Practice Panel: boy behaves violently in secure unit

Social workers and a service user offer advice on a case involving a boy who is now in a secure unit after behaving violently at his residential children’s home

SITUATION

John* is 15 and has been in care since he was six. He had a chaotic upbringing and was often neglected. His mother and father used violence against him at various times.

John was very withdrawn when he first went into foster care but became more aggressive as time went on. He had a series of foster family placements but each one broke down, usually because he was violent.

He was often in trouble and regularly truanted from school. Eventually, he was permanently excluded from one school aged 12 for fighting. Since then he has had erratic attendance at subsequent schools and pupil referral units.

PROBLEM

At 13, John was placed in a residential children’s home. At first he lacked confidence and self-esteem but later began to thrive for a while. He was seeing a therapist regularly and seemed more settled at the home and at school.

But then he started to use illegal drugs, which the other children in the home had introduced him to. He has since been missing school and become more aggressive.

John recently smashed up the communal lounge in the children’s home and assaulted several members of staff. He is being charged with criminal damage and assault and has been placed in a secure unit.

*Name has been changed

The social worker view

Jim Sullivan, chair, Independent Children’s Home Association

John’s behaviour indicates he has not been given the opportunity to develop effective communication with others. His lack of attachment to a significant individual leaves John vulnerable, hence his tendency to deviate towards antisocial behaviour just to belong.

There can be a lack of acknowledgement that it is the system that has failed John. We have a responsibility to protect individuals such as John from others. An adequate risk assessment would look at risks to and from John. Compatibility with others is also often overlooked when placing young people into residential care.

Criminalising John will not address his emotional state. It will compound his lack of self-worth. John requires a one-on-one staffing placement where he can be given the time he needs to learn new skills and build confidence in his own ability. This needs to be manned by skilled, experienced, robust staff with firm boundaries that will keep John safe when he is feeling unsafe.

His carers will need to take responsibility for the environment and provide support by identifying services, both within and outside the home.

John needs to feel that he belongs and is worthy of support, and that he can make a positive contribution.

John Diamond, CEO of Mulberry Bush, a charity that provides therapeutic residential care to children

John’s early formative experience of his father and his home environment is one of neglect and violence. John has been left without any good experiences of adults as safe, caring, and nurturing figures. In such situations, young children construct “hard wired” psychological defences, including withdrawal or “fight or flight” mechanisms, in response to trauma.

These defences remain active without long-term relationship-based therapy in a nurturing environment. For John, they are reawakened in any stressful or emotive situation. The breakdowns in his foster placements and schools are symptomatic of his state of ongoing hyper vigilance, which drives him to act out his mistrust of intimate family life, and of his confused sense of belonging through aggression and a lack of concern for others.

The children’s home offered some temporary respite, but drug use propelled John back into avoidance of relationships. He would have felt that adults have again failed to provide for his need for security and protect him from destructive influences. It is again symptomatic that, in the absence of an emotionally responsive environment, John finds himself physically contained in a secure unit.

John has missed access to an early intervention, and the criminalisation of his behaviour is likely to entrench his hostile view of the world. If agencies can recognise his needs, a placement in a specialist adolescent therapeutic environment is probably his only chance for treatment and recovery.

Will McMahon, chair, Care Leavers’ Association

It appears that John is in an almost permanent stage of rage and his violent behaviour is probably only the tip of the iceberg of his personal distress. Research shows that witnessing persistent domestic violence towards a main carer when a child can carry devastating consequences.

Precisely the wrong thing to do is to press charges – another key finding from research is that the younger the first contact with the police the longer the stay is in the criminal justice system. However, this does not mean that a secure and safe place for John is not needed.

One of the consequences of effective therapy can be an ignition of further rage as John recognises how harmed he and his mother were by domestic violence.

What John is clearly in need of is a place in a therapeutic community, yet there are too few such places for young people and too few councils who are prepared to pay for them. Nevertheless, his social worker should try to access such a resource.

Important steps are to always involve John in decision-making processes and fully explain the options available to him and the reasons behind particular decisions. He should be offered ways forward and be asked to give reasons for why he is taking drugs and behaving violently. It is also crucial to go back over John’s records to get a better understanding of the time when he was “stable” for a while. Vital clues lie therein.

This article is published in the 28 May issue of Community Care magazine under the heading Building faith in adults is the way to recovery