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CHAPTER 1
Introduction
The psychological well-being of children in the care system has been receiving increasing levels of attention due to corresponding increases in research on both the difficulties and the interventions involved in helping those children with mental health needs (Carr 2000). Surveys have consistently shown that the psychological needs of children in the care system are significant, in terms of high levels of arrested physical and psychological development (Roth and Fonagy 2004). Specific research in the UK such as that by Maguire (2005) has also shown with increasing clarity the role that foster families can play in accelerating the childâs return to a path of more healthy developmental progress.
There have also been recent discussions of âprofessionalisingâ foster carers (e.g. DfES 2006; Hutchinson, Asquith and Simmonds 2003). This means that other professionals have been looking at developing the knowledge and skills of foster carers in order to enhance their work, given what we now understand to be the costs to individuals and society of not meeting the needs of the increasingly complex and psychologically vulnerable children in foster care. Our background research in writing this book has indicated that, despite this combination of facts, there is still a serious lack of accessible literature available to support foster carersâ understanding of the very significant needs of these children, and to contribute to the development of their increasingly specialised role. We hope this book is a first step in a series of developments to address this issue.
In our view, the need for this book has become quite urgent. Many good people are arriving at foster panels with limited understanding of the wide range of needs of looked after children and the possible impact of these needs on themselves and/or their families. This book is essential reading for registered foster carers, and people putting themselves forward for selection as foster carers. It is a book for you to read as early as possible in the process, so that you are more aware of both the fulfilment and the challenges that the role can bring. Every bit of help that foster carers receive to support children is an investment in the children themselves. The book will be useful for adoptive parents, too. It is also expected that it will be useful background reading for both experienced and trainee practitioners in the professional systems of care outlined in the âprotective shieldâ (see Chapter 2) in understanding their statutory role in supporting children looked after by foster carers, and also supporting the foster carers themselves.
This book will be an essential guide to some of the dominant psychological issues facing looked after children and their carers. It will also discuss the foster carerâs ideal role(s) in contributing to the reparative and developmental work that needs to be done as an integral part of their task of caring for distressed and vulnerable children. This book has been written to alert you to a wide range of information on the psychological processes that may affect you and your family as well as the foster child. You will also be introduced to the truism that we each seek a sense of ânormalcyâ. In our experience, normalcy exists around ideas such as that we all have a desire to reduce anxiety and to increase security; that we all anticipate change as integral to the process of growth; and that we are all part of many social systems, all at the same time. The purpose of sharing this information with you is to increase your awareness and understanding of the psychological issues facing looked after children and how this potentially impacts on foster carers and their families in their unique responsibility as 24-hour support workers with multiple roles (e.g. as biological parent, partner, employee, daughter/son, sibling). The book will describe some of the most prevalent psychological needs of these children and offer guidance on how to support them and also on how to address them in collaboration with other professional partners. For each main concept introduced we will provide a case study or vignette to illustrate the type of needs that characterise the concept. The book will also provide foster carers with language and understanding about the features of stress and distress in children who are placed for child protection reasons, as well as the developmental needs of children with learning difficulties who are placed in foster care to provide respite to the biological family
In our specialised work with foster carers (direct therapeutic/psychological interventions and training), we have found that foster carers often reflect the psychological impact of their relationship with the child(ren) by mirroring powerful feelings of impotence, disappointment and insecurity, or lack of certainty about the future â for example, they express feeling let down, neglected or abandoned by their fostering agency (whether it is their local social services department, or another social services department, or a privately run agency). Although this empathy has some utility, it can become paralysing and disruptive to the necessary collaboration between the carer and the other professional systems. Foster carers can also feel angry with child and adolescent mental health services (CAMHS) because of their high-priority agenda of confidentiality. This is often experienced as âsecrecyâ and âobstructiveâ, as foster carers may feel they can only understand the child if they âknowâ what the child is saying to the therapist. The skill of the therapist is to attune the foster carer to the needs of the child without breaching confidentiality. Such issues are identified and explored.
Similarly, when a placement breaks down, it is experienced as failure for both the foster carer and the child, and the feelings of loss and rejection percolate through to subsequent placements for both the foster carer and the child. Our work with looked after children gives us a very good indication that the mechanism for reducing the risk of placement breakdown pivots around improving the fit between the foster carersâ threshold of tolerance and their understanding and respect for the childâs communication of its turmoil. Annexed to this is the hugely important point that the key to foster carers increasing their understanding of children will be accomplished through the parallel process of increasing their self-understanding of the range of feelings that the child evokes in them.
Children who are fostered, especially those who have more enduring problems and mental health needs, are likely to get access to many professionals â social workers, counsellors, teachers, paediatricians, nurses, psychologists and even psychiatrists. However, typically these professionals come and go. You may indeed find some answers or some bits of theory or knowledge that enlighten you. However, our belief is that no facts revealed in the pages of this book can be half as helpful as the ideas and concepts that you must actively develop in understanding the children you are fostering now, or go on to foster. In truly understanding their needs you will discover that, as a foster carer, the most valuable tool you have to give a child in your care is yourself.
This book begins by outlining some of the legislative framework around fostering and we introduce the concept of the âprotective shieldâ, which is the network of professional and community-based support that a foster child may have access to (Chapter 2). The cultural, social and legal structures associated with various aspects of foster care and looked after children are described (Chapter 3). Some of the very key theoretical frameworks underlying foster care are then introduced (Chapter 4), allowing you to think through the critical role that foster carers and their families are expected to play in welcoming children in need into their homes and assisting them on their journey through to psychological health. Chapter 5 is an orientation to the rich tapestry that foster caring can be. Thinking about how culture is crucial in the way we all conduct our lives is a vital exercise, because it becomes so automatic for us within our own families that we forget how diverse people are in âthe real worldâ. How is it that you can open yourself up to the opportunity to welcome and support a child who does not have the same attitudes, conventions, customs and behaviours that you have?
We then go on to describe the psychological issues that present for so many looked after children, and give ideas on how you can help children who have experienced challenges to their physical and psychological development (Chapters 6 and 7). An increasingly non-negotiable aspect of the foster carerâs work is to âjoin withâ other professional systems that the foster child is involved in (e.g. education, social services, health), in order to increase the childâs access to the statutory services that have duties to ensure that the childâs wide range of developmental needs are met. Chapter 8 embellishes the idea of the âprotective shieldâ first introduced in Chapter 2, and explains why the foster carer is an integral and significant part of that network of support. We will then introduce you to some of the issues around the many assessments that foster children may have to experience, the contributions that you may have to make to these, your potential feelings and attitudes towards these assessments, and the support that you may have to offer as a consequence of them (Chapter 9). We go on to give you some insight into your own psychological processes by looking at the feelings you may be left with when a placement ends, or the potential devastation when a complaint is made against you or someone in your household (Chapter 10), or how you might feel about the assessment process for registration as a foster carer (Chapter 11). Following the conclusion (Chapter 12) you will find two appendices, a glossary of commonly used terms, and a list of sources of further information that you may wish to explore.
References
Carr, A. (2000) What Works with Children and Adolescents? A Critical Review of Psychological Interventions with Children, Adolescents and their Families. London: Routledge.
Department for Education and Skills (DfES) (2006) Care Matters: Transforming the Lives of Children and Young People in Care. London: HMSO.
Hutchinson, B., Asquith, J. and Simmonds, J. (2003) âSkills protect: Towards a professional foster care service.â Adoption and Fostering 3, 7, 8â13.
Maguire, S. (2005) âMental health literacy and attitudes in foster carers: Identification of factors that influence help-seeking.â Unpublished dissertation supervised by J. Guishard-Pine. University of East Anglia.
Roth, A. and Fonagy, P. (2004) What Works for Whom? A Critical Review of Psychotherapy Research (2nd edition). Hove: Guilford.
Useful websites
â˘www.BAAF.co.uk
â˘www.barnardos.org.uk
â˘www.familyfutures.co.uk
â˘www.fostering.net
â˘www.fostering.org.uk
â˘www.nch.org.uk
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CHAPTER 2
Context
Wherever foster care exists across the world, its function is to provide for the physical, emotional, social and psychological needs of children who for varying reasons can no longer be parented by their mother and/or father or extended family, or whose care needs to be shared, as in respite care. Sellick (1999) referred to these vulnerable children as âsocial orphansâ. This chapter will summarise the growth of foster care in the UK and also draw the readerâs attention to global issues around foster care. An account is given of the earliest recorded history of foster care in the UK, and this provides the canvas on which we paint a picture of the developing complexity of the role. The following history is adapted from Ruegger and Rayfield (1999).
The history of foster care in the UK
The earliest records on caring for orphans date back to the 1500s, when they were placed with nurses. By the 1800s a range of institutions (such as Barnardoâs) were set up, with the principal aim of meeting the physical needs, but not the social and emotional needs, of neglected children. The earliest institutions for neglected or orphaned children were essentially workhouses. The most significant record of fostering as we understand it today was made in 1853, when a child was removed from a workhouse in Cheshire and placed in a foster family under the legal care of the local government. The foster parents were given an allowance by the local government for subsistence, to the value of what the child would have earned in the workhouse. These fostering practices were not wholeheartedly welcomed by the public. The opponents of this method were concerned about a decline in responsible parenting, as it was felt that some parents would neglect their children because they knew that the government would take the responsibility for child rearing away from them. Another fear was that foster carers would house children in exchange for money, but would then go on to mistreat them. As a consequence of such concerns âboarding-out committeesâ were formed, with the role of coordinating placements. At the beginning of ...
