Case Study (childrens residential services)
Antecedent Brief History - (S - 13 years)
Diagnosis: Reactive Attachment Disorder, Specific Learning Difficulties, Mild Learning Difficulties, institutional upbringing, experiential privation, pervasive social disability.
S was born in Romania and spent the first 4 years of her life in an orphanage. When she first moved to the UK she had severe developmental delay. She had no spoken or written language; she could not chew and would only eat soft foods. She could walk but she had wasting of her lower limbs and she had deficits in her motor skills. As she became older the social differences between her and her peers became more apparent and with increased social demands placed on her, she developed more aggressive and destructive behaviours. These behaviours continued to the point where she was unable to continue mainstream schooling. She attended a school for children with complex learning difficulties. However, this placement also broke down due to her high levels of aggression. Her behaviour at home had deteriorated to the point were her adopted parents found it dangerous and uncontainable. S was later admitted to Alder Hey Hospital as an inpatient on their Child and Adolescent Unit.
Assessment and Person Centred Plans
The Consultant Psychiatrist at the Unit concluded that at present home integration would not be possible at this time and a specialist placement would need to be identified. The Doctor had worked with another of our young people and had been clearly impressed by our management of this young person. A request was made to Liverpool Children's Integrated Commissioning Board (CICB) and European Lifestyles was identified through the integrated commissioning process. S's parents had a difficult relationship with both social services and the adolescent unit and so we had to build a trusting relationship in a short space of time as the discharge date was set. Both parents and professionals were consulted as to how they envisaged the new service and a number of child centred initiatives took place, including a Person Centred Plan in the form of an Essential Lifestyle Plan.
The parents commented on how positive the process felt. Assessments were commenced by our residential and educational service in order to gain a holistic perspective. Meeting arranged with her unit staff team and stakeholder professionals and a review of case files helped compile a comprehensive picture of S's needs. We then identified how her new home and staff team should be configured to meet those needs.
Progress and outcomes to date
Because of the careful preparation, the initial contacts by her new staff with S on the unit were positive. The move took place in August this year after nearly a year in the Adolescent Unit. There was an initial testing of boundaries by S but the consistent professional approach by the staff team overcame these initial problems and by assiduous application of their training, clear progress was made. It was stated that we would not be able to convince S to attend our school but again by careful preparation she attended on the first day of term and has attended every day since. Her recent LAC review highlighted the remarkable progress made to date with positive comments from the reviewing officer, social worker and parents alike. In meetings we attended with Local Authority Commissioners, prior to her arrival, this was considered one of the Authorities' most highly visible and difficult cases. Our success with S will be seen as a 'test case' for future placements. The authority has identified a number of young people that will need to return to Borough and this case will help us in acquiring new business. A request has since been made for our Company to make a presentation of our services to the Children's Integrated Commissioning Team. This is unprecedented and presents us with a great opportunity to further our reputation.
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