Therapy for neglected siblings

CASE NOTES:

Practitioner: Jamie Bromfield, Caldecott Foundation

Field: Residential child care

Location: Ashford, Kent

Clients: George, a 6-year-old boy and his sister Samantha, 5, were subject to a Care Order having experienced chronic neglect and abuse.

Case History 

As looked after children, George and Samantha were placed with foster families together. George has assumed an ‘adult’ persona caring for his sister, but this has resulted in confrontation with foster carers and placements breaking down.

Dilemma

Whether to continue placing the children together in the hope George’s behaviour improves, put them with separate foster carers or address the problems with therapy in a residential setting.

Risk Factor

The siblings are the only constant feature in each others’ lives so splitting them up could seriously damage them. However, George’s relationship with his sister is undermining efforts to establish a long-term foster placement.

Outcome 

By placing Samantha and George in a residential home for a period of assessment and therapeutic intervention, it is hoped that they will be better able to live together successfully with a new foster family.

COMMENTARY

A stable foster family is normally the best environment to place looked after children. But sometimes the most vulnerable children, damaged by years of neglect, can present behaviours too challenging for foster carers. When fostering arrangements repeatedly break down, sometimes a therapeutic placement is necessary.

Samantha and George were referred to the Caldecott Foundation by their local authority. They had a history of foster placement breakdowns and an adoption interruption. George saw himself as a carer for his sister and had adopted age-inappropriate interactions with his sibling.

They were placed with the Caldecott Foundation whose brief was to support and assess their needs. In view of the foster placement breakdowns, the question was whether to keep them together or separate them.

Jamie Bromfield, a throughcare social worker for the Caldecott Foundation at the time, says it was never the intention for this to be a long term arrangement. “The residential placement was chosen to give them a break from family life and the intensity of emotions that can arise in family homes,” says Bromfield.

Support work

Caldecott’s multidisciplinary team were able to put a range of support in place. “We co-ordinated a package of care where they were allocated separate key workers to look after their individual interests,” says Bromfield. “The key to changing the unhealthy dynamic between siblings was to help George give up the caring role.”

Once settled in the residential home, they were assessed individually and referred to Roy Fears, Caldecott’s specialist drama therapist. Bromfield explains: “Because of their age, expressive arts were considered appropriate. In therapy we needed to understand what they were bringing to foster families and what we needed to address.”

After several months of therapy, George felt less of a need to parent his sister and eventually gave up therapy entirely. It is this child-centred approach that Bromfield feels is crucial to the success of their work. “The therapeutic work carried on with his sister, while he got on with his football. It was a decision based on his own needs. When young people are in a position to make healthy decisions about their own lives we do everything we can to help them.” This development allowed George and Samantha to build the brother-sister relationship necessary to make a success of a future foster placement.

Based on the detailed knowledge gained of Samantha and George, the Caldecott Foundation team made a number of informed recommendations about prospective foster carers. “They needed to be in an established relationship with tight communication skills. We wanted a man and a woman where the man would identify with the boy and provide a father figure. There needed to be no other children in the household. Finally, and it sounds obvious, we also needed them to want to have a boy and girl,” says Bromfield.

After 18 months at Caldecott, the children left the care home and were successfully fostered. A suitable family was not identified locally, but one was found in another borough.

Bromfield now heads the Caldecott Foundation’s new fostering service – a permanent facility that developed, in part, as a result of the success of Samantha and George’s case.

*All names have been changed.

Caldecott Foundation

ARGUMENTS FOR RISK:

• Keeping the children together was clearly in the children’s best interests, particularly as they were the only constant feature in each other’s lives.

• Many of the long-term outcomes for the siblings are dependent on George accepting he needs to interact with his sister in an age-appropriate way.

• Holding out for a foster family with the exact skills required should ensure a successful placement.

• The home’s strong multi-disciplinary approach has resolved many of the difficulties in the children’s lives.

ARGUMENTS AGAINST RISK:

• Intervening in the relationship between brother and sister could undermine the only consistent aspect of their lives.

• A further foster placement breakdown could reinforce the patterns of failure in their lives. This could have a long term negative effect on them, undermining any further therapeutic work.

• Considering George’s history of challenging behaviour, and a restricted local authority budget, a simpler, less expensive option might be to place the siblings with separate foster families.