The Long Journey Home

Thursday, July 1st, 2010 by Clair Davies

Appletree Treatment Centre is in Cumbria. There are two children’s homes, Appletree and Fell House, with schools on site for girls and boys aged 6 to 12 years with emotional, behavioural and learning difficulties due to abuse and neglect. We work alongside our clinical team to help our children return to foster families or families and day schools before they reach their teenage years.

We are successful with the majority of our children. However, there is a small minority who can not return home, usually because their families would not cope and get them to school. Our third home, Willow Bank, supports these children through their teenage years and Appletree’s Next Steps Education ensures they receive an individually tailored curriculum both with us and in the community.

We would like to share the stories of our recent leavers, known here as Spencer, Susan, Daisy and Carl.

The First Step

Spencer was referred to Appletree when his specialist foster placement broke down. He was seven years old and court proceedings were in process for him to become Looked After.  His parents were being investigated for sexual, emotional and physical abuse of him and his sister who was six years old.  They had initially been placed in foster care together but Spencer was moved following sexualised behaviour between the siblings. His specialist foster placement broke down as his wish to be around his foster mother and exclude his foster father was jeopardising their relationship.  At the same time he was excluded from his Pupil Referral Unit for violent behaviour.  He was described as severely under-achieving in school with possible moderate learning difficulties.

The Second Step

Spencer was referred to us as we had already made significant progress with another child from his authority.  They particularly liked the fact that we do not have children older than twelve years, so our children are free to enjoy the play they have missed out on without the influence of much older young people.  Spencer was considered by our admissions panel which includes the Principal, Head Teacher, Senior Care Manager, Registered Manager and Clinical Psychologist.  As we do not exclude children and aim to work with them over the years to return to families and day school, it was vital that we make the right decision for Spencer and for the other children we currently had placed with us.  It was a unanimous decision.  Spencer was coming to stay.

The Third Step

We invited Spencer and his Social Worker to visit.  We had decided that he would best be placed in our Fell House Children’s Home and School as this specialises in vulnerable children in need of an extremely nurturing environment.  We already knew which bedroom he would have, which classroom he would be in and who would act as his key worker.  We wanted to ask him how he would like his bedroom decorated and what he would like for his first tea.  He wanted trains in his room and spaghetti bolognaise.

The Fourth Step

Spencer joined us at Fell House and initially it was as if we were dealing with a “model” of a child.  He showed no spontaneous emotion of any kind.  He was entirely guarded, polite and “masked” from our view.  He refused to do any school work but was not disruptive.  We commenced our assessment and our clinical psychologist offered consultation to the care and teaching teams for Spencer.  This consultation continued throughout his stay and is now offered for all children.  We drew up an Individual Programme for Spencer with targets in Health, Social Skills, Home and Family, Anti-social behaviour, Education and Psychological Growth.  The assessment and targets were discussed and agreed with Spencer, his parents who had supervised contact and his social worker.

The Fifth Step

Spencer and his sister were awarded a Full Care Order.  Her plan was to be adopted by her foster carers, his to remain with us.  There was to be direct contact twice a year.  Spencer’s parents were not to have direct contact with his sister but could have supervised contact with him.  They decided they would not have contact with Spencer as it would be “too hard”.  Spencer could have monthly supervised contact with his maternal grandmother and this continued throughout his time with us.

To the Nine Hundred & Ninety Ninth Step

Over the next three years Spencer continued his journey.  There were times when for months he would have rage-filled outbursts which he could not control.  He hurt team members and other children.  It was a memorable moment when one of these rages ended in tears and Spencer allowed himself to be comforted.

Later in his journey he wanted to sexually touch female team members, particularly one whom he cared about.  Love for Spencer was associated with hurt and sex. Our Clinical Psychologist helped our teams to respond therapeutically to Spencer and to process their own feelings when he touched or hurt them.

Spencer engaged in play therapy which we contract from the NSPCC.  His therapist held regular meetings with the Fell House team to feed back themes.  Gradually Spencer allowed us to parent him.  Appletree has been described as ‘giving the best possible parenting until a child is ready for the best possible parents’.  Spencer made friends with the other children and then with other children in the area.  He loved cadets and looked so smart in his uniform.  He enjoyed the challenge of rock-climbing.  He began to risk doing some schoolwork, although initially much was quickly destroyed once done.  Slowly he started to learn, then learn quickly and finally enjoy himself.  His crowning moment came when he starred in a Christmas production of Charlie and the Chocolate Factory which he had written.

The Hardest Step

Spencer was now ready to leave us and live with forever foster carers.  He was excited but scared.  Predictably his anxiety resulted in a regression.  How could we love him and still let him go?  He waited at the window to meet his foster carers for the first time.  He ran up the drive to meet them.  “Can I call you Mum and Dad?” were his first words to them.

Spencer left us in the summer of 2005.  He is still with his foster carers and attending a day Moderate Learning Difficulties school.  His journey is typical of the children we help.  Over the last four years 75% of our leavers have joined families and day schools.  Of those children 90% are still with the same families. The cost of all of Appletree’s services is little more than the average cost of a local authority children’s home.  The cost if Spencer had not been helped back onto normal paths is incalculable.

Susan’s Story

Susan and her three younger siblings were taken into care when she was six after serious concerns of sexual, emotional and physical abuse from their parents and extended family.  Her two youngest siblings were adopted together and her younger sister was fostered by her mother’s sister.  Susan spent time in foster care and a children’s home but her soiling, sexualised behaviour and language, violence and complete lack of understanding of social cues and interactions meant that nobody felt they could cope with her.

Susan was seven years’ old when she was referred to us and after careful consideration and liaison with her social worker and Special Educational Needs officer we offered her a place at Appletree.

When we met her she was a little girl who appeared to have been failed to be given the care, love and consistency which a baby needs to begin to gain a sense of themselves, that they are valued, that their needs can be recognised and met.  We were going to have to give her this intensive experience and she would find it very hard to accept.

Over the next two years Susan slowly began to respond to the patient and consistent care she received.  Signs of improvement were small but so significant.  She finally kept a soft toy on her bed without defiling, destroying or throwing it from her window.  She allowed her teacher to praise her work without ruining the moment with lewd behaviour or violence.  She managed ten minutes playing football, which she loved, with other children and without some conflict leading her to storm off or become violent.

Susan also began to engage in play therapy.  There were many disturbing themes in her play and her therapy and gradually Susan became able to give them a voice.  She disclosed the things she had suffered and, along with her sisters’ evidence, this was sufficient for her abuser to be imprisoned.

She still had many struggles to overcome her loss of family.  Susan was however one of the most vibrant and spirited children I have ever known.  As she began to find a sense of herself she developed an amazing sense of humour and she was often now heard laughing and entertaining others.  She began to have some respite with her sister and Aunty. It was difficult and Susan had to accept that they could not look after her all the time but she was able to have fun with (and argue with) her sister.

After three years Susan was able to make friends in our village and attend the village primary school for a limited time each week.  We worked with her authority to identify appropriate foster carers for her and then carefully planned a transition over many months.  When Susan was ready to leave the primary school her classmates gave her a party and presents.  She could not stop smiling and laughing and hugging everyone at Appletree and when the tearful goodbyes came they were heartfelt.

At the time of writing this Susan has been with foster carers and mainstream school for two years.  She visits during the Summer holidays and it is wonderful to see her.  She is still loud and lovely and the corridors again resounded with her cheeky laughter.

Daisy’s Story    Joined : April 2007     Left : July 2010

Daisy and her elder sister Poppy were neglected and abused from birth. They witnessed extreme domestic violence and drug abuse. When Daisy was six and a half years old and her sister eight they were placed with foster carers. Daisy’s sexualised behaviour and extreme violence were very difficult for the carers to manage and after two years she was referred to Fell House. This is our extremely nurturing home and small school which specialises in helping children who have missed out on vital early years’ experiences of feeling safe and loved.

When she joined Fell House Daisy was having difficulty verbalising her needs and was unable to control her feelings. She was showing inappropriate sexual awareness and there were gaps in her emotional development. Her ability to learn in school had been severely limited by her life experiences and her additional learning difficulties.

After 3 years at Fell House

  • Daisy has made strong positive attachments with adults at Fell House.
  • Daisy’s foster carers now feel able to cope and want her to live with them permanently.
  • Daisy has a loving and caring relationship with her sister.
  • Daisy has made good friends with some Fell House children and also has a good friend near her foster carers.
  • Daisy has engaged in individual therapy, contracted from the NSPCC and made great progress including making sense of her sexual muddles.
  • Daisy’s maths levels have increased from P8 to Level 1A, her speaking and listening from P8 to Level 1A, reading from P8 to Level 1B and writing from P8 to Level 1C.
  • Daisy’s vocabulary knowledge has gone from 5th to 25th centile.
  • Daisy’s ability to understand spoken sentences has gone from 1st to 10th centile and she is assessed as having gained the ability to analyse, explain, reason and reflect.

Carl’s Story    Joined : April 2008           Left : April 2010

Carl and his younger brother were born into a family in which there was domestic violence and substance misuse.  Their father left when Carl was two and had no further contact with him.  Carl’s mother went on to have his half-sister with another partner who also left but maintained contact.

As Carl grew up he began to have very violent outbursts, particularly towards his younger brother but also others.  He also had sexualised behaviour towards his half-sister which very much shocked and upset his mother.  Carl was referred to Child and Adolescent Mental Health Service and given a diagnosis of ‘unsocialised conduct disorder’. He was prescribed medication for this.  He was referred for art therapy but his violent outbursts in therapy and school led to him being excluded from both.

Carl was referred to us by his local education authority and after talking with professionals, reading reports and a visit from Carl and his mother, he was admitted to Appletree when he was 8 years old.

Joining Appletree

When we met Carl he appeared to feel worthless, had no empathy for himself and unconsciously he tried to ensure that others had no empathy for him too.  He behaved well but seemed to be suppressing his emotional responses.  It is likely he developed this strategy as an infant when his needs were not responded to or were met with anger or rejection.

Our Work with Carl

We needed to help Carl to express his emotions and realise that they could be contained and responded to by the adults around him.  This would take some time and our first task was to begin to build relationships which could then be used to increase his self esteem.

Carl was very academically able and during his very compliant stage did incredibly well in school.  This led to lots of recognition of his achievements on an hourly, daily, weekly and even termly basis.  Carl still holds the record for getting the most ‘Star of the Term’ Awards of any pupil.

Slowly the praise and positive regard helped Carl to trust us and himself enough to express some of his anger, anxiety and sadness.  We were able to acknowledge his emotions and also help him to realise that he can make mistakes without catastrophic consequences.  He engaged in weekly therapy where he explored these themes through play and his therapist consulted with the teams to help them to support his progress.

Things were going well at Appletree but there were still difficulties, particularly with his siblings at home.  Eventually his mother was able to acknowledge that although she loved Carl, she could not manage him at home.  This was hard for Carl as he loved his Mum and yearned for her.  We supported him to understand that she would always be important in his life.  We then needed to work with the professionals in his home area to identify a foster placement and support Carl’s transition

Carl’s Transition

A male carer was identified and he and Carl ‘clicked’ straight away.  Since the carer lived close to his Mum, Carl would be able to see her more and excitedly spoke about popping in to see her after school before going ‘home’.

We had been working hard with Carl to increase his ability to manage within the community.  He had been helped to get to the stage where he could walk to the swimming pool or local shops on his own and manage with groups of children without becoming violent.  We referred him for reassessment of his diagnosis and the conduct disorder was no longer evident.

Carl gradually built up time with his foster carer and was able, almost exactly two years after joining us, to go to live with him permanently.

Leaving Appletree

I spent time with him the day before he left and was able to share with him my feelings of fondness for him and sadness that I would miss him.  I was so pleased that he was able to have a hug and a cry before he left, a totally changed child from the emotionally closed and frightened one who had come to us.

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