The making and breaking of relationships: Organizational and clinical questions in providing services for looked after children?

Abstract

The mental health of children in public care has received considerable attention in recent years. There are significant differences in the prevalence rates compared to children living at home and not in public care and these are added to by other adverse lifestyle issues. Considerable attention has been focused on the importance of stable and secure placements supported by access to a range of services including education, health and mental health. Identifying and classifying mental health needs proves to be challenging as the child’s genetic inheritance, pre- and post-birth experiences, including maltreatment, interact with the uncertainty and delays commonly associated with child protection processes, action in the legal system and the difficulty in establishing secure and permanent placements. Clinical need is also related to the age of the child and the reasons they came into care and the length of time they remain. A case illustrating many of these issues, publicly reported in the court’s judgement, is used as the basis for exploring the complexity for the identified child in understanding and making sense of their experiences as placement plans are made for them. These are used to explore the difficulties in establishing clinical protocols such as those recently published in the USA. Particular emphasis is given to the issues faced by children and their carers in establishing new family relationships which address the child’s inheritance from their family of origin especially where these are traumatic and conflicted in origin.

Keywords

adoption assessment children in care clinical need fostering mental health planning treatment protocols

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References

Alexander, J. , Barton, C. , Gordon, D. , Grotpeter, J. , Hansson, K. , Harrison, R. , Mears, S. , Mihalic, S. , Parsons, B. , Pugh, C. , Schulman, S. , Waldron, H. , & Sexton, T. ( 1998). Functional family therapy: Blueprints for violence prevention, book three. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.

Burns, B. , Phillips, S. , Wagner, H. , Barth, R. , Kolko, D. & Campbell, Y. ( 2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child and Adolscent Psychiatry, 43(8), 960-970.

Conway, P. ( 2009). Falling between minds: The effects of unbearable experiences on multi-agency communication in the care system. Adoption and Fostering, 33, 18-29.

De Bellis, M. ( 2005). The psychobiology of neglect. Child Maltreatment , 10(2), 150-172.

Department of Children, Schools and Families & Department of Health (2008). Children and young people in mind: The final report of the National CAMHS Review. London: Department of Health. Available at: http://www.dcsf.gov.uk/CAMHSreview/downloads/CAMHSReview-Bookmark.pdf (accessed 16 February 2010).

Department of Children, Schools and Families & Department of Health (2004). National service framework for children, young people and maternity services: The mental health and psychological well-being of children and young people. London: Department of Health.

Department of Health (2000). Framework for the assessment of children in need and their families. London: HMSO.

Loxterkamp, L. ( 2009). Contact and truth: The unfolding predicament in adoption and fostering. Clinical Child Psychology and Psychiatry, 14(3), 423-435.

Meltzer, H. , Gatward, R. , Corbin, T. , Goodman, R. , & Ford, T. ( 2003). The mental health of young people looked after by local authorities in England. London: HMSO.

10.

Meltzer, H. , Gatward, R. , with Goodman, R. , & Ford, T. ( 2000). The mental health of children and adolescents in Great Britain: Summary report. London: HMSO.

11.

NHS Health Advisory Service (1995) Child and adolescent mental health services: Together we stand. The commissioning, role and management of child and adolescent mental health services. London: HMSO.

12.

Olds, D. , Hill, P. , Mihalic, S. , & O’Brien, R. (1998). Nurse-family partnership: Blueprints for violence prevention, book seven. Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.

13.

Pallett, P. , Blackeby, K. , Yule, W. , Weissman, R. , & Scott, S. ( 2005). Fostering changes: How to improve relationships and manage difficult behaviour. London: BAAF .

14.

Price, J. , Chamberlain, P. , Landsverk, J. , Reid, J. , Leve, L. & Laurent, H. ( 2008). Effects of a foster parent training intervention on placement changes of children in foster care. Child Maltreatment, 13(1), 64-75.

15.

R (Children) [2007] EWCA Civ 139. Available from BAILII at: http://www.bailii.org/ew/cases/EWCA/ Civ/2007/139.html (accessed 17 February 2010).

16.

Romanelli, L. , Landsverk, J. , Levitt, J. , Leslie, L. , Hurley, M. , Gries, L. , Pecora, P. , & Jensen, P. ( 2009). Best practices for mental health in child welfare: Screening, assessment and treatment guidelines. Child Welfare, 88(1), 163-188.

17.

Ross, J.W. , Hooper, L. , Stenhouse, E. , & Sheaff, R. ( 2009). What are child-care social workers doing in relation to infant mental health? An exploration of professional ideologies and practice preferences within an inter-agency context. British Journal of Social Work, 39(6), 1008-1025.

18.

Rushton, A. , & Monck, E. ( 2009). Enhancing adoptive parenting: A test of effectiveness . London: BAAF.

19.

Sinclair, I. , Baker, C. , Lee, J. , and Gibbs, I. ( 2007). The pursuit of permanence: A study of the English care system. London: Jessica Kingsley .