Meeting the EmotionalMental Health Needs of Older LAC

1
Meeting the Emotional/Mental Health Needs of
Older LAC

• Tamsin Owen
• Clinical Psychologist for Looked after Children

2
Outline

• Background Challenges to LAC in Education
• Common Issues
• Attachment as a key influencing factor
• Barriers to education
• Indicators of problems
• What can help?
• Practicalities
• Direct contact with YP ways of engaging
  supporting looked after YP with emotional
  difficulties
• Case study
• Questions

3
Background

• DoH commented that the single most important
  indicator of childrens life chances is
  educational achievement (DOH/DFES, 2000)
• Education can largely be based on the assumption
  that most children are able, willing and
  supported to take up education opportunities.
• The experiences of LAC undermine their capacities
  and disrupt their opportunities.

4
Background

• Looked after young people are like any young
  people, but our picture of them needs to be
  sharper.
• Ages, stages abilities or disabilities range in
  all children, but for children with poor early
  experience and disrupted care there are
  additional complexities.
• From the moment of birth the foundation for the
  childrens capacity to benefit from a learning
  environment is being laid.
• However early and however brief, the experience
  of adversity will have consequences for the
  childs emotional cognitive development. This
  means that there are likely to be difficulties in
  thinking, reasoning, planning and organisation.

5
Challenges facing LACPlacement Moves

• YP in looked after system can often experience
  numerous and often unplanned moves of home.
  Disrupted schooling and disruptions in their care
  placement are two major contributory factors
  accounting for their low educational
  achievements.
• Garnett (1994) noted that only 27 remained in
  their same placement during their stay in care,
  half the children had two placement changes and a
  quarter had at least 4 changes.
• Evans (2003) 34 of all children in care moved
  home within the final 6 months of statutory
  schooling.

6
Challenges facing LACMental Health

• Meltzer et al., (1999) 2500 LAC between the
  ages
• of 5 and 15. An assessable mental health problem
• as found in
• 42 of 5-10 yr olds
• 49 of 11-15 yr olds
• Compared to 8 and 11 in the wider population.
• Of these, 37 had conduct disorders 12 had
• anxiety depression.

7
Common Issues

• Multiple placement moves
• Loss / Bereavement
• Low self-esteem
• Problems with identity
• Problems with friendships
• History of child abuse/neglect
• Mental Health Problems
• Post-traumatic stress disorder
• Depression
• Anxiety
• Attachment related problems
• ADHD
• Cognitive Problems

8
Attachment

• Secure Attachment associated with responsive
  caregiver and positive outcomes for child
• Insecure Attachment associated with
  unresponsive caregiver and negative outcomes for
  child
• Insecure Avoidant Avoids and nonchalantly
  ignores caregivers. Associated with an angry or
  defiant presentation in children.
• Insecure Ambivalent Oscillate between anger
  towards the parent and rejecting and wanting
  closeness. Associated with children who are
  emotional and overwhelmed by anxiety.
• Insecure disorganised Show confusing
  contradictory attachment behaviour. The child may
  show an angry burst and then be dazed or try to
  escape. The child may have a Frozen
  watchfulness of the maltreated child. The child
  may sit on caregivers lap but be physically
  stiff and with its eyes averted from the carer

9
Internal Working Models

• Secure Attachment
• Self. I am good, wanted, worthwhile, competent,
  loveable
• Carers. They are appropriately responsive to my
  needs, sensitive, caring, trustworthy
• Life. The world is safe, life is worth living
• 2. Insecure Attachment
• Self. I am bad, unwanted, worthless, helpless,
  unlovable
• Carers. They are unresponsive to my needs,
  insensitive, hurtful, untrustworthy
• Life. The world is unsafe, life is not worth
  living

10
The Effects of Secure Attachment

• A strong attachment will enable the child to
• Attain their full intellectual potential
• Think logically
• Develop social emotions
• Develop a conscience
• Become self-reliant
• Cope better with stress and frustration
• Overcome common fears and worries
• Increase feelings of self-worth

11
The Effects of Insecure Attachment

• Behavioural a variety of anti-social and
  aggressive acting out
• behaviours e.g. lack of impulse control, lying,
  hoarding, sexually
• inappropriate behaviours, destruction of
  property, sleep disturbance,
• cruelty to animals.
• Cognitive Functioning lack of cause-and-effect
  thinking, learning
• language disorders (due to early neurological
  damage foetal alcohol
• syndrome, failure to thrive, physical abuse).
• Affect anger, unaffectionate/indiscriminately
  affectionate, sadness,
• Helplessness, inconsistent emotional responding.
• Social Behaviour unstable peer relationships,
  blames others for
• own mistakes, lack of eye contact,
  indiscriminately affectionate
• with strangers, manipulative.
• (Levy Orlans, 1998)

12
The Effects of Insecure Attachment

• Insecure attachment has been implicated in
  various
• mental health diagnoses e.g.
• Conduct disorder (Speltz et al., 1999)
• ADHD (Green Goldwyn, 2002)

13
The Effects of Insecure Attachment
Attachment Disorder I was treated badly abuse
neglect Multiple disruptions
Negative Responses Others treat me badly
parents, teachers, peers Punishment, rejection,
reinforce NWM
Negative Working Model I am bad,
unlovable caregivers are unsafe, unreliable
Behavioural Problems I will act
badly aggressive, oppositional, dishonest
14
Other Barriers to Education

• Not being properly prepared adjustment to new
  environment
• Unidentified learning needs
• Finances
• Housing
• Support systems reducing difficulties accessing
  services
• No parents to encourage
• At an age where YP start to process whats
  happened to them
• Complex Systems

15
The Childs System

• Foster Carer/Residential Staff Birth
  Family
• Guardian Contact Supervisor
• LAC nurse
• Social Worker Foster Carer SW School
  Staff
• Reviewing Officer
• Other Workers LAC Education Staff
• Substance Misuse
• Mentors
• Therapeutic Input
• YOT worker

YP
16
The Professionals System

• Fostering Support Team Adoption Team
• LAC Team Mental Health
• Schools YOS
• Substance Misuse Residential Units
• CIN Team Recruitment Assessment Team ART Teams

Education
17
Indicators of Problems

• Non-attendance
• (lack of motivation depression avoidance
  anxiety/low self-esteem hyper vigilance PTSD
  level of work)
• Withdrawal from peer groups
• Self-harm
• Problems with peer relationships
• Conduct problems
• Not completing work

18
What can help?

• Practical Stuff
• Create a safe space for young person
• Have a designated member of staff for that person
  (designated teacher, mentor)
• Link in with professional network
• Link YP in with college-based groups supports
• Use your own support lots of pressure on school
  staff
• Awareness of local mental health/counselling
  resources support YP in linking in with these
  services
• Linking in with previous school to see if theres
  any change in YPs presentation

19
What can help? Direct Input

• A Solution Focussed Approach to increase self-
• esteem engagement
• Change the focus from the problem to the solution
  of a preferred future for the young person
• see a person as being more than their problem
• look for resources rather than deficits
• to explore possible and preferred futures
• and to treat young person as the experts in all
  aspects of their lives

20
What can help? Direct Input

• Problem Free Talk
• I know very little about you except what brings
  you
• here today. How do you spend your day? What are
• you interested in? What are you good at?
• Exceptions
• When doesnt the problem happen?
• When does it seem to be less intense?
• When do you resist the urge to . . . ?
• How come you still go to school/work/etc on some
• days?

21
What can help? Direct Input

• Coping
• That situation sounds pretty overwhelming, how do
  you
• cope?
• How have you been getting through?
• What might your friends admire about the way you
  have
• coped with this?
• Locating resources/ building on strengths
• When youve faced this problem in the past, how
  did you
• resolve it?
• How would you know if you were doing that again?
  What
• would it look like?

22
What can help? Direct Input

• View of Self identity questions
• What does that teach you about yourself?
• What do you know now about yourself that you
  didnt
• know last week?
• If you read about someone who had been through
  exactly
• this, what would
• you think of them?
• Scales
• On a scale of 0-10, with 0 being the worst that
  things
• have been in your life and 10 representing the
• achievement of your best hopes, where are you
  today?
• What is is you are doing that means you are at
  and not
• 0?

23
What can help? Direct Input

• Other peoples perspective
• Who will be the first teacher to notice youve
  moved
• up one point on your scale?
• Who will be the hardest to convince that you mean
  
• business this time? What will he/she need to see?

24
Attachment Problems - PACE

• PACE was suggested by Dan Hughes as a way of
  helping the adult remain emotionally engaged and
  available to the child.
• It can be especially useful for engaging with
  young people who are experiencing attachment
  difficulties.
• The worker becomes attuned to the YP through a
  stance of acceptance and curiosity, empathy
  and/or playfulness.

25
PACE

• Curiosity This is the starting point of being
  able to relate to the YP and to help the child to
  learn to manage feelings and to think about
  experience.
• Includes wondering with the YP about the meaning
  behind the behaviour being displayed. It is
  different from asking a YP why s/he did something
  in a confrontational manner. It is more an
  attitude of figuring out what is going on.
• Having an attitude of curiosity can lead to
  feelings of empathy for the YP.
• The YP will then be more willing and able to
  think about the behaviour and the consequences
  that ensued.
• Curiosity sometimes means making best guesses
  about what is going on. The YP and adult can
  figure it out together as the YP may genuinely
  not understand the behaviour themselves.

26
PACE

• Acceptance Following curiosity comes
  acceptance. Acceptance means understanding why
  the YP felt s/he had to behave as s/he did.
• The adult accepts both the behavioural choices
  the YP is making and the feelings that underlie
  these choices.
• Acceptance conveys understanding rather than
  condoning of the behaviour. As the YP feels
  understood s/he will be more willing to think
  with the adult about the consequences to the
  behaviour that s/he now has to face.

27
PACE

• Empathy Acceptance is conveyed to the YP
  through empathy.
• To empathise the adult needs to enter
  imaginatively into the experience of the YP.
  Acceptance of this inner experience is
  communicated to adult helping the YP to feel that
  his or her inner life is important and valued.
• Playfulness At times a playful attitude can be a
  key factor in helping a YP feel connected within
  the relationship.
• A light-hearted, relaxed and playful attitude can
  help the child, sometimes unexpectedly, to
  experience fun and love. If the resistant YP does
  not see it coming and if it is over quickly s/he
  will find it harder to avoid and disengage.

28
What can help?Direct Input

• Insecure Avoidant
• Encourage expression of
• feelings
• Enactment
• Role play
• Empathic questioning (e.g.
• how do you think carer feels?)

• Insecure Ambivalent
• Encourage expression of
• cognitions
• Genograms
• Life line
• Belief systems
• Scaling questions
• Shared family beliefs

29
Case Study

• Karis is a 16 year old girl who has been in care
  since the age of
• 8 due to neglect. She was initially placed with
  an aunt and uncle,
• however, she was sexually and physically abused
  in this
• placement and so had to be placed in a short-term
  emergency
• foster placement, before being moved into her
  current, long-
• term placement where she has been for the past
  four years.
• Karis currently has a learning mentor. She
  experiences problems
• with anxiety and during the recent exam period,
  this has
• escalated and she has also been experiencing
  panic attacks. This
• has prevented her from sitting two of her exams.
  She is
• receiving therapeutic input for this.

30
Case Study

• Karis has problems getting up in the morning and
  is often late
• for school. She has also shown some avoidance of
  attending
• certain lessons, which she find anxiety provoking
  (e.g. drama).
• This has created a lot of problems between Karis
  and her foster
• carer and has made the placement fragile at
  times.
• Karis loves working with children and excelled on
  her work
• experience placement at a school. She is due to
  attend college
• and study nursery nursing.
• What are the concerns for Karis?
• What are her areas of strength?
• Thinking about what your colleges/services
  currently
• offer, what support could you provide for Karis
  or what
• services/activities could you link her in with?

31
Questions