The Risk Factor: How intensive therapy helped a severely neglected boy

When it comes to the care of children, there is a desire to keep the birth family together or keep siblings together if they have to go into care. But, if followed rigidly, this maxim can actually minimise a person’s life chances.

Sometimes, for example, it may be possible to keep siblings together, but not desirable. The conflict didn’t seem to be a consideration in the case of Chris Haslam and his older brother, Sam. They were kept together both in the family, where their mother neglected and abused them, and in care, despite Sam trying to kill his younger brother no fewer than 10 times.

Family split up

The boys were split up only after Sam’s father reappeared on the scene and took him home. Chris, who had a different father, was placed with his maternal great aunt, Rosa, who had been a nurse. Chris had suffered since he was a baby with nocturnal enuresis (accidental and repeated bed wetting at night). Rosa decided to do something about this and catheterised him – but in doing so burst Chris’s penis and then his bladder. After that he was placed back into the children’s home, and then into a semi-therapeutic community, where he began wandering on to main roads, throwing himself into lakes and urinating over everything.

It was not until he turned 17 that he was allocated to consultant therapist John Ball, who supervises therapeutic staff with care provider New Forest Care, which specialises in working with young people where all else seems to be failing.

“The only other choice at the time was long-term in-patient care – and he didn’t need much tipping,” says Ball. “His mother was diagnosed as a paranoid schizophrenic, and it would be possible to view him in that light as well, although I’m not sure how useful it would be. It would tell you what medication to give him but wouldn’t tell us how to help him live his life.”

Ball began to do some narrative work around the enuresis. “We found that ‘Mr Wet’ was his only friend,” he says. “Mr Wet was the only thing that had been with him throughout his life. For those reasons we decided to leave that alone and, in so doing, it decreased enormously. Having been told that it’s all right to do it, he doesn’t want to do it now.”

Given Ball’s drama therapy background, Chris became suspicious that their work together was like a script, and that everybody was doing everything specifically to run his life for him.

Laughing at behaviour

Ball admits using a few scripts. “A lot of my work with kids is getting them to a different analysis of things that allows them to laugh at their own behaviour – because if you can do that it makes it difficult for them to keep doing it.”

Ball also did a lot of work with Chris on shared experience, sexuality and sexual safety. “He has been in the care system all his life and it is rampant with sexualised behaviour so he was confused about what is right and what’s not,” says Ball. “Chris tells the story of one particular care worker who, he thought, loved him. She was later found having sex in a cupboard with another member of the care staff. This was a denouement in Chris’s life because he then realised that nobody cared.”

Three years with New Forest Care have seen Chris’s life chances improve. “He is a great deal better than he was,” says Ball. “I would say he’s unrecognisable. He’s coming off medication – he needs to handle his own anxiety and doesn’t need props to do it.

“We’ve got him into college – his first education since he was 10. He is also now looking to travel to college on his own, which is about 20 miles away. He goes to the pub – and had a job there collecting glasses. He has become a lot more ­socialised.”

Ball is proud of his team’s work. “When we got him I’d say the odds were 90-10 against him having a real life. It’s more like 50-50 now. There’s been a huge improvement.”

The names of the young person and members of his family have been changed.

Practitioner: John Ball, therapy consultant.
Field: Young people who display challenging behaviour and mental health problems.
Location: South of England.
Client: Chris Haslam, now 20, has one brother. His mother is now dead and his father’s whereabouts is unknown.

Case History: With the family known to social services, a case conference was held in the hospital when Chris was born. It was decided to allow Chris to go home with his mother. Four days later, he was back in hospital having not been fed or given a drink. A week later he was sent home again only to be removed because of neglect. This happened four times. When Chris’s brother, Sam, was discovered to have bite marks from his mother on his penis, social services placed both boys in foster care. Over the next 18 months, 14 failed attempts were made to return the boys home. They were then placed in a children’s home. Social services kept the boys together, even though Sam hated Chris and had tried to kill him on several occasions.

Dilemma: For 17 years, people proved unable to cope with Chris. Why should this time be any different?

Risk Factor: Chris’s behaviour in the past seemed to be containable only in care settings. As he became an adult, it was feared he would end up in prison.

Outcome: His supported placement has seen a marked improvement in his life chances. He is coming off medication and is attending college regularly.

Arguments for risk 

● People are worth fighting for, says Ball. “My feeling is that if New Forest Care didn’t give these kids a service, then they wouldn’t get one. They would be contained, constrained or fall into the criminal justice system.”

● Ball’s preferred approach is to have an open mind about each person, believing that any “problems” in a young person’s life have been placed there as a result of situations and decisions over which the young people have rarely had any say or control. He says: “I’m looking for what the potential is rather than what the ­situation is.”

● Crucially, the time, space and resources that have perhaps been lacking in previous placements are available for each young person.

Arguments against risk

● Undoubtedly, Chris has had a traumatic life. His subsequent behaviour is the product of 17 years of this experience. His behaviour is surely entrenched and simply needs containing.

● Chris’s experiences in the semi-therapeutic community proved that, even if he is a nuisance to others (urinating everywhere and so on), he is a positive danger to himself (wandering on to main roads and throwing himself into lakes). More therapeutic input – certainly outside of secure accommodation – could be the catalyst that leads to this damaged young man taking his own life.

● The care provided – while seemingly effective over a long time – is not cheap. The placing authority will incur significant costs – particularly if he remains with New Forest Care until he is 25.

Independent Comment

Chris’s early life illustrates several of the problems that I most commonly encounter in the course of chairing serious case reviews and offering expert evidence. His first 18 months show us how insensitive we tend to be to neglect and its potentially devastating effects. Too often we suffer what I refer to as a “failure of cumulativeness”: we treat each incident separately instead of adding them together and asking what it must be like to live in this family.

When we combine this approach with an over-reliance on rules of thumb like “children are generally best brought up within their own families or, failing that, with their siblings” instead of detailed individual assessment, we can find ourselves providing services which are perilously close to institutional neglect.

John Ball’s assessment style is refreshingly different. He starts with few basic assumptions and builds his understanding from the ground up. Crucially, in forming his judgements he pays full attention to case history and seeks to place the behaviour which he now observes within its historical context.

Many of the most damaging errors of practice that I encounter arise from a failure to do this. Too often, vital information is lost or workers concentrate on the present and fail to recognise behaviour that has been evident for years.

Patrick Ayre is an independent child care consultant and senior social work lecturer at the University of Bedfordshire

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This article appeared in the 24 May issue under the headline “Life’s drama gets an encore”