Jane Mitchell February 2015

When Families Break Down - Taking the Last Stand

As harsh as it seems, not all children are able to live within a family unit. Although it is well known from research that the majority of children will achieve best outcomes from a family environment, for a very small minority, that emotional intensity is unendurable, and leads to extremes of behaviour as the child acts out their overwhelm and fear. However, there is a way forward in these cases whereby the child can maintain the advantages of inclusion in a family, as long as Local Authorities and other professionals are prepared to work alongside adoptive parents to find a solution. Let me tell you about an example of such a case.

This case study involves a 14 year old girl whom we shall call Annabel. Annabel was born in 2000. Her birth Mum suffered chronic depression, anxiety and OCD. Her birth Father separated from the birth Mum before Annabel was born. Birth Mum had previously had 4 children by separate fathers and had been unable to care for any of them. She was, however, determined to try and be a mother to her new baby. Unfortunately, she found the intensity of caring for a new-born too much to manage, and Annabel went into foster case at three weeks. She then returned to her birth Mum, only to be returned again to foster care from a few months old, until 18 months old. At this time she returned to her Birth Mum with a package of care to support her including 4 days with a specialist childminder per week. When Annabel was just over two years old, she was placed in foster care, and then adopted into a family at age 3.

Annabel presented early on as a challenging child with complex needs. Her foster mum – who was very attached to her - nonetheless found her exhausting and difficult to care for. She showed extremes of temper and would often resort to physical attacks such as hitting, pinching or kicking as a vent for her frustrations, not helped by the fact that even at age three she had an extremely limited vocabulary.

Annabel was placed with a family where there were already three birth children, and parents who had both been childminders and were well versed in childcare from personal experience and in the case of the adoptive mum with additional knowledge due to study. The new Mum took on the task of learning more about the challenges her new daughter was facing and over time absorbed new knowledge as it emerged about attachment disorders, neurological development, and nurturing a traumatised child. (As this was 2003 onwards, this was a rapidly expanding field with new understanding continually developing

Jane Mitchell February 2015

over the subsequent period). The new Mum studied, attended courses, reflected, and worked on behalf of her daughter to get support in place, including two sessions of play therapy, resources, and inclusion on useful seminars. Over the next few years the family as a whole experienced extreme challenges in meeting Annabel’s complex needs, maintaining boundaries, developing strategies, and thinking and rethinking ways to help her to manage her overwhelm. The family began to feel the strain, and other family members and friends became less tolerant and withdrew, reducing the available support system around the family considerably. Annabel was referred to CAMHS, who diagnosed her with autism which gave an additional perspective to consider as a likely cause of some behaviours and anxieties.

Fast forward to age 9, and Annabel enters puberty, and a whole new challenge emerges as she struggled to deal with her body, which was defiantly maturing at a rate of knots. Not an eventuality that Annabel was emotionally prepared for, she found the process scary and uncomfortable – as her developmental age was around 7, she could not comprehend what is happening to her and her mood swings started to escalate in line with her menstrual cycle. She started to menstruate at age 10.

The combination of transition to secondary school and onset of puberty proved a very difficult and heady mixture. Although there were no really challenging behaviours at school in the first year, her home behaviour became worse, plus of course she grew much bigger and stronger. Her adoptive parents were concerned about their ability to manage her strength. After September at the start of her second year at secondary school, there was a massive escalation. Annabel had been getting more and more violent towards her adoptive mum, frequently attacking her verbally and physically, with regular bouts of destruction in and around the house and garden. She was threatening to kill her adoptive mum, and threatening suicide. She started scratching her wrists. The adoptive Mum got a referral to CAMHS and an assessment procedure started in October. Annabel and her Mum went every week to explore her feelings a bit, with the intention of helping her to talk through and gain insight into her overwhelm. Many strategies were suggested and adopted, and many more were thought up and put into place by the family. In the meantime her ability to manage school also deteriorated, with a huge escalation of unpredictable outbursts and incidents until the school felt unable to manage her needs, and am assessment of special educational needs was instigated.

Jane Mitchell February 2015

Finally following two episodes where Annabel needed to be restrained by professionals to keep her from attacking her Mum at the CAMHS offices Annabel was admitted to an Adolescent Mental Health Unit. Here they instituted a routine for Annabel which really concentrated on her autism, as well as an additional diagnosis of being emotionally dysfunctional and of course attachment disorder and she settled into the environment and regular visits from her family, and was sent home, with a support package provided by a local charity. She was unable to return to her school, and temporary arrangements were made pending the Local Authority’s decision regarding a suitable placement for her.

Annabel responded well to the new strategies which were put in place on her return home, but was still attacking her Mum, and also attacked several other carers from the charity, after which multiple carers were provided to lessen this eventuality. A specialist school was identified for her, but unfortunately she suffered another severe escalation, again needing to be restrained by a member of the CAMHS team after severely attacking her Mum, and was again admitted to a psychiatric unit. By this time, most people who knew the family were scared of her unpredictability and outbursts, and felt completely unable to visit. Friends and family were very scared on behalf of the adoptive mum, who was the usual target.

It was suggested now that Annabel should not return to the family home because of the danger to her Mum, however it proved difficult to find a suitable placement, and in the meantime, Annabel really settled down and the family felt that they could try again, because a lovely school had been identified that she really engaged with, and it was hoped that an appropriate school environment would make the difference for her in reducing her overwhelm. Unfortunately this proved not to be the case at home. Annabel’s violence escalated and her adoptive Mum had to take a decision that she could no longer keep herself or Annabel safe – at this point, her older children had left home, her husband had left, and she was on her own. There had been attacks with cutlery knives and other weapons, and escalating physical and verbal abuse. Police were called to the house on several occasions – 5 times over the course of one single weekend. In the opinion of the consultant psychiatrist, this was because Annabel found the emotional intensity of the relationship (especially with her Mum) too difficult to manage. At a multi professional meeting, the adoptive mum asked for her daughter to be accommodated under a voluntary placement order, making it clear that this was for safety reasons and in no way impacted on her love for her daughter or her wish to continue to have parental responsibility.

Jane Mitchell February 2015

Annabel was moved to a specialist residential home, where there were very few other resident children (one other girl at first), a nice homely atmosphere, multiple carers and 1:1 care. She gradually settled and calmed. Her family were able to assert their right to remain her parents, and to maintain this as a voluntary arrangement. The placement was some distance away, and visits were shared – each parent taking an alternate week. There was also phone contact.

Over time, this reassurance that her family were still her family, and still loving and caring for her helped Annabel to manage and settle in her new environment. She calmed down and found new confidence and self esteem, and lost her fear of rejection and abandonment as her family remained a constant presence, and her sisters and other family members were enabled to visit and have phone contact as well.

Annabel relied heavily on this contact with her family for support and reassurance, which they were able to provide and she was able to accept because the intensity of the relationship when living in the same house all the time was no longer present. In this way she was able to develop resilience and confidence in the family unit. Previously this had not been possible as her inability to manage her overwhelming emotional state and subsequent attacks on her Mum eroded her ability to believe in the unconditional love which was offered.

There were some factors which enabled this outcome, which are useful for other adoptive parents in similarly difficult situations to bear in mind:

1. The adoptive parents were able to continue to support Annabel despite their own relationship issues.

2. The adoptive parents were very clear about the reasons why Annabel could no longer be accommodated in the home.

3. Correct procedure was followed regarding safeguarding and restraint according to Local Authority guidelines.

4. The adoptive parents were consistent and clear in asserting their right to be indentified as Annabel’s parents, and her right to retain her family.

5. There was an effective team of professionals that were able to work together to find solutions. Parents had access to professional’s meetings with few exceptions.

6. Disagreements and concerns were openly canvassed and discussed, with a degree of compromise being achieved by all parties at different times.

Jane Mitchell February 2015

7. There was clear paper evidence in terms of reports, emails, letters and minutes to meetings. All important discussions and decisions were requested as a written record.

8. Where there were concerns about Local Authority decisions, written requests were submitted to have those concerns responded to, and to ensure that there is absolute clarity where decisions have gone ahead that the adoptive parents have not agreed with.

In dealing with Social Services, keep clear records, always ask for written confirmation of verbal discussions, minute meetings yourself or take someone who will do so for you, if you can afford to, then take legal advice. Identify the managers and ask to deal with them directly. Above all, be aware of your rights and those of your child.

The case outlined above is not of course unique. Adoptions placed under this level of stress can break down. What some adopters are not aware of is that they can assert their own rights as parents and their child’s rights to continue to be a part of the adoptive family so that further rejection, separation and loss is minimised, and after a period of time the relationship may be strengthened and be an extremely positive influence for the child, even if it is not possible to live together as a family. These situations are also not unique to adoptive families – birth families whose children have suffered developmental trauma or have a severe leaning difficulty may also be sufficiently violent to be accommodated away from home, without any suggestion that this may be due to poor parenting. In the model above, the effects of further traumatisation due to loss, rejection and abandonment were minimised for the child and also significantly minimised for the family.

If you are struggling with violence within your own home, do ask for help. Be clear about the extent of the problem. Involve professionals such as your GP or CAMHS or the Police that may be able to help you. By raising awareness of the issues that are sometimes faced, we can help to bring about a necessary change of attitude.

Our children need us to be the best parents we can be – and all families are different. Maybe we need to think of ways to enable families to be intact through separation. Families need to be listened to, but in order to be heard you have to speak out. It is part of parental rights that their views are heard and taken into account, and as longs as views are expressed appropriately and coherently, there should not be issues as a result of parents asserting those rights.

Jane Mitchell February 2015

Adoptive families are committed, motivated, loving and change lives – I wish all of you success in your individual journeys.

About the Author:

Jane has been a trainer for AUK for 8 years. She has worked in Early Years Education and as an FE tutor teaching Childcare and Health and Social Care, and has managed a local Children’s Service. Jane has recently decided to concentrate on delivering training and supporting adoptive families, and is awaiting OFSTED registration.