This was a short talk given at the Coram Family and Child Centre ‘Permanence’ event , London, on 25.11.2019
I would like to thank the Coram Team for inviting me to speak at this event. The Mulberry Bush is a national charity which runs the Mulberry Bush School in Oxfordshire and extended community services. Clearly residential care is not about creating permanence but it has an important role of preparing children for permanence, by providing children with a sense of belonging through: 1. Stability of placement 2. Opportunities for internalising good individual and group relationships (social /emotional and educational learning) 3. Daily therapeutic experiences with a highly trained and well supported staff group
This paper explores the role of specialist therapeutic residential child care and how it can facilitate emotional growth and a subsequent sense of ‘belonging’ for some of the most emotionally damaged children in our society. It also explores how high quality residential provision can decrease mental health problems for emotionally troubled children, complement and support foster placements for them, and lead to a deeper sense of self and belonging.
Little has been written in either the mental health or social care literature on the nature and importance of belonging. However, Baumeister and Leary (1995), define the need to belong as a ‘desire for interpersonal attachments as a fundamental human motivation’ and define two critical elements:
‘Human beings have a pervasive drive to form and maintain at least a minimum quantity of lasting, positive, and significant interpersonal relationships. Satisfying this drive involves two criteria: First, there is a need for frequent, affectively pleasant interactions with a few other people, and, second, these interactions must take place in the context of a temporally stable and enduring framework of affective concern for each other’s welfare’. (Baumeister,R. & Leary,M. 1995, p. 497).
Pearce and Pickard (2012) argue that a psychotherapeutic approach, can ameliorate the negative effects of a lack of a sense of belonging:
‘Decreased belongingness is associated with increases in stress and mental health problems, as well as somatic illness such as heart disease; conversely, increases in belongingness lead to a decrease in health problems and an overall increase in happiness (for a review see Baumeister & Leary 1995). A psychotherapeutic approach that is able to promote belongingness is therefore likely to have a range of beneficial effects’. (2012, p.3)
A rising tide.
Between April 2018 – March 2019 CAFCASS, the courts advisory service, received 13,559 new care applications.
According to the Department for Education 1st statistical return of March 31st 2018, there were 75, 420 Looked After children and young people in England and Wales. 63% of these were originally taken into care under the category of abuse or neglect.
73% were placed in foster care.
11% were placed in secure units, children’s homes or semi – independent living and hostels subject to Children’s Homes regulations.
Foster care remains the preferred option for looked after children and young people. Government and Local Authority policy focuses on finding substitute families for those who, for whatever reason, cannot be with their birth family. The logic goes: children who have been rejected or displaced by their birth families need a stable placement and loving parental figures. But what if many of those children find the concept and intimacy of family life alien and intolerable? Many children who due to early year’s trauma have no basic trust in adult or parental figures, and are driven to test the containment provided by a family to destruction, still find themselves placed in foster provision. The intention is clearly to foster a sense of belonging, but the outcome is all too often is increase the experience of multiple placement breakdown, and to increase the child’s sense of alienation and social exclusion and to internalise the feeling that he or she cannot ‘belong’ to anyone.
The nature of the problem:
In such absence of the experience of belonging to a family, children and young people in the care system may become further dislocated from the possibility of meaningful integration into a family.
Clough, Bullock and Ward (2006) propose a distinction between three groups of young people who find themselves in the care system:
- Children with relatively simple or straightforward needs who require either short – term or relatively ‘ordinary’ substitute care.
- Children or families with deep rooted, complex or chronic needs with a long history of difficulty and disruption, including abuse or neglect requiring more than simply a substitute family.
- Children with extensive, complex and enduring needs compounded by very difficult behaviour who require more specialised and intensive resources such as a therapeutic community, an adolescent mental health unit, a small ‘intensive care’ residential setting or a secure unit.
Many of the children in the first category are suitably placed in foster care, many of these children will have enough of a coherent sense of self to be able to be discerning about how their needs might be best met, or with support they can be helped to identify which placement best meets their needs. Some children and young people prefer residential care as a positive option; In 2007, after consultation with young people in the care system, the ‘care matters’ white paper unequivocally identified in paragraph 4.49:
‘Residential care will always be the placement of choice for some children and we know that some children say they do not want to be in foster care. We need these children to be able to enjoy a genuinely excellent care experience, drawing on the best of what homes in this country and elsewhere do now’ ( Care Matters, HMSO, 2007)
For some children choosing residential care over foster care is an informed and conscious choice. Others – those in the second and third category who are more unintegrated and traumatised (or too young) have less ability to act on their own sense of agency and make such decisions. For these children the role of the professionals who have responsibility for them is to find a placement that will best increase their chances of belonging, but all too often the ‘corporate parent’ is made up of procedural systems, and if the child does not feel that these are ‘navigated’ by empathic adults, they are at risk of feeling further ‘cast adrift’.
This group of children have often suffered severe early trauma: deprivation, neglect and abuse. These traumatic experiences have often left them with a profound sense of confusion and mistrust and without a coherent sense of self. Without a sense of agency these children and young people need the active involvement of social workers and other professionals acting in their best interests, to make difficult and complex decisions about the type of placement that will in their case keep them and others safe, and to meet their needs in a placement that will provide the best possible outcome for them.
Residential care can offer a different experience from that of foster care. Thoughtfully delivered residential care can provide an ethos of professional neutrality, which allows children and young people a safe environment and the conditions in which to explore relationships, and if this is backed by a responsible financial commitment they can do so in their own time. This requires the provision of a relational system that can provide appropriate ‘emotional distance regulation’.
Unfortunately, in a time of economic uncertainty there is a tendency for residential care and foster care to be constructed as in competition, rather than with the potential to complement and support each other, and this can work against the development of a system of flexible provision. Also, in the current context of Local Authority cuts and the general ethos of national austerity, the costs associated with residential care do little to raise the profile of this important and valuable resource into public consciousness.