By Douglas Cameron

Date Posted: Sunday, 22 June 2008

Douglas Cameron spent most of his childhood in Nairn in the north of Scotland and after leaving school he had a number of jobs including a period as a chef and another as a security guard and it was while he was working for a private youth custodial service that he decided he wanted to work with young people but in a different way. He enrolled at the West Lothian College in Scotland and gained a qualification in social care. After this Dougas worked as a volunteer befriender before moving to London to take up a post  working with young people preparing to leave the care system. He now works as a residential child care worker in a children’s home in the southeast of England.

In this article Douglas explores the different  elements of the relationship between a young person in care and  the people who in various roles represent the care system. He illuminates the aspects of a young person’s experience of being looked after in the care system which in his view work against necessary and consistent concerned attachment relationships being formed. He argues that this produces an environment which is conducive to placement breakdown. In reading Douglas’ unique analysis of the causes of placement breakdown for children and young people in the care in England and Wales, it is tempting to understand it as an interesting polemic in which Douglas expresses the frustrations experienced by many of us who are charged with the care of young people no longer able to live with their families. It becomes much more than this when the reader has to confront the experiences of Ian, the young man whose story Douglas tells.

Disrupted relationships : a personal view of the causes of placement breakdown for children and young people in care.

The causes of placement breakdown for children and young people in care: a personal view

In this article I am making a personal exploration of some of the factors which lead to the all too frequent breakdowns inwhich children and young people in the care system in the United Kingdom  experience. In a vignette of my work with a young man who was placed with the leaving care project for which I work I attempt to illustrate some of the issues I raise, and I highlight the significance building good relationships has – even in the face of resistance –   in preventing a placement breakdown.

 
Factors external to my own work which may lead to the breakdown of young people’s placements in care

Inconsistencies in the care system
In considering the breakdown of placements for young people who are looked after in the public care system and the wide range factors which cause them I do not wish to lose sight of the idea that it is the first real change for any child or young person – when they are removed from their family home – which must affect the child most. Such a change may in some ways bring immediate release from what may be an unbearable situation, but moving away from what they have always known must bring its own uncertainties and insecurities. What is of further concern is that in my experience so many of the young people who have been placed in care with the view to making them feel safer and to provide them with consistent care find themselves in a public care  system which actually makes them feel less secure and less safe. Too many young people who are looked after in the care system find that it is only their behaviour and not the cause of their behaviour which is responded to by substitute parenting figures. Such was the experience of Ian, a young man I describe later. Young people like Ian are not responded to at a caring emotional level and all too soon their misunderstood behaviour is presented as the cause for a placement with foster parents or a children’s home to end. This is frequently the beginning of a domino effect which leads to the young people moving from placement to placement in a system which declares itself as one which seeks to provide consistency of care. It seems to me that in assessing these young people we label them trouble makers long before we begin to think whether what we are providing for them is suitable to their needs.
In a very short time such children and young people begin to feel alienated in unfamiliar territory within a society which is supposed to be their own! (See Sergeant, 2006)  Living in a state of anxiety about what is going to happen to them next, it is no wonder that these young people can lack the trust to make connections and to build relationships.

Changes in social work personnel
Another and frequently overlooked externally imposed change in the lives of these young people is a change in social work personnel. For instance when a social worker leaves the local authority or a new social workers is allocated to a young person without any consultation or notice, may only serve to confirm in that young person previously engendered feelings of separation, loss and worthlessness.

Overloaded social workers
In my experience the lack of sufficient social work time has an impact on the consistency of care provided to troubled young people and it is my view that this has a significant influence on the frequency of breakdown in the placements of young people. All too often social workers’ caseloads are so high that it is inevitable that they fall behind in their work. Important meetings are delayed, vital information is not communicated, planning decisions are not properly worked through, and, in turn, all this means that there is insufficient time available for the social worker to build an effective relationship with the young person.
Poor Assessment
It should also concern us as that the service provided for a young person may not be the right one for that young person. In my view too many social workers and other caring professionals working with a young person lack information about the young person and so it becomes difficult to make a holistic assessment of their needs. Frequently I have found that local authorities withhold information about a young person because they fear the young person will no be accepted by the resource they are seeking for the young person. I have also observed that young people are placed not according to their needs but at a less expensive resource because there is insufficient funding to place the young people in more appropriate, and expensive resources. Placements made on the basis of what I described are clearly more likely to end in breakdown.
When this has occurred at the resource I work with we as staff are very soon aware of our shortcomings but since there is no prospect of the young person being placed where his or her needs would be more fully met, we have sought to find ways of looking after the young person as best as we possibly can.

 
Factors in my own workplace which may cause the breakdown of the placements of young people

Forming a relationship
When I turn to looking at the issue of placement breakdown in my own workplace I am increasingly convinced that it is the quality of relationship we the staff build with the young people which predicts the success or failure of our work.
Sometimes it can seem an impossible task to establish a relationship which is at the same time both professional and caring. In working professionally we are always seeking for improvement in the young person’s symptoms at the same time as working within professionally acceptable boundaries. In contrast to this, in the caring relationship there are boundaries but we as carers must carry within an acceptance of the young person and all that he or she brings to us – how they look, how they speak, how they act and how they feel. Added to this I would add that as both carers and professionals we have to consider and to analyse the imperfections which we, the caring professionals bring to the relationship. (See, Sharpe, 2005).
In our direct work with young people the first obstacle we have to face is young people’s resistance to making a relationship with us. We are often surprised by this and yet why should we be? Usually, the young people have not specifically asked for us to help them and more significantly their previous experience of relationships with adults who have had a responsibility to look after them has seldom filled them with a healthy sense of security.
This resistance to our care, which therapeutic theorists call transference (Ward 1998) is a process by which the young people unconsciously displaces feelings on to us which belong to a relationship with another significant adult figure from their past (usually a parent). This response can often be angry and aggressive. It is important that we do not interpret this as a response which is directed against us as individuals. If a relationship is to be established with a young person then we have to able to contain these responses until he or she begins to trust that we will not confirm their previous experience of adults who inappropriately retaliate to this behaviour and who inevitably reject the young person.

Often too we can find that some of the experiences the young people we look after stir up memories of painful periods in our own past which in turn can make us feel as hopeless and helpless as the young people. In such situations I have found it important to take time to reflect on why I am feeling what I am feeling in order to overcome my own anxieties and contain my own feelings so that I don’t fall apart in the face of a troubled young person. This has allowed me to stay with the feelings of the young people and contain them for him or her. It seems to me that it is  this often quite extended period of containment that the young person and I can  find common ground  where a trusting relationship and working together can begin to take place. It is when professional carers do not feel able to contain a young person emotionally and when they feel that the young person is out of their control that   the young person is at greatest risk of being rejected and moved on to another placement.
It should be needless to say that repeated rejection has a damaging emotional effect on anyone but it is dismaying that as professional carers we are frequently involved in the rejection of troubled youngster. Each rejection adds to a history which makes it harder for a young person to trust others and consequently makes it more difficult to form a positive, healthy relationship with an adult.

Staff changes
Any change in the staffing structure within a resource offering practical, social and emotional support to young people creates insecurity for both young people and staff alike. This is particularly so when a new regime changes routines and working methods. More significant than this is when a member of staff leaves at a time when both the worker and the young person may have begun to establish a trusting relationship. Even when such a situation is dealt with the utmost sensitivity, it is likely that it will arouse feelings of rejection and loss within the young person. In turn this may influence the way a young person feels to he extent that their behaviour changes for the worse.  If this behaviour is not contained and recognised for what it is – an expression of rejection and loss – then there is a danger that other staff and the young person’s social worker may see the deterioration of behaviour as a reason for doubting the appropriateness of the placement.  I am pointing out here that it is at times like this that young people are very vulnerable to over hasty rejecting tendencies in the adults who are looking after them.

There are other reasons why a young person in care may experience repeated placement breakdowns but my main thrust has been to I demonstrate the importance of relationships in a placement. If we choose to ignore this phenomenon – that a failure to engage in a real relationship with a young person will lead to a placement breakdown – then in my view we would not be doing our jobs satisfactorily. Forming relationships is an important factor in everyone’ psychological development. For the young people who we look after, forming a relationship is no longer as straightforward as it should be, and so we should be patient with them. In order to illuminate and summarise the views I have expressed, what follows is an account of work my colleagues and I did with a young man who came into our care.

Ian

Ian, a young person I worked with was 16 years old when he came into our care, had experienced two placement breakdowns before he came into our care. Since his birth Ian’s father had been absent from his life and his mother had not told Ian anything about his father. However when he was 13 years old Ian’s father returned to the family home but shortly after his return his father died. After I had got to know Ian he was able to tell me that he felt both feelings of confusion and loss at this time. His relationship with his mother broke down and his relationship with his father’s family was not good.  His behaviour deteriorated and he became less and less welcome in the family home to the extent that he was placed in care when he was 15 years old. Ian took this rejection very badly not only did he miss being at home but he said the loss of seeing his little brother every day made him at times sad and at times angry. Before coming to us Ian had two different placements which broke down. One was with foster parents who found it difficult to cope with Ian’s anger and his unwillingness to join in the activities of the family. Ian was then placed in a children’s home but he failed to engage with the staff their and he was asked to leave because of his angry and aggressive behaviour towards the staff. Ian has since said that in neither of the placements did he feel he was given a chance and that every time he got into any sort of trouble he was told that if he didn’t improve his behaviour he would have to leave. It seemed to me that Ian felt (whether his judgment was factually right or not) that his placements were under threat as soon as he arrived at them. This threat to his need for emotional security combined with his feelings of loss, separation and rejection from his family home, in my view makes it becomes understandable that he might have feelings of frustration and anger. This should have been better understood by his carers.

When Ian was placed with us, a project whose function is to prepare young people of over 16 years of age for leaving care, he was moved into his own flat and I was appointed as his keyworker. To begin with he was very suspicious of me and the other staff, and was reluctant at first to accept our caring intentions but he seemed to settle down and the only serious problem we encountered was Ian’s poor relationship with his social worker. The latter’s unwillingness to meet with Ian on his own without a member of staff being present was not really conducive to developing a relationship. Ian’s reluctance to engage with his social worker appeared to stem from his anger with the local authority for taking him into care in the first place.  After some weeks I began to feel, like the carers in his previous placements, that Ian did not engage with me and that I did not have a real relationship with him. I did not mention this but allowed things to remain as they were, yet making sure that I met with him regularly. At this time Ian became ill and was found to be suffering from a serious kidney complaint which required Ian to be in hospital for a number of weeks. Ian was alarmed at this prospect and was unsure why he had been placed in hospital. I spent a great deal of time holding his anxieties and trying to re-assure him. Nevertheless, Ian was very frightened about going into hospital. Here was another change in his life, but a change of a frightening kind that he had not experienced before. At this time I still did not feel I had made an effective relationship with but during a supervision session with my manager she mentioned to me that Ian had told her that I was a good keyworker. This really encouraged me and though all was not plain sailing through either Ian’s period in the hospital, or after he was discharged, I thought that for the first time Ian was beginning to be more sure of himself and his worth. Getting used to taking medication every day frustrated him but he managed to accept our help in establishing a routine to look after himself. He managed to adapt to staff sleeping over in his flat while his condition remained delicate.  Around this time too his relationship with his mother improved and he was now welcome to visit the family home again. Furthermore his relationship with his social worker improved.

I do not wish to give the impression that a miracle occurred for Ian. He did not return permanently to his family home but he had re-established his relationship with his mother and his brother and has since been able to cope with that situation as it stands. He still finds it difficult to make relationships but he has found that in trusting my colleagues and I through what was a difficult period for him he found he was able to survive.
One of the most important things that I learnt from my work with Ian was the need to reflect on what I was bringing to our relationship. Like previous carers I had felt that Ian was not engaging with me and I had not thought about how much I had engaged with and affected him and without the observation of my supervisor I may have been influenced to deny my relationship with him and created a situation in which he might have suffered further rejection and a further breakdown.

 
References
Sergeant, H. (2006) Handle with Care: an investigation into the care system.  London London Centre for Young Policy Studies pp 34-53.

Sharpe, C. (2005) ‘Residential Child Care Can Do With All The Help It Can Get’ in http://human-nature.com/free-associations/sharpe.html  ed. Young, R.M. Accessed 8.1.07.

Ward, A. (1998) ‘Help and the personal response’ in Intuition is not Enough eds. Ward, A., and McMahon, L.  London   Routledge pp 34-35