Case Studies
John
Keywords: Physical abuse, sexual abuse, inappropriate sexualised behaviour, challenging behaviour, aggression and violence, personality disorder.
Age 17 years on admission, 13 month placement
The Starting Point
Following a number of foster and residential placements John came into our care during 2008. John has history of physical abuse, alleged sexual abuse, and as a result, displays smearing of faeces, extreme violence towards others and sexual inappropriateness. Prior to coming to Bryn Melyn Care John had a number of incidents involving acts of violence causing considerable harm to some individuals. He was destined to be yet another statistic in our justice system if his aggression and violence were to continue and not be managed appropriately. He has also recently been diagnosed as having a personality disorder. The Achievments John was placed in an individual therapeutic home to ensure safety to him and others. Since being with Bryn Melyn Care he has been given the opportunity to grow and develop. He has managed to build healthy relationships with staff based on mutual respect in an open and honest environment. John has engaged fully in his Care Plan. Following robust risk assessments he attends a local college without staff supervision. He is fully engaging his in education and hoping to complete this year’s course with a merit. He has already applied to the college to complete the higher course in September 2009. He has been given the opportunity to spend unsupervised time with his peers that he met through college, this has enabled him to build his social skills and integrate into our society reducing the stigma of being a “Child in Care”. He is currently taking driving lessons with a local driving instructor and has recently booked his theory test; once he has passed this he can go on to complete his practical test- another achievement for him to take into independent living. As John showed an interest and a skill in rock climbing he has become a member of an indoor climbing club and spent the summer increasing his skills by attempting various outdoor climbs. Last year he went on a holiday to France whereby he spent two weeks camping and climbing various mountain routes. He is a member of British Mountaineering Council and once the weather improves is hoping to gain the Single Pitch Assessment climbing award; this will enable him to teach groups how to climb single pitch routes. The Future John is now 18 and as he shall be leaving within the next 6 months, we are already planning for his future. This entails following a Semi Independence Programme to give him the skills and knowledge he needs for when he moves to his own accommodation. If requested by the Placing Authority we shall also provide an Outreach Package to support him in independent living for a period of time.The last 8 months have passed without incident and the future looks very bright for this young man. I am very proud of him and his achievements.
Jenny
Keywords: Neglect, abuse, violence, arson, absconding, attachment disorder, personality disorder, integration, semi-independence
Age 14 years on admission, 2 year placement
Jenny’s early years were highly traumatising for her. Her primary experiences were of neglect, unpredictable stress, persisting fear and persisting physical threat. Jenny’s adaptive responses to her situation were hyper arousal (fight, flight in the form of violence, arson and absconding) and also a dissociative response (tuning out, psychosis and withdrawal in to fantasy, which resulted in false allegations against staff, family and members of the public). Jenny has a Reactive Attachment Disorder and an emerging personality disorder probably of the Borderline type. Psychiatric reports also pointed to ‘emotional disorder’ and ‘conduct disorder’. She had not attended school regularly since infants school and at 14 had the educational ability of a seven year old. Jenny was a frightened young woman who believed that she was beyond help, mad and evil. The first year of Jenny’s placement was about stabilising her. The integrated service of Home, Education and Therapy worked together to really get to know Jenny. The success of this year was highly dependent on our maintaining a high level of predictability, security and nurturing in Jenny’s life. With our intervention, within this period Jenny was largely settled. Incidents of absconding and threat or actual violence reduced to almost nil. She was able to form positive relationships with her team. She was engaging well in therapy and attending school regularly. If the first year of Jenny’s placement was about stabilisation, the second was about integration. Previously control of her behaviour had had been external i.e. provided by her carers within a restricted environment. Now she began to internalise both control and understanding. With the help of therapy and the work of the team Jenny built new cognitive constructs of herself, her family and her world. Jenny began to understand and talk about how she got her need for nurturing, validation and attention met by engaging in some of her most disturbed and frustrating behaviour. This was demonstrated in our weekly key worker sessions were Jenny might say, “I’m really feeling like hurting this member of staff, here’s what I’m doing about it and here’s what I’d like you to help me with.” This was a tremendous step forward for Jenny who had previously only managed reactive patterns of behaviour. The newfound ability to think ahead and to problem solve impacted in every area of her experience. At almost 16 a new educational assessment found her to be age appropriate in most subject areas. Jenny gained exam success and began planning ahead to a future career. Jenny was accommodated in care and at 16 chose to return to the care of her local authority in order to be nearer home. At the transition we undertook a period of outreach work with Jenny and her new team, working along side them to settle Jenny in. We helped to establish in her new setting the basis of the next step of this model. Jenny will now be supported to accumulate experiences in which she can gain confidence in her new framework of thinking and behaving. Because of Jenny’s personal tenacity and because of the work that we were able to undertake with her, this once suicidal and out of control young person will now move towards semi independence and finally independent living.
Tracey
Keywords: Arson, self-harm, bullying, violence, inappropriate sexualised behaviour, semi-independence
17 years old on admission, 12 month placement
Tracey first arrived at Bryn Melyn in September 2007 for a specific period of six months. Tracey had just turned 17years of age but had very few life/independent skills, low self esteem and unable to build and sustain healthy relationships. Tracey came to us with a range of behaviours including - arson, self harming, inappropriate/sexualised behaviour, bullying, intimidating and aggression. Tracey also displayed a lacked of motivation and willingness to progress in to her independence. It was clear that Tracey was used to displaying these behaviours in an attempt to get her own way or as a defence mechanism when she was in the wrong. Tracey’s time limited placement involved positive role modelling, consistency, routine, and accountability, reflecting, learning opportunities, contribution to the day and developing semi-independent skills in preparation for living independently. During her placement Tracey has developed the skills to live independently, from completing chores around the house to arranging medical appointments by phone and travelling to them using public transport and has built healthy significant relationships with her staff team using the 1-1 model. Arranging appointments by phone was a huge issue for Tracey but after lots of encouragement, guidance and support she attained these skills. Tracey used her time at Bryn Melyn to reflect on her past behaviours, developing better coping skills and empathy for others, identifying her feelings in an environment which was safe, preparing her for the transition in to her independence and adulthood. Tracey requested her placement be extended for a further 6 months to allow her to have a more realistic time frame to prepare for leaving care this was agreed by the Local Authority, due to the obvious progression Tracey had made. Tracey has now completed the transition back to her home town where she is currently in college studying art and design residing in her own flat with ongoing support from CAMHS.