Sister act

It is considered good practice to keep siblings together
wherever possible, but sometimes this can be very difficult to
achieve, particularly when one child is perceived to be destructive
to the placement. This was the situation faced by Essex social
services in the case of Abby and Keeley Hart.

It was important to find ways of listening to and understanding the
emotional pain of these children. Was Keeley so torn apart that it
could only be conveyed by tearing apart other people’s property? To
reach a conclusion, the children needed to be assessed both
individually and together, and this was achieved by intensive
therapy aimed at building trusting relationships. Many traumatised
children behave in ways which are often described as “disruptive”.
To reduce anxiety, the children were encouraged to direct the
activities and to tell their own life stories symbolically.

Principal social worker Jenni McRae noted early on that Keeley
desperately needed to have the complete attention of a parent –
something she had never experienced at home. “Her behaviour
certainly brought attention, and negative attention was better than
none,” says McRae. “Keeley’s play suggested that she thought that
‘all mums were nasty’, so foster mothers were no different.”

Therapeutically, Keeley needed to re-work this missing phase in her
development. She did not trust anyone, expected to be rejected, and
resisted well-meaning carers before they rejected her. This pattern
had to be interrupted and repaired, or it would continue into
adulthood.

“A few weeks into the therapy, Keeley lined up teddy bears and
began, very symbolically, to feed them,” continues McRae. “Each
bear represented a significant person, always male, never women,
with the exception of Abby. So I knew that she was an important
attachment in her life.”

Abby, however, had learned how to manage her pain by keeping quiet,
being compliant, and hiding behind her sister’s acting out. “This
made her much more acceptable to carers, who found it easy to
attach to her,” says senior practitioner Sarah Carter.

“We had concerns that Abby showed signs of depression early on in
the sessions, always having to be this good enough child,” adds
McRae. Carter agrees: “There were times when you could see her
thinking her actions through: ‘How do I get this right? How do I
please this person?'”

Between them, Carter and McRae became the good enough mother
missing from the girls’ lives. “We had sought to be role models,
always looking the same, always speaking in the same way, and never
shouting,” said McRae. “They needed to learn how to predict.”

If they could not make a session, the workers would write to the
children personally, including pictures.

“They needed to know that we would not let them down,” says McRae.
It was clear that the girls had a valuable attachment to each
other, and as they had already suffered so many losses and
rejections, it would benefit them both to remain together.

Keeley’s anxiety needed to be understood and responded to, whenever
she gave the signal by acting out and controlling others. Abby
needed to be released from the responsibility of always being
“good”, and experience what it would be like to be herself.

When a prospective long-term family came forward, the Lionmede
workers became involved in the assessment to discover if the family
could recognise and meet both girls’ needs.

“We were clear about expectations, and that it was important that
this was the last move as we were seriously worried about their
long-term mental health if they were moved again,” says
Carter.

Although they have moved away from the area, similar services have
been put in place, so that the therapeutic work continues. But this
time for the girls, unlike the past, the separation has been a
positive one. “It was a good goodbye,” adds Carter.

The children are happy and blossoming. They are, for the first
time, being given space to develop their own personalities.

As the children’s current social worker remarks: “Outcomes like
this reassure us and remind us why social work exists, to make a
difference to people’s lives.”

Case notes

Practitioners: Jenni McRae, principal social worker, and Sarah
Carter, senior practitioner.

Field: Mental health assessment and treatment service for
looked-after children.

Location: Essex

Clients: Sisters, Abby (aged seven) and Keeley Hart (five) have
been in the care of the local authority almost since birth – their
mother was drug dependent and their father’s whereabouts was
unknown.

Case history: The children (always together) had a history of
disrupted placements, mainly because carers viewed Keeley’s
behaviour as unmanageable. She repeatedly demonstrated her despair
by breaking things and by controlling others. Most carers were keen
to keep Abby, who was seen as compliant and loving, but not Keeley.
Their individual needs seemed so diverse. The children were then
referred to the Lionmede Centre, which offers a rapid response
short-to-medium term multidisciplinary assessment and treatment
service, to assess the emotional needs of the children, and the
quality of their sibling attachment. Also, to advise whether they
should remain together or be placed separately. The work had to be
focused and intensive.

Dilemma: Should the sisters be denied the chance to be brought
up together because the adults in their lives can’t manage
them?

Risk factor: How long must this pattern of placement breakdown
be repeated to the detriment of both children’s mental health?

Outcome: Both children have now been placed together with
long-term carers and are thriving in their new environment.

Independent comment

The case highlights the need for specialist and dedicated
therapeutic services for children requiring permanent placement,
writes Alan Burnell. It is very important that children such as
Abby and Keeley are seen first in the context of their traumatic
past, rather than as a failure of parenting in the present. It is
Family Futures’ experience that, as in this case, when Jenni MacRae
and Sarah Carter were able to address the children’s traumatic past
and provide them with a constant and safe relationship, that their
behaviour began to change before a permanent placement was made. In
order for children to make secure attachments to permanent carers,
it is essential that therapeutic work is done as early as possible
in the placement process, as only then are children freer to begin
to form secure and healthy attachments. It was heartening to read
that the workers involved systematically considered the risks
involved in the children being placed separately and together,
rather than just assuming that placing them together was “a good
thing”. The priority has to be that each child need’s to be
re-parented and to form a secure attachment to a safe, caring
adult. For this to be achievable, intensive support and therapeutic
input are essential. I believe that, without the therapy, the
sibling placement would have been unsustainable as in previous
placements.

Alan Burnell is director of Family Futures, an agency
specialising in adoption assessments and post-placement
therapy.

Arguments for risk

• Despite the history and pattern of placement breakdowns it was
  clear to the workers that Abby and Keeley did have an attachment,
  and that Keeley’s behaviour had caused people to miss this. Their
  relationship needed to be worked on.
• By targeting the children’s emotional neglect and abuse, the
  workers were able to begin to positively fill those voids. It was
  recognised, through the team’s specialism, that Abby and Keeley
  could not be treated in an age-appropriate way, as they were not
  sufficiently developed emotionally. Therapeutic play helped the
  team understand the different ways these children communicated
  their feelings of abandonment.
• Separating them would not have been useful to either child.
  Once the Lionmede team began to engage with Abby, they realised
  that her compliance was rooted in her need to be accepted. However,
  they were mutually dependent and Keely acted out Abby’s
  frustrations for her. Removing Keeley might cause a deterioration
  in Abby’s well-being.

Arguments against risk

• The department felt there must be a time when it draws the line
  over how many times Keeley would be permitted to break up the
  placement. Her needs could not be met in the same place as her
  sister because she was simply too disruptive. Also, Abby herself
  was entitled to a family of her own. She had a right to be settled
  in one place and not to be moved every time Keeley inevitably
  decided to play up.
• The sisters had been freed for adoption for some time. The plan
  had always been to have them placed together but no carers had been
  found. How much longer before permanent decisions are made that
  give at least Abby a decent chance of stability and
  permanence?
• Carers had been making it very clear that they had successfully
  developed attachments to Abby and wanted to make permanent
  commitments to her, but would not tolerate Keeley.