Footsteps to Futures is committed to providing a warm, safe and therapeutic environment to help improve the lives of looked after children. As part of this we have done extensive research into looked-after children. Forensic Psychologist in Training at Footsteps to Futures, Richard Jones has written a blog regarding children in care.
Children and young people who are looked after are a demographic that is a particularly disadvantaged section of society. The population of children and young people in care has steadily increased since 2008, with a total of 69,540 Looked After Children (LAC) in England on the 31st March 2015 (Department for Education, 2015). Numbers of children in care who have been abused or neglected have also increased over the past five years in England and Wales (Bentley et al., 2017). This accounts for over 60% of children who are in care. Often these Looked After Children (LAC) have experienced more than one type of abuse in childhood and adolescence.
Children who have been placed in care may often experience multiple placements breakdowns either due to a need to manage their presenting behaviour or in the search for a more suitable placement to address their needs. Ultimately, placing a child in a surrogate family placements such as foster care is preferred as it mirrors a family home. This type of placement can aid the attachment process of the children and help to increase positive outcomes for the child. However, often these services are ill equipped to manage more severe types of emotional and behaviour difficulties such as physical aggression, self-harming behaviours, drug overdoses, sexualised behaviour and trauma symptoms to name a few. In these circumstances, more specialised therapeutic placements are required to meet the complex and significant needs of young people in care.
Often LAC who are referred to specialist residential children’s home services have experienced a number of adverse life experiences that have traumatised them. These traumatic life experiences may include; physical abuse, sexual abuse, maltreatment, neglect, bereavement, exposure to parental substance misuse and exposure to domestic violence. All of which may impact the child negatively depending on their individual experience of the trauma and the meaning they ascribe to the event. In my experience, common emotional and behavioural difficulties presented in referred LAC include; impulsivity, emotional liability, verbal and physical aggression, a range of self-harming behaviours, depression, anxiety, low self-esteem, poor educational attainment, and difficulties in forming stable and meaningful attachments with peers and adults.
Without intervention, these difficulties can manifest and exacerbate to the point where the young people may lose their independence and have restrictions placed on them in order to keep them safe. This can often be a vicious cycle as increased supervision and restrictions in their living environment will undoubtedly impact their quality of life. Decisions to place restrictions or increased supervision are not taken by professionals lightly. They require agreement from a multi-disciplinary team involving the social care team who share or have full responsibility for the young person (depending on the type of care order).
These decisions are made due to concerns about safeguarding or the safety of the young person or their peers. However, once the young person’s quality of life is impacted, an escalation or continuation of difficulties is likely to arise. This makes early intervention key and as a Forensic Psychologist in Training at a private residential children’s provider one of my core responsibilities is to provide therapeutic support for these young people who enter our care. Therapeutic support involves robust psychological assessment, case consultation and bespoke therapeutic interventions either individually or in a group.
Largely, my services are provided as part of the young person’s placement in the residential home. However, it would be unfair to ask local authorities to pay for individual psychological intervention on top of this if it is not necessary. Individual psychological therapy can therefore be commissioned should the need be identified. However, I experience a number of challenges in providing individualised psychological therapy that is often required to meet the complex therapeutic needs of these young people.
It can become an arduous and bitter journey to get the individualised psychological therapy, that the child needs, commissioned from local authorities. Often LAC may not meet the criteria or threshold for Child and Adolescent Mental Health services (CAMHs) to intervene. This may mean that for a young person to receive the support they require; the difficulties need to worsen. Is that the right way to look at the problem? A reactive rather than proactive system that focuses on more severe cases and neglects the needs of those who are asking for support. This can lead the child to feel disillusioned by the services in place to support them. It can also lead them to feel ambivalent towards therapy and interfere with their motivation to change (something which can be difficult to build up in the first place). The child ends up feeling let down, confused and in a state of hopelessness.
It ultimately becomes a question of cost, which is often looked at in terms short-term rather than the bigger picture. In the long-term, early intervention may prevent LAC from presenting at Accident and Emergency departments, adult inpatient or community based services. All of which cost the taxpayers more than commissioning private psychological services as the child’s emotional and behavioural difficulties arise. This works on the principle of ‘a stitch in time may save nine’. So, I ask you, the readers, are we doing a disservice to these young people?
My thought is yes, because the services that are already provided free of charge are burdened with government cuts and the demand for specialist services is greater than the supply. Research suggests that the barriers for LAC accessing services like CAMHs are not at the initial referral stage but later on in the process where they are expected to wait a long time for any specialist provision (York & Jones, 2017).
Perhaps in naivety, I thought that local authorities would look at the availability and flexibility of private psychological services as beneficial due to the speed in which the child can access the support they require and because they can build a positive therapeutic alliance with the therapist through their presence within the residential home. However, in my experience I have come across a stigmatisation from commissioning bodies about privately providing psychological interventions. For more information on potential barriers to the commissioning of private therapeutic intervention for young people please visit the following link: https://thepsychologist.bps.org.uk/volume-30/april-2017/are-we-failing-children-care
Overall, it makes no difference to me whether a young person receives individualised therapy from myself or another service (e.g. CAMHs). What does matter to me, is that they receive the support they are asking for to meet their therapeutic needs in a timely fashion. I feel that the system itself does not properly account for the thoughts, feelings and wishes of the young person which should be prioritised. Therefore, in my view the system does not work in the best interest of the child. This needs to change and professionals need to talk about it more to instigate change.