucial.

• Obtain relevant advice to put together a treatment package based on a shared assessment.

• If the child is thought to be too dangerous to freely wander then the following considerations become pertinent:

- The child is likely to want to feel secure. This is in relation to a long-term plan and also to physical boundaries in relation to adults being in control and sometimes even physical barriers to absconding or contact with inappropriate friends.

- The child should continue to receive an education as this is a statutory right and an ongoing vehicle to future resilience.

- Good health care should also continue in relation to physical health. The environment should look and feel nice.

- Qualified staff should oversee a treatment programme. Various chapters identified treatment techniques that have been shown to work, particularly multi systemic therapy. This is expensive but reflects the needs of the child as by this stage they are probably suffering from a multiplicity and complexity of need.

- Provide for frequent team discussion with a person who is outside the case as there is a danger that those involved become embroiled in the dynamics of the case.

- Have clear rules that mean that children are treated as children first and not objectified as can easily happen when similar children are placed together. Rules should also inhibit staff from identifying too much with the children.

- Have inspection regimes that recognise the difficulty of the task but also demand transparency in treatment approaches and outcomes. There will be problems but careful review rather than a mechanistic response is required.

- Basics like a stable workforce and funding for the placement over time are important. These children will have experienced instability and being somewhere long enough to begin to feel safe and become understood will be very important.

- Talk frequently to the child through treatment interventions but also provide for others to do so in other settings.

- Have a range of provision. It may be necessary for some adolescents to be kept in secure accommodation but others may benefit from specialist foster care.

- Even when incarcerated in prison remember that these adolescents will also have the needs of others of a similar age for nurturing and care. In fact they are likely to need more of it because of their particular histories. Make sure their problems are being addressed through treatment. Research shows that many will have mental health needs that will need addressing.

- Even if there are no facilities that offer treatment, remember that these adolescents will need to be somewhere where they feel secure. They may be boys, (as they often are) who are hard to control and presenting as bad but often it is the element of sadness in their lives that is fuelling their behaviour. Remember what sad children need and attempt to provide it.

• Respect and reward staff, wherever they are working. Working with these children needs patience and expertise, and you need to keep your staff in post.

• Learn from your experience. There is no better way.

The above is an extract (pages 199-200) from the chapter Children who act dangerously – conclusions, from the book Children who Commit Acts of Serious Interpersonal Violence: Messages for best practice edited by Ann Hagell and Renuka Jeyarajah-Dent.

Jessica Kingsley Publishers, 2006 (Copyright © Jessica Kingsley Publishers 2006)