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Lost Words Of Residential Child Care – Recovery

Lost words of Residential Child Care – Recovery

Children come to RCC with life experiences that are beyond those of most of the people caring for them.

They arrive considerably unsettled, often with challenges to regulate their thoughts or emotions and requiring close care from informed people who can provide boundaries and thinking when they are overwhelmed by their past, which might be often.

An environment of care is established that, if it meets the needs of the child, allows them to feel contained then begin to be able to accept being cared for, not a small thing when for so long you have had to be self-reliant in environments that were actively destabilising you.

There are developmental stages to a placement. After bewilderment, often described as a honeymoon period and which sometimes social workers describe as stabilisation, comes a degree of settling. It isn’t.

Commonly based on this misunderstanding comes a mistaken call to arrange a change of placement because the child has stabilised, a ‘step down’ to a foster placement. When there is a move at this stage the child loses the ground that they have gained and is again in emotional turmoil which is frequently manifested through their behaviour, going missing or being what is described as ‘uncooperative’ or ‘challenging.’

If the placement continues, as it should, comes a stage of ‘testing out’ boundaries and relationships. This is ‘normal’ and to be expected. It is a sign of hope, this spark is a sign the child is trying to return to the moments where all was going well and to  continue their development. There can be no telling when this stage will come, all children have had a unique set of experiences before coming into care and before we have known them. This communication through behaviour has meaning and needs to be understood. What is important is that the staff are ready for it whenever it comes. There will be no surprise, there will be calm, supportive care and regard. There are any number of internal scenarios that might be in the forefront of the child’s mind.

This followed by fleeting glimpses of reciprocity in relationships.

The key is for there to be a primary care relationship with one grown up. The ‘keyworker’ is given. Previous events and experiences are played out and these require understanding and exploring. To be successful both the child and keyworker need to be ‘held in mind’ by the person managing the care. They do so by reflecting on what is going on for the care to be given and received as well as can be. Sometimes children will choose another particular grown up. This too has to be understood as a memory from previous relationships. It is important to recognise if this is a positive memory and a helpful recreation, or one that is a reminder of a person who, through no fault of the child, failed him or her. It is a question worth thinking through whether parents are given or chosen.

The test comes when the primary care giver is not around and the effect on the child when they come back.

As this relationship grows and strengthens so does self-regulation and the transferability of that primary relationship to others.

There is a diamond shape to this exploration of the lifeworld. It grows then tapers as the primary carer is less present. This is still a fragile achievement, perhaps diamond shaped but with the vulnerability of a fine crystal.

Once again at this stage sometimes there a move to make a move, to step down now they have ‘really’ stabilised, for them to be cared for by a family.’ When there is a move at this stage the child loses whatever they have gained and communicates this through their behaviour, going missing or being what is described as ‘uncooperative’ or ‘challenging.’ Often the placement will be said to be a ‘failure.’ In reality the responsibility rests with the external decision makers. Reasoning by the care givers might be seen as ‘wanting to hang on to the child.’ This would be true, for the good reason the necessary experiences are only halfway through, they have not been internalised. They have formed a relationship the child is beginning to be loved and to love in return. The crystal is shattered.

Assuming that the interests of the child are followed, and the placement is allowed to continue, there is then the need for a second diamond with the primary carer in support. Lessons are learned from a different perspective by all.

This is the moment for transition.

It needs to be understood that the child is still in recovery, as they have been throughout the previous stages. Getting ‘better’ is something that takes time. It is the reason the concepts of Continuing Care and Through Care are considered relevant where Leaving Care is not. Terminology matters as it determines practice. The idea of ‘leaving care’ needs interrogation. For example, what is support if it does not have care? Few people ‘leave care’ in their life. Care changes, but continues, the need for it does not diminish.

If the active stages of containment and nurture are complex and frequently misunderstood so the recovery continuing is now a forgotten aspect of care. There is a rush to normalisation of children whose previous life has not been normal. There are still many gaps and spaces to be filled in positively in a manner that removes them as risks for the child to fall into. There are islands of functioning and for as long a time as the child, or young person needs assistance in recognising that they are getting close to the edge then trusted adults with whom they have chosen to form relationships need to be there to guide them gently back explaining what was happening and why and how to avoid in the future.

Accepting of recovery is not always easy. For so long the child had to ‘be’ someone else and now is being asked to ‘be’ another, to adopt a new identity relies upon accepting another view of the past and this can be jumbled with loved ones who one now sees in a different way.

We are asking children to do a lot inside of 3 years. The reality is that most children are not given 3 years but  a matter of a few months.

Recovery is just as turbulent, not something to be welcomed easily perhaps. It is as unpredictable and strange as previous phases of confrontation. Healing hurt minds come slowly.

But the budget says quicker. The ideology says ‘family,’ though family may still be a sore subject, a place where the child is not yet ready to go. We idealise family and family life but for a child whose family life experience is one of trauma it may not be their goal. The practice model says support though there is still a lot of care needed and needing two people. Now there is one.

But we have been moved on. We are now apart from the people who helped us feel different, be different, who knew how to do things differently when you felt ‘that way.’ They saw it and changed in a subtle way that did not bring attention to your need.

The questions about what is happening to us are not answered but someone’s actions, or answered more slowly, or not at all. The communication is that ‘you’ (before it was ‘I’) are a lower priority than before. So button it up. Use whatever resources you have for as long as you can. It is up to you now. The world is so big, and my boat is so small. The ground is churned and the few green shoots growing there stand far apart are not seen by others as worth gathering.

Recovery is a discrete therapeutic entity in itself.

It deserves our full attention as much as any previous stage.

It is in recovery that we face our greatest challenges yet children in care are given less. Less people. Less care. Less money. More stress, More responsibility. More expectations, More things that can go wrong (on your own) after them going right (with others).

Not everything can be fixed quickly or easily and sometimes never quite completely.

Recovery is slow paced and enabled.

It requires recognition. Rebuilding needs recognition. Regeneration needs recognition.

We used to know this, but somewhere we forgot and came instead to expect the instant and the effortless.

Implications and consequences

There used to be a long-standing ‘hand me down’ RCC saying, ‘A year for a year.’ This means a year of recovery for every year that preceded the interruption in development. (Recovery here can equate with recuperation, recovering what was lost. There is also a group of children for whom emotional and psychological development has been severely delayed by life events, for them this is the recovery of the beginning. The ideas of rehabilitation and convalescence are old fashioned and come with negative connotations in England, but not elsewhere in the world). Thinking about it, for most children now coming to RCC, that takes them to mid-twenties. There is the case not for Care to 18 but for Care to 25. What do we have under the new supported accommodation standards? Care to 16. Nothing has changed for the children and their recovery. Recovery requires the provision by others of a social network, not an individual with depleted means seeking out others.

This is a case of removing key concepts and the practice upon which the are built. Where fostering, with often children with lesser needs, has Staying Put, RCC has Staying Close, Staying Connected. This place is not that where you have felt safe, secure, settled, loved. The removal of relationships inhibits recovery. Dominos falling.

‘Domino dynamics’ is a concept from climate change: non-linear change, proliferating from one part of the system to another, ‘cause and effect need not be proportionate,’ a small disturbance, in the right place, can trigger a massive response from a system and flip it into a new state. This new state can be positive or negative.

A civil servant at the time explained to me this disruption was the intentional use of the Innovation funding of No Wrong Door. So it is also with the idea and practice of Supported Accommodation.

The idea of domino dynamics is that new technologies bring greater efficiencies, economies of scale and industrial synergies reinforce each other, causing their price to fall. An analogy can be made with the financially driven but ecologically argued bubble that is electric power and especially electric cars.

The removal of fossil fuels makes space for electric.

The removal of relationships and care make space for the entry of support and accommodation.

Electric power has the attraction of being from solar, wind and wave. This form of power might be locally clean, but it is globally filthy. (Thanks to George Monbiot for opening this thinking Domino Theory – George Monbiot). It takes no collective responsibility. It heaps it on to individuals. There is collateral damage.

Electric power requires the mining of the materials, cobalt, lithium, copper. It destroys environments, communities, ecology, and living and working conditions. Add to this the need for more roads and more vehicles.

Put ‘simply flipping the system from fossil to electric cars preserves everything that’s wrong with the way we now travel, except the power source’ (Monbiot).

Supported accommodation does nothing to address the deficits of the current system.

‘Then there’s the question of where the money goes. The fruits of the new, “clean” economy will, as before, be concentrated in the hands of a few: those who control the production of cars and the charging infrastructure; and the construction companies still building the great web of roads required to accommodate them. (Monbiot)

In a few years will we look at the providers of supported accommodation and find that they are the same few as in fostering and RCC? (which by then will have aggregated still further). It is highly likely. The large providers will have avoided the development costs that are incurred by small providers and bring greater efficiencies through economies of scale.

Already there are providers looking to invest in supported accommodation. We are beyond the tipping point in the creation of a new status quo. A critical threshold is reached when a certain proportion of the population change their views.

The sense that the wind has changed, and people are tacking around to catch it is seen in the acceptance by purchasers and providers of the idea of supported accommodation. Whereas once the absence of care and relationships would have been unthinkable now it has been accommodated.

We are well beyond the tipping point. This is an evidence informed evaluation ( Experimental evidence for tipping points in social convention (science.org)). The tipping point line is passed when the size of a committed minority reached roughly 25% of the population. At this point, social conventions suddenly flip, and people swing round destroying previously stable social norms. ‘The power of small groups comes not from their authority or wealth, but from their commitment to the cause.’

The loss (another lost word) of recovery and increasingly relationships has become normalised.

NCERCC