She can be a child again

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