Helping a ‘lost child’ regain self-worth

After a catastrophic early history of neglect and abuse, a child is then pushed over the edge by the death of his only sibling

CASE STUDY

SITUATION

David, now 12, and his sister Rachel, then six, were taken into care five years ago after being abandoned following the death of their mother, Moira. She had been a crack-cocaine addict and suffered clinical depression.

While overdosed on drugs she had also been physically and sexually assaulted in front of the children before her death. Their father had died of a drug overdose soon after Rachel’s birth. Moira had become involved with men on the drug scene, spending the last two years of her life moving her family from squat to squat with a man who would pimp her in order to pay for drugs.

David and Rachel became “lost children” and were severely neglected, often starved (her mother often forgot to feed them) and regularly beaten. Rachel – but not David – was also sold for sex.

PROBLEM

Efforts to keep the siblings together were thwarted because of their challenging behaviour. David was violently protective towards Rachel, whose self-harming left her regularly hospitalised. David blamed himself. He was violent, verbally and physically aggressive and would vandalise each of their foster homes. He also sexually and physically assaulted other boys and girls.

The siblings were split up – Rachel placed with foster carers and David in a children’s home. Soon afterwards, Rachel died after throwing herself through her bedroom window. Uncontrollable, David was placed under secure psychiatric care.

He has since been moved to several secure establishments. However, a newly allocated social worker wants to try something different.

THIS WEEK’S PANEL

John Diamond, Chief executive, Mulberry Bush School, Oxfordshire
Andrew Durham, Consultant practitioner, Sexualised Innapropriate Behaviour Service, Warwickshire
Mary Walsh, Chief executive, SACCS
John Ball, Consultant therapist, New Forest Care
Maeve McColgan, Family therapist, Leicestershire CAMHS

PANEL RESPONSES

John Diamond

My first thoughts were to reflect on my sense of despair at the depth and intensity of the multiple trauma and chaos that David will have internalised during his experience of this catastrophic case history.

This sense of despair might also be seen as a reflection of the despair, mistrust and sense of abandonment that David will be living with. Because he has been failed by the adults who were meant to look after him, it is not surprising that he is unable to live within any construct of “the family”. He requires the physical containment of a secure establishment to meet his need to feel emotionally contained.

This will be long term and costly work. Given his history of triple bereavement, damaged attachments and severe neglect, maintaining a relationship with anyone will be difficult for him. The answer is to create a long term rehabilitation plan within the secure environment.

A psychotherapeutic assessment would identify the need for long term therapy and a key worker to focus on meeting David’s more day-to-day infantile needs. The keyworker would need to be both robust and sensitive to manage the range of strong feelings that David will communicate.

The aim would be to provide David with emotional stability through purposeful and caring routines, and to work through his grief and feelings of abandonment.

If David is able to respond to a relationship-based intervention, then, with time, a move from secure to a more open residential setting would match his growing sense of self-worth. From here on, attempts might be made for gradual reintegration into a specialist foster family.

Andrew Durham

There are significant bereavement issues in David’s life which would be difficult for any boy his age. He has been severely neglected and is therefore likely not to have the emotional resources to cope.

There appears to be no significant adult in David’s life at present to whom he can turn to. Added to this, he has also lost his only sibling. David has also been exposed to negative male role models, and is likely to be more vulnerable to being influenced by the behaviours they have modelled, because of the lack of any other guidance.

David has regularly witnessed physical violence and sexual aggression it is possible that he may have been sexually assaulted himself. David has expressed his anxieties in probably the only way he feels he can. Unfortunately these behaviours present significant risks to others and the immediate focus has had to be on his containment.

Now in a secure establishment it is unlikely David will move to a less secure setting until it can be demonstrated that his risks can be managed by him and by those around him. He needs urgent therapeutic help in a secure enough therapeutic setting. It is important that he receives specialist work that will engage him meaningfully and help him process the traumas he has experienced and undo the negative perceptions he has about himself.

For many reasons it is not unusual for a child in David’s position to feel responsible for his losses and problems. Equally, this therapeutic work will need to help David to see how and why some of his responses have hurt others. In this context, David will need a comprehensive programme of work around sexual behaviour and sex and relationship issues.

It is important for David’s therapeutic setting to be staffed by carers who will be supported in providing appropriate caring responses and setting out boundaries for him, providing good adult role models.

THE USER VIEW

Mark Houston

The social worker is quite right in wanting to try something different and I believe it could be very feasible as well as in David’s best interest.

Nevertheless, it must be remembered that there is no quick fix. David has experienced horrific trauma and has had little continuity. We also know that, all through his life, he has felt the blame for all the difficulties he and his family have encountered. All this must have left him with deep-rooted psychological and emotional problems, which will affect his thinking and ability to cope in different situations.

For example, certain environments may trigger painful memories and lead to him behaving unpredictably, and key workers need to be aware of such environments.

It is very important that David is involved in making decisions around future placements for himself and I believe that the first step should be for the social worker to discuss with David at length the long-term aims and the various options.

David is in desperate need of some stability and so forward-planning and thinking decisions through very carefully is essential. Unless the social worker can be fairly certain of success, it would be wrong for David to change placement.

I would hope that David would be able to move on from secure accommodation in the not too distant future. Nevertheless, I believe that wherever he is placed he will need continuing emotional support and possibly continued psychiatric treatment. Not surprisingly, he has trouble in expressing his feelings and emotions, so David might also need help to manage his anger and frustrations.

His deep-rooted emotional problems could lead to things changing very suddenly without warning. He will therefore need to be monitored and reviewed regularly, even at times when he appears to be making good progress.

David’s past has clearly led to him having very low self-esteem and a lack of motivation. He therefore needs help to recognise his achievements and appreciate his strengths and attributes. If he has been in psychiatric care and secure accommodation for some time, he is likely to be becoming more socially excluded and isolated, which will also impact negatively on his emotional wellbeing. Support to mix and integrate with his peers would therefore be very beneficial.

While academic progress may not seem the current priority, I think it is important that he is encouraged to engage in education and convince of his abilities to succeed.

● Mark Houston is a care leaver