Will living in isolation help boy of 14 with sexually harmful behaviour?

A boy of 14 with a history of sexual abuse is to be housed in isolation. But will this affect his social and emotional development? Mark Drinkwater reports

CASE NOTES

 PRACTITIONER: Kate Jones (pictured), head of care at Branas Isaf

FIELD: Residential child care

LOCATION: Denbighshire, north Wales

CLIENTS: John*, 14, has a history of sexually harmful behaviour.

CASE HISTORY: John* was placed in foster care at age six after being sexually abused. He had numerous foster placement breakdowns before returning briefly to the family home at 12. However, there was great concern when he was found in bed with his sister. He was placed in several children’s homes before being referred to Branas Isaf.

DILEMMA: John presents a risk to others and his social worker wants him to reside in isolation. But such a placement would ­­severely hamper his social and emotional development.

RISK FACTOR: John is allocated an individual cottage where lives alone, although six other young people live on the same site. Staff must be vigilant that other residents are not exposed to risk.

OUTCOME: John responds well to the therapeutic interventions. His placement goes without incident and he considers his options for independent living, including the prospect of returning to his family.

*Not his real name

The NSPCC estimates that about one-third of sexual offences against children are perpetrated by other young people. Dealing with these young people who display sexually harmful behaviours presents numerous challenges for practitioners who need to meet developmental needs while reducing risks to others.

Kate Jones, head of care at Branas Isaf, describes a complex case of a 14-year-old boy. “At the referral stage we spoke with professionals who had worked with him: therapists and his social worker,” she says. “John* presented a risk to others because of his sexually harmful behaviour. That’s why he was placed with us. He presented a risk to male and female younger children. He has a younger sister at home and there had been an allegation that he had been found in bed with her.”

When choosing the most appropriate residence, professionals assessed several risk factors and considered the benefits of different types of residential setting. “The social worker’s view was that they wanted a solo cottage for him. That would be great on one level, but it wouldn’t give him any interaction as he would be totally isolated, apart from the staff member,” says Jones.

Having considered the options, John was allocated an individual cottage on a site where there were a cluster of other residential placements. The rural complex comprises four individual cottages and a three-bedroom house. Jones says that at this placement he was closely supported but still had significant opportunities for peer interaction with the six other residents at the site.

John was sexually abused by his birth father when his father lived in the family home. As a consequence, John had difficulties with attachment. Jones says the boy had a high degree of shame and blamed himself for what had happened. “Understandably, he didn’t trust many adults,” she says. “And because of the number of previous placement breakdowns, it took him a while to believe that he was going to stay in the placement. He felt he would be moving on and that the placement would break down.”

Once settled at the home, staff supported John with managing his outbursts. They taught him a range of techniques, including stop-and-think strategies, as John had difficulty recognising his different emotions. “Everything to him was anger,” says Jones. “So we worked with him on strategies to help him think about the consequences that might arise from his behaviour.”

Progress was slow initially, partly because of John’s low self-confidence. His education had been sporadic and staff developed his self-esteem, setting realistic goals and praising him for the smallest of achievements.

But Jones recalls a breakthrough after he had been living at the home for four months: “John had gone climbing with a staff member who was frightened of heights. John supported and encouraged her and this was the breakthrough in their relationship. It really did help him to develop his self-esteem. It was like a role-reversal, where he had taken care of someone else for the day. It really did help them form a strong working relationship.”

From this point John’s behaviour improved markedly. His trust in staff increased and together they could turn their attention to helping him address his sexually harmful behaviour. This work involved a number of approaches, including developing a risk management plan and implementing the Juvenile Sex Offender Assessment Protocol (J-SOAP-II), a tool that Jones found to be effective in monitoring John’s rehabilitation.

Although it remains uncertain as to whether John would ever return to live with his family, one of the goals set was to increase his contact with them. Initial visits were supervised, but John has since progressed to unsupervised contact. Support was also given to his mother to implement strategies developed at Branas Isaf.

Jones says that on visits home John says a code word to his mother if he finds that he is inappropriately aroused: “We worked with John so that when he was feeling aroused he had strategies that he could use and share them with his mother. One of the strategies was that he could tell his mother if he was aroused and they could change the environment at that point.”

Jones remains optimistic about John’s future prospects, although this view is tempered by the knowledge that he still requires continuing support. “There is a lot more work to do with John and his family,” she says. “At the moment he’s not sure whether he would want to return to live with his family again, but it is something that he’s looking at as a possibility.”

WEIGHING UP THE RISKS

Arguments for taking the risk

● Provider is a specialist

John’s behaviour renders him and others vulnerable to abuse. But the provider is a specialist in dealing with young people who display sexually harmful behaviour.

● Support in a nurturing environment

The programme of support is provided in a nurturing and therapeutic environment. This should help bring about the transformation required in John’s thoughts and behaviour.

● Supervision and containment

The professionals will be aware of the need to balance effective supervision and containment. Having his own living space, while being near other young people, should minimise risk and ensure positive social experiences.

Arguments against taking the risk

● Staff need to be vigilant

Staff must ensure that, even in his isolated living area, other residents are not exposed to risk.

● Concern about budget cuts

When council budgets are under review there is the constant possibility that this kind of resource-intensive placement is under threat.

● An uncertain future

The long-lasting effectiveness of the therapeutic interventions will only be truly tested when John moves to a mainstream community setting.

INDEPENDENT COMMENT

Patrick Ayre senior social work lecturer at the University of Bedfordshire

By age 14, many of John’s difficulties – behavioural and psychological – will have become entrenched features of his personality.

While this placement clearly provided John with a nurturing and supportive environment, the crucial added extra which it offered seems to have been work on transferability of learning.

But, often, councils charged with corporate parenting of young people with the most challenging behaviour pay huge fees to specialist residential establishments only to find that, on discharge, there has been little net gain.

In most cases, it is only necessary for the young people to enter care in the first place because the environment in which their social learning takes place is unhelpful. Learning to deal with the weaknesses of the world outside is at least as important for young people in therapeutic care as learning to cope with their own.

*Not his real name

➔ Contact mark.drinkwater@rbi.co.uk to submit your Risk Factor case studies

➔ NSPCC briefing – Sexually harmful behaviour

● Sexually Harmful Behaviour in Children and Young People: Community Care Conferences 2 November 2011, Leeds

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