Risk Factor: therapeutic placement for a child in care

Bill’s foster placement was at breaking point and needed additional expert help, writes Mark Drinkwater

CASE NOTES

PRACTITIONER
John Diamond, chief executive, Mulberry Bush School.

FIELD
Therapeutic care and education for children with severe emotional and behavioural difficulties.

LOCATION
Oxfordshire.

CLIENT
Bill, a seven-year-old boy who has experienced chronic neglect as well as physical and sexual abuse.

CASE HISTORY
Bill’s mother has mental health problems and an alcohol dependency. By age seven Bill was avoiding school and often wandering the streets. His lifestyle left him vulnerable and he was physically and sexually abused. He was taken into foster care, but the family is struggling to cope with his aggressive and controlling behaviour.

DILEMMA
The foster placement is in danger of breaking down and is jeopardising any progress with Bill’s development. A therapeutic educational placement is available, but can it deliver significant benefits and save money in the long term?

RISK FACTOR
Bill’s controlling and aggressive behaviour has resulted in exclusion from school and made him unmanageable in the home. Will the radical intervention help him re-integrate with his foster family and mainstream school?

OUTCOME
It is hoped that a three-year educational placement will introduce enough stability for Bill to learn about positive adult role models and help him move on from his troubled past.

A loss of trust in adults can severely impede a child’s educational and developmental growth. Bill had experienced chronic neglect and his chaotic upbringing had not prepared him for the stability of a caring foster family.

After six months, Bill’s foster carers found themselves struggling with his violent rages. With little understanding of family life as a positive experience, Bill found it difficult to make sense of relationships. Above all, he had no trust in adults.

Bill was referred to the Mulberry Bush School, a charity that provides education and therapeutic residential care for children aged five to 12. “Most of our children have experienced forms of neglect and often abusive situations in their formative years,” says chief executive John Diamond. “Due to these adverse experiences they are deeply mistrustful and confused about relationships.”

12-week assessment

After a 12-week assessment, Bill joined one of the group households, living in term time alongside other children with a specialist staff team. The school’s multi-disciplinary team worked together to create an individual treatment plan, including intensive classroom support, help managing his antisocial behaviour and regular psychotherapeutic counselling.

There are always risks involved, Diamond says, when dealing with a child who has a traumatic past. “Risk factors are assessed during the referral process and throughout the initial assessment period.”

Initially, Bill tried everything to disrupt the school routines using aggressive and controlling behaviour. “Bill’s chaotic past did not allow him to develop an internal ‘working model’ for building relationships,” says Diamond. “In the absence of these ­emotional building blocks of good experience, children can develop severe attachment difficulties.”

Abusive behaviour

In his first year at the school, Bill started to form an attachment with his key worker. He continued to test her feelings for him through abusive behaviour, but the violent outbursts gradually decreased. This attachment can be intense, so staff at the school can access intensive support alternating between individual supervision one week followed by a group session the next.

Having learned to trust adults, Bill’s self-esteem grew and he began to read and write for the first time. In his second year he joined a sports club which enabled him to connect with adults and peers outside school. In his final year he increased weekend contact with his carers and visited the mainstream school where he settled.

Despite some setbacks, Bill’s three years at the residential school enabled him to return to his foster parents full time and he now thrives in mainstream education. He still maintains contact with his birth mother but has accepted he cannot live with her.

ARGUMENTS FOR TAKING THE RISK

Weighing up the risk

● Expertise and respite: Bill’s foster placement was at breaking point and needed additional expert help. In partnership with carers, the school placement offers expertise and respite for both Bill and his carers.

● Integrated education and care: The school has more than 60 years’ experience of nurturing traumatised children. A skilled multi-disciplinary team provides the integrated education, care and family work that Bill needs.

● Essential stability: Relationships take time. Once trust is established other developmental outcomes should follow. The continuity and stability of a three-year placement are essential for integrating back into the home and school.

ARGUMENTS AGAINST TAKING THE RISK

● Progress may not be transferable: Progress made at the school might not transfer to the foster home environment, undermining developments taking place with his foster carers.

● Risk of outbursts: Bill’s violent outbursts present a risk to staff and to the other vulnerable pupils.

● Lengthy and expensive: A dedicated three-year placement is a lengthy and expensive option. There is no certainty that it will resolve Bill’s deep-seated problems.

INDEPENDENT COMMENT

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

Human development depends on cumulative processes, in which each new level is built on the previous one’s foundations. When one or more of the early emotional layers is not laid down securely, the whole edifice of a child’s personality can become unstable, as in Bill’s case.

As with a building, these problems cannot easily be corrected by making adjustments to the layer under construction. Rectifying this is likely to require more intensive work on the foundations. This tends to be lengthy, expensive and best entrusted to experts.

Placing Bill in a good, basic, supportive foster home could never have rendered him stable. Indeed, his fundamental instability may have posed a severe risk to those around him.

Tackled anger and alienation

Mulberry Bush painstakingly chipped away at the layers of distorted perception of the world which had left Bill angry and alienated and began to replace them with a consciousness that adults could usually be depended on to meet his emotional and physical needs.

At some phases of the process, removing the emotionally damaged structure will have left Bill even more unsteady than he had been before, so setbacks were inevitable. At such times, it was vital that he was placed in an environment which had the strength, security, experience and expertise to see him through.

This article is published in the 5 March edition of Community Care under the headline “Schooled in curbing his anger”