1. Children and Young People’s Emotional Wellbeing and Mental Health Conference 10 th October 2012

2. Attachment in Mind, Looked after Children and Adopted Children – The Local Picture By Richard Lindsley (CAMHS Clinical Nurse Specialist)

3. Numbers of children affected Approximately 65 000 children in UK are looked after (source DfE 2010) 3200 children adopted from care in 2010 (source British Association of Adoption and Fostering) Northamptonshire is a net importer of Looked After Children How many LAC children are there in Northants today?

4. Why does CAMHS need a specialist CAMHS team for LAAC? Children with this history are 20 times more likely to experience mental health problems Approximately 50% of the people currently in prison were in care during their childhood

5. Rates of mental health disorder are between four and five times higher amongst looked after children compared to children in the general population (ONS 2003). Children in care have less success in the education system than their peers and are far less likely to go on to university. Source Young Minds: http://www.youngminds.org.uk/publications/all- publications/mental-health-of-looked-after-children

6. Basic Attachment Model Secure Base Seek reassurance Explore Anxiety

7. Basic Attachment Model Secure Base Seek reassurance Explore Anxiety Unavailable Self SufficientClingy

8. Basic Attachment Model Secure Base Seek reassurance Explore Anxiety Unavailable Self Sufficient Clingy Dangerous Fake Use Charm Provoking Controlling Destructive

9. Safe Stable Parent Holds Child in Mind Learns: “I’m OK” “You’re OK” “The world’s OK” Socially Skilled reflective child Becomes a healthy adult Has a child The cycle repeats

10. Chaotic parent Can’t hold child in mind Child doesn’t feel safe, can’t relax- ready for fight/flight Chaotic, unreflective, child defends against trying to understand others minds/intentions, poor empathy Chaotic Adult Unhealthy relationships Have a child The cycle repeats

11. Breaking the Cycle By removing the child from chaotic and dangerous parents and placing with secure, predictable and safe parents Children can adopt their new families attachment cycle The vital piece of work is helping parents and carers to understand the children’s attachment needs, giving them the skills to respond to these needs and the strength to work through some extremely difficult behaviours If successful the child ESCAPES their previous cycle

12. Group Exercise Brick Wall of Children’s Needs 3 groups On pieces of paper write one word or a short phrase relating to the needs of a very young child that are provided through good care 3 areas: – Physiological – Safety – Love and belonging

13. FoodShelterWarmthToys PlayRulesEmpathyBoundaries Stimulation Safety Shoes Clothes EducationHealth ChecksStabilityLove FriendsSchoolUnderstandingNurtureSpace Peace Eye contactGuidancePredictabilityTrustFun

14. Then we ask people to take away the bricks they think their child may have missed

15. FoodShelterWarmthToys Play Shoes Clothes School

16. FoodShelterWarmthToys Play Shoes Clothes School

17. Therapeutic Work The CAMHS-LAC team have a model of working that is based upon Attachment theory. Wherever possible we aim to support or improve the relationships a young person has with the adults caring for them. In this way we aim to promote a positive or nurturing parental environment which then has a therapeutic impact upon the young person each day. It is this level and extent of therapeutic intervention that is most useful for young people.

18. Individual Work - Contra-indications Individual therapeutic interventions are regularly recommended by professionals contributing to care proceedings. Individual work with this client group is usually contra- indicated where there is placement instability, it is a short term or transitional placement or the child has been recently placed. Individual work under those conditions can actually be harmful and has been known to contribute to placement breakdowns.

19. A multi-agency virtual team approach 4 level approach: No additional or mental health needs – met by universal services Some additional or mental needs – met by targeted services Definite emotional or mental needs – met by specialist services Needs not met by specialist services – highly specialist services required

20. A multi-agency virtual team approach Level 3 – Specialist Services Weekly meeting called the Virtual team meeting Involves professionals from health, education and social services All referrals for emotional wellbeing and mental health processed at this meeting

22. The End