Should he stay at home?

CASE NOTES

PRACTITIONERS: Alison Scott, intensive support worker,
education; Jacki Hayes, education liaison, and Kath Smith, manager,
intensive support service. 
FIELD: Children and families.
LOCATION: Isle of Wight.
CLIENT: Ben Turner, 10, is the oldest child who
lives with his mother, brother, sister, stepfather and baby
stepsister.
CASE HISTORY: Ben’s parents split up three years
ago and his mother has recently remarried. Ben has a high level of
fear because he was placed in situations he could not handle, such
as domestic violence and substance abuse. He stayed out late at
night unaccompanied since he was very young and mixed with older
children. He had no pre-school experiences or preparation for
mainstream education, and consequently changed schools frequently.
He spent time in care which meant him being moved off the island to
mainland residential care, again resulting in exclusion. This also
added to his emotional damage and also proved financially
expensive.  Additionally, Ben has a hearing impairment, for which
he did not receive treatment until he was five.
DILEMMA: Although Ben’s was an education referral
it became clear that his witnessing of domestic violence and his
mother’s inconsistent parenting were significant factors.
RISK FACTOR: With pressure to reintegrate Ben too
quickly back into the mainstream, the underpinning issues may
remain unresolved.
OUTCOME: Ben continues to live at home with
ongoing support from the intensive support service.

As social care is these days shaped by targets and time-limits it’s
worth remembering that making the time and space to work at a
service user’s pace and reinvesting in core social work values can
reap lasting dividends.

For many damaged young people, in particular, there are often no
quick fixes; sometimes services have to hang in there for the long
haul.

Damaged young people with testing behaviour often end up at
supposedly specialist care homes, which often only fence- in
problems. For the Isle of Wight, which has no children’s
residential services, this also means sending young people across
the water to the mainland; young people such as 10-year-old Ben
Turner.

However, Ben was brought back home after being referred for
assessment to the island’s intensive support service, a specialist
team made up of four agencies – health, education, social services
and substance misuse.

Ben is aggressive, especially verbally, and has symptoms of
Tourette’s syndrome. He has a hearing impairment and language
difficulties which have delayed his social interaction, emotional
development and relationship-building.

“The complexities at home mean that Ben is unable to share and talk
through experiences and has become used to holding on to his
fears,” says education liaison Jacki Hayes. “He tends not to seek
out adults as a source of comfort and doesn’t trust them.”

Ben had an underdeveloped sense of risk, which manifested itself in
actions such as running out into the road, and asking questions
such as “What would happen if I jumped out of the window?” (he
lives on the second floor).

Through the work with the intensive support service, he is now able
to ask questions and explore and become more aware of the world in
which he is living. “Education is the focus for our work with Ben,”
says intensive support worker, Alison Scott, “because the way Ben
needs to learn and what he needs to learn in order to move on are
at odds with our mainstream education system, as is the case for
many of our children. Because of this, he has a history of
exclusion which included specialist mainland provision.”

Manager Kath Smith continues: “In his care plan we are looking at
the disparities between Ben’s chronological, emotional and
educational ages. This means taking Ben back to pre-school
activities and curriculum, stimulating the development of the
building blocks essential to both his educational and social
development.”

This is being interspersed with age-appropriate education. “Through
this approach Ben is growing in confidence and self-esteem,” adds
Hayes. “Because of the way in which the educational work is carried
out, we have identified areas of concern that relate to social care
and to therapeutic need and address these within the weekly
care-planning session.”

Through a good working knowledge of each child, the team is able to
identify small but significant signs of emotional or physical
discomfort that the child is trying to deal with. It may be, as
with Ben, a case of prompting and support to use the toilet because
of his fear of monsters. Relationship-building is crucial for the
team’s work. “Ben’s teacher is attuned to his needs, can push him
and move away, can let him cope and support him, all as
appropriate, thus truly meeting his needs,” says Scott.

When a child is ready to begin the careful integration to
mainstream the team forges strong supportive links with the school.
“Those who have developed a solid understanding and capacity to
work with the child link with key school staff,” explains Smith.
“We have been able in the past to put in the necessary classroom
support to enable the child to see themselves as capable of
managing the environment and therefore to develop the confidence
and skills they will need for mainstream integration.

“This also allows for school staff to really get to develop their
understanding of the child. Time and personnel are issues, but
reducing either are false economies.”

Within the package is support to help Ben’s mother and family look
at problems and be able to work with Ben’s progress. “Mum has her
own needs that we need to consider as they relate more directly to
her capacity to parent,” says Hayes. “We need to work with the
parents to identify needs and to support them to ensure long-term
maintenance of progress and to break the bonds that hold these
families down.”

And that, of course, will take time, patience and
perseverance. 

Arguments for risk

• A mainland placement, which is the alternative, will only
  succeed in taking Ben away from his home, peers and community,
  thereby possibly adding an extra layer of rejection and isolation
  onto his vulnerability.
• The team needs time to develop trusting relationships to ensure
  its desired outcomes. “The measures we use might appear small,”
  says Smith, “but when people ask what we have achieved with young
  people, we say they are getting out of the bed in the morning and
  coming to us, at the time that we’ve arranged to meet them. And
  they carry out a task that we had planned to do.”
• The team takes a risk as a service by challenging the standard
  approach that moves children and families through systems hastily:
  the need to take steady steps may not be recognised. If Ben is
  moved on too quickly it is highly likely to undermine his progress,
  as has been seen with other children.

Arguments against risk

• It is not known to what extent the family can be engaged as a
  whole and this needs to be fully considered. When a challenging
  child remains in a home where the adults are struggling at times,
  there is always a degree of risk as boundaries will be pushed and
  routines broken. Any good work could be undermined by such
  behaviour.
• This chosen path means that the workers of the intensive
  support service will need to work hard to ensure that Ben’s mother
  and stepfather are supported to continue the work at home. If the
  parents do not fully engage in the agreed service the benefits of
  the work will be reduced.
• In these types of cases there is often a history of difficulty
  in both maintaining engagement, in applying parenting skills
  consistently and in sustaining what is learned, whereas if Ben had
  been placed in a specialist residential and educational
  establishment these strict parameters could be consistently
  applied.

Independent comment

Budgetary constraints and the ever rising cost of specialist
out-of-county residential provision are leading many local
authorities to rethink radically
their provision for young people who display challenging behaviour,
writes Patrick Ayre. 

A wide range of in-house facilities has arisen to meet this need.
The least innovative, and often the least successful, are attempts
to create cut-down local versions of specialist residential
services. Because of their small size, such homes often lack the
depth of staff expertise and specialist support available in the
establishments they seek to reproduce. More effective are projects
such as the Isle of Wight’s intensive support service.

Even the best out-of-county residential services struggle when the
child returns home. The improved behaviour is not maintained when
the young people are  back among families where life is often
chaotic and frequently abusive.

By contrast, the intensive support service is working creatively
and effectively to help Ben to overcome his poor experiences of
parenting while remaining in his family home.

However, as they recognise, their success will always be in some
doubt unless it proves possible to engage Ben’s parents in change
as well. To achieve their full potential such services need to
address both the child and his context.

This requires them to devote as much of their energy and expertise
to devising strategies for engaging hard-to-reach parents as they
do to devising strategies for work with young people.

Patrick Ayre is senior lecturer at the University of Luton
and an independent child welfare consultant