Reflections on the non-accidental death of a foster carer

Abstract

This article is a case study and analysis of the death of a foster carer in Scotland at the hands of the child for whom she was caring. The death was the subject of a Fatal Accident and Sudden Deaths Inquiry in 2015. The case study explores whether or not this was a unique case, its messages for understanding child on parent violence, the adequacy of foster carer training, approval for blanket or specific age ranges, information about children provided to foster carers, meeting the needs of traumatised children and birth family contact when children have access to social networking sites. It considers if there are lessons that can and should be drawn from this case.

Keywords

Foster carer training risk matching child on parent violence (CPV)support

Introduction

Very little is known concerning foster child on foster carer violence and aggression. We do not know its prevalence across foster homes or, when it is occurring, its frequency or severity. We do not know the particular attributes of the children involved, although it is possible to hypothesise that older age, gender and previous exposure to violence are likely to be salient factors. We do not know what the outcomes are for the children and carers concerned. For instance, how often are carers injured and how frequently do placements break down? We do not know what parenting approaches and de-escalation techniques are effective in preventing or reducing such violence and aggression and whether carers have had training and support to implement these approaches and techniques.

This article analyses some of the issues raised by a particularly severe case of foster child on foster carer violence. The carer involved tragically died and her death led to a Child Protection Significant Case Review and a Fatal Accidents and Sudden Deaths Inquiry. The result of these processes was that the case came into the public domain and was the subject of considerable scrutiny. Nevertheless, both the case and the subsequent Review and Inquiry received relatively little publicity, especially outside Scotland, and there has been limited response to date in government policy or guidance. This article particularly focuses on the assessment, approval, training, matching and support of foster carers and the circumstances and needs of the often very complex children placed with them. It outlines some potential implications of this case for future practice and highlights areas for future research.

Background to the case

Dawn McKenzie, approved with her husband as a foster carer in late 2010, was stabbed to death by her 13-year-old foster son, D,¹ on 24 June 2011. A Significant Case Review (SCR) was held in 2012–2013 by the Glasgow Child Protection Committee (CPC). A brief and heavily redacted summary of the review was published (Glasgow CPC, 2013). Subsequently, a Fatal Accident and Sudden Deaths Inquiry (FAI) was held during spring 2015 presided over by Sheriff Bicket. His ‘Determination’ was published in August 2015 (Bicket, 2015).

D had suffered prolonged neglect prior to his accommodation in 2008 when he was aged nine.² He had been a witness to, and increasingly involved in, violent and anti-social behaviour in his home community from around the age of four. He was repeatedly bullied by one of his older brothers. Once accommodated, he had two moves of foster placement, neither caused by his behaviour, and around 12 periods of respite care with seven different respite carers. Contact with his birth family was initially frequent and described as ‘chaotic’ and ‘rejecting’ even though it was supervised. While its frequency was later reduced, the quality was still of concern. D’s circumstances were not unique for a looked after child. I have presented a number of workshops concerning this case to social work staff in a range of agencies and most of the staff involved could think of examples of young people with similar backgrounds to D.

The organisational situation was far from ideal although, again, probably not unique. There were significant staff shortages in the local authority social work team (sometimes as high as 50%), regular staff turnover and a management reorganisation. Supervision was neither sufficiently available nor reflective and a chronology of events and interventions was not kept in the case record. Prior to Mrs McKenzie’s death, the family was described as ‘not the worst’ the office was working with. All these factors appeared to lead to short-term, repetitive and sometimes ineffective social work responses, including the case being closed for a period in 2006–2007. While there were no staff shortages in the independent fostering agency that provided all three of D’s placements, rapid organisational growth led to frequent staff promotions or moves to new offices. This often resulted in changes of supervising social workers, or their managers, for foster carers.

The author was involved as a consultant in both the SCR and FAI processes. I was asked by the CPC to review fostering aspects of the case, in particular the assessment, approval, training, matching and support of the three foster families where D was placed while he was accommodated, and also whether placement in foster care had been an appropriate placement choice for him on each occasion. As far as the FAI was concerned, my remit was to produce a report for the Procurator Fiscal³ concerning ‘the reasonable precautions, if any, whereby the death might have been avoided’ and ‘whether there were any defects in systems of working’. These are standard questions asked at all FAIs and were not specific to this case (Fatal Accident and Sudden Deaths Inquiry (Scotland) Act 1976).

Conclusions and recommendations of the SCR and FAI

The investigation that I carried out for the SCR concluded that there were no known risks or reasons that should have prevented D from being placed in foster care when he was first accommodated or when he subsequently moved placement. Both the first two foster placements were good matches as the carers either had sufficient fostering experience or sufficient life and professional experience to care for a boy with D’s background. Mr and Mrs McKenzie provided his third foster placement. They were a childless couple in their 30s, approved as foster carers for one child aged 0–16 with a preference for children aged one to eight. Their preparation, assessment and approval included receiving a Skills to Foster (Fostering Network, 2014) preparation course and assessment by a freelance assessor. Mrs McKenzie was an experienced day-care worker for nought to five-year-olds. Mr McKenzie had much less child care experience, although they had offered regular overnight stays to their nephew who was by then a teenager. They were approached about the possibility of taking D three weeks after their approval. At the time, their allocated supervising social worker was off sick. Consequently, the workers who discussed D being placed with them had not met them before.

In my reports to the SCR and the FAI and in my evidence to the FAI, I argued that D should not have been offered to Mr and Mrs McKenzie as a first placement as I considered his needs and circumstances were far beyond their skills, previous experience and preferred age range. I concluded that the fostering agency had a duty of care towards the foster carers which had not been sufficiently exercised. On the basis of a range of evidence presented, Sheriff Bicket stated that, ‘…. [Mr and Mrs Mckenzie] should not have been recommended as suitable prospective carers for the said child D’ (Bicket, 2015: 64). All relevant witnesses considered it understandable that the local authority accepted the placement once it had been offered and Sheriff Bicket agreed.

In considering ‘the reasonable precautions, if any, whereby the death might have been avoided’, I concluded that, in the particular circumstances of this case, a lockable drawer or box for kitchen knives might have prevented Mrs McKenzie’s death. The view of all other relevant witnesses was, given that D had never previously been known to use knives, that this provision would need to apply in all cases of older children placed in foster care and they considered this ‘would upset the balance of normal family life and would present practical difficulties’. Sheriff Bicket (2015: 65) stated, ‘The question is whether or not such a precaution was a reasonable one. I have come to the view it is not.’

Sheriff Bicket made three recommendations and he also repeated and commended the 18 from the SCR and the report on the independent fostering agency.⁴ A number of these recommendations, including all three made by Sheriff Bicket, are discussed below.

Case analysis

It is unusual to be able to spend many weeks considering in detail all the circumstances of one very complex and harrowing case. Although this case potentially had some unique features, it led me to carefully reflect upon and analyse a range of aspects of working with foster carers and looked after children. I found some of my longstanding views and practice both challenged and subsequently changing. I hope that highlighting these aspects will be helpful for future practice.

1. Was this a unique case?

At the time of the SCR and also prior to the FAI, I researched whether there had been any similar cases in the UK or further afield. I did not find any cases in the UK and although there had been a small number in North America, these had mainly been killings with firearms. This finding might have led me to a view that the case was a unique one in the UK from which there was no relevant learning. However, the FAI coincided with the publication of Selwyn, Meakings and Wijedasa (2015), which recorded high levels of child on parent violence in their sample of cases where adoptions had disrupted or were under extreme stress. In 80% of these cases, violent behaviour had been present from the start of the placement but adopters had found its severity increased as the child grew bigger and stronger. In 20% of cases, the onset of violence coincided with the onset of adolescence. A considerable number of these violent incidents included threats with or use of knives. While there had been no fatalities, there was clearly a risk that such levels of violence and aggression could lead to a fatality.

A literature review found that research in this area is both relatively recent and comparatively rare, possibly because ‘Child to Parent Violence (CPV) is the most hidden, misunderstood and stigmatised form of family violence’ (Wilcox, et al., 2015). Condry and Miles (2013) described CPV as virtually absent from policing, youth justice and domestic violence policy, despite being widely recognised by practitioners in those fields. UK government guidance for professionals was issued by the Home Office in 2014 (this guidance does not apply in Scotland). Definitions and descriptions of such violence vary and often like is not being compared with like. For instance:

Some researchers include verbal aggression, emotional abuse, violence on property and/or financial abuse as well as physical aggression and violence. A commonly used definition is that of Cottrell (2001: 3) who stated that ‘parent abuse’ is ‘any harmful act of a teenage child intended to gain power and control over a parent. The abuse can be physical, psychological or financial.’

Age ranges of children and young people covered in research and policy vary; for instance, Condry and Miles’s (2014) study featured young people aged 13–19 whereas the Netherlands Centre for Social Development (2014) proposed including an age range of 12–23. Occasionally elder abuse by their adult children is also included. Often only abuse by adolescents is covered (e.g. Home Office, 2014), despite the fact that parents often report such violence starting much earlier in childhood. Parentline Plus (2008), in a website survey, reported that parents described CPV starting prior to adolescence in 72% of cases.

International research on children living in their birth families found very varied prevalence of CPV, e.g. 0.6% in France (Laurent and Derry 1999), 10% in Canada (DeKeseredy, 1993) and 7–18% in two-parent families and 29% in one-parent families in the United States (Peek, Fisher and Kidwell, 1985). While these disparities may be explained by societal differences in the above countries and, possibly, differences in willingness to admit that such violence is occurring, variations in definitions of CPV and of the age groups included are also likely to have played a part.

No studies of prevalence in the UK were found in the literature review. However, studies of reported CPV such as Condry and Miles (2014), which considered nearly 2000 cases of CPV reported to the Metropolitan Police during one year, and Parentline Plus (2008), which had received over 22,000 calls from parents concerning CPV, including 7000 concerning physical aggression, during a two-year period, indicate that such violence is almost certainly widespread in the UK.

Particular risk factors for CPV, identified in a wide range of research studies, were current or previous domestic violence or child abuse within the family and single-parent families headed by a lone female. The victim was usually female and the perpetrator, where the violence was physical as opposed to verbal, was usually male (for example, Condry and Miles (2014) reported 77% female victims and 87% male perpetrators).

The literature review did not identify any specific research on foster child on foster carer violence but the particular risk factors described above are often present when foster children are living in their birth families. It can be hypothesised that child on carer violence is likely to be higher in foster care than in the general population. Reflecting on my own foster care practice and that of colleagues, it did not take me long to recall a number of cases where foster children and adolescents had threatened or been violent to their carers or other children in the household. Other than ending the placement, which was often not in the best interests of the child, there were few effective strategies to offer. Placement breakdowns and foster carers leaving the service or being de-registered were not unusual in these circumstances.

I stated above that the investigation I carried out for the SCR ‘concluded that there were no known risks or reasons that should have prevented D from being placed in foster care when he was first accommodated or when he subsequently moved placement’. This conclusion was based on my longstanding knowledge and experience of children and young people placed in foster care and on a review of D’s behaviours prior to and within his placements. It did not take account of research into risk predictors and risk assessment for violent offending in children and young people (e.g. Hawkins, et al., 2000; Wasserman, et al., 2003). Had I (and the agencies involved with D) considered the factors in the different domains of D’s life that predict risk of violence (individual, family, school, peer-related and community and neighbourhood), he would undoubtedly have scored quite highly. However, this would only have told us that there was a heightened risk of violence, not that it would happen or what to do to reduce its likelihood. I have not changed my conclusion about the appropriateness of D being placed in foster care, but consider there is a role for more systematic risk assessment of children and young people entering and moving within such placements. Where risk is heightened, it is important that staff and carers are aware of this and also that effective strategies to minimise risk are put in place.

In terms of the provision of strategies for reducing risk or intervening in potentially violent situations, Child and Adolescent Mental Health Services (CAMHS) may have effective approaches to offer, but lengthy waiting lists and sometimes tightly restricted referral criteria are often found unhelpful by families in crisis. Even where, as has happened in some Scottish local authorities, specialist CAMHS services for looked after children have been established, capacity to meet demand can be insufficient. Some fostering agencies, particularly those in the voluntary and independent sectors, employ their own therapists and they may be able to offer helpful strategies to carers. It is not known whether and how often the expertise and assistance of youth justice/youth offending teams is sought for young people in foster care and whether this is effective in assessing risk or reducing violence. Some fostering agencies offer de-escalation training.⁵ The fostering agency in this case offered Crisis Prevention and Intervention (CPI) training after carers had been approved for one to two years. While I considered it positive that this training was offered, the logic of only offering it to more experienced carers was unclear. Either newly approved carers were only having the youngest and least troubled children placed, which was evidently not the case, or the most vulnerable carers were being left at the greatest risk.

Sheriff Bicket (2015: 80) recommended that ‘Staff and carer training needs should be reviewed to ensure that all first-time foster carers approved to take children in middle childhood or adolescence should receive Crisis Prevention and Intervention training prior to taking up their first placement.’ I fully supported this recommendation. However, such training will only be successful if it changes carers’ habitual behaviours to ones that are more likely to de-escalate violence and/or it provides them with self-defence manoeuvres that they use effectively in crisis situations. The literature review undertaken for this case did not find any research which either confirmed or refuted these points. As well as de-escalation training, other violence reduction programmes are becoming available to some parents/adopters in the UK and internationally, for instance, Break4Change, Non-violent Resistance and Step Up (see, for example, Holt, 2013). It would be extremely helpful if either the UK or Scottish Government, or both, commissioned research into the prevalence of CPV in foster care and into the most effective risk assessment models and harm prevention and reduction programmes and services. Guidance should then be issued to fostering and other involved agencies.

2. Do foster carers receive the right amount of training at the right time?

Since the late 1970s, when the Training and Development Group of the National Foster Care Association (now Fostering Network) published Parenting Plus, the duration and content of preparatory training for foster carers has not changed a great deal. Skills to Foster (Fostering Network, 2014), which is widely used by fostering agencies in Scotland, provides approximately three days training with roughly half a day of this time spent on learning about abuse, loss, trauma and attachment. In the early 1980s, Added to Adolescence (National Foster Care Association, out of print) was also published for carers intending to foster teenagers but its equivalent does not appear to be available today. While length of training does not necessarily equate to quality or effective practice, it is interesting to note that in the intervening 35 years or so, social work training in Scotland has doubled in length to become a four-year honours degree and residential workers have been required for the last few years to have HNC/SVQ 3 qualifications. From 2026 they will be required to have a degree. The question must be asked as to why the task of foster caring is so completely different that carers only require three days training before embarking on caring for damaged, difficult and sometimes dangerous children and young people.

Arguments against increasing the length of preparatory training include that:

Prospective carers would not tolerate greater duration as it is usually provided prior to approval.

Carers also learn during the home study.

Carers mainly or only benefit from in-service rather than pre-service training.

It is possible that there is an optimum duration of pre-approval preparation training (although the literature review did not reveal any research in this particular area), but this should not preclude pre-placement induction training once carers are approved. It is possible that training will be better absorbed once anxieties concerning approval are over. The barriers to providing induction training are more likely to be practical (e.g. needing to use newly approved carers quickly) rather than any evidence that such training is unnecessary or ineffective. There is, or at least should be, some learning during the home study process but this is not its main focus and learning is probably limited. There is no evidence that foster carers, uniquely, can only receive benefit from in-service rather than pre-service training. Indeed, it is sometimes difficult to persuade or facilitate foster carers to attend in-service training, at least in part because of their caring responsibilities.

Research concerning outcomes from foster carer training has often discovered rather limited effectiveness. Sinclair (2005: 119) found that ‘training seems to influence carer morale but there is a lack of evidence that it influences outcomes’. Research on foster carer training since then has mainly been small scale and, rather frustratingly, usually concerns different training courses delivered in different ways to different types of carers (e.g. Allen and Vostanis, 2005; Bammens, Adkins and Badger, 2015; Gurney-Smith, et al., 2010; Herbert and Wookey, 2007; Hutchings and Bywater, 2013; Ogilvie, Kirton and Beecham, 2006; Robson and Briant, 2009; Warman, Pallett and Scott, 2006). Results are mixed and a number of the studies have acknowledged limitations including small sample sizes, self-selection of participants, lack of control groups and/or lack of long-term follow-up. Almost all found that carers welcomed training and, where assessed, reported an increase in carer confidence and morale (arguably all these were positive outcomes, particularly if they aided carer retention). Hutchings and Bywater (2013) found a 40% drop in carers’ self-reported levels of depression. Allen and Vostanis (2005) and Gurney-Smith and colleagues (2010) recorded carer self-reports of improvements in children’s behaviour and well-being after training. A few studies recorded independently measured improvements in children’s behaviour (e.g. Hutchings and Bywater, 2013) or carer reflectiveness (e.g. Bammens, Adkins and Badger, 2015).

The reasons for limited effectiveness of carer training do not appear to have been researched. They could potentially range from:

deficiencies in course content or duration;

ineffectiveness of teaching methods;

inability of carers taking part to understand and/or implement the content;

lack of course follow-up and reinforcement; to

some children placed in foster care having very intractable difficulties.

For instance, if carers have had little or no post-16 education, they may lack the ability to understand and implement theoretical inputs or, if supervising social workers have not undertaken the course, they may be unable to help carers put learned strategies into practice. However, I do not believe these are reasons to abandon foster carer training. Rather, they are reasons to try to improve the range and effectiveness of training and its follow-up and to undertake much more thorough and wide-ranging research.

In an article published in 2003, Barbara Hutchinson (then Deputy Chief Executive of the British Association for Adoption and Fostering) commented (p. 12) that:

The specific needs of the looked after population will only be met by highly trained and skilful carers. Such carers are obviously not therapists but they must be able to provide a therapeutic environment for traumatised children . . . I do not believe that the level of knowledge and skill needed will be achieved by providing general preparation and training pre-approval and then allowing individual carers to decide whether or not to attend further training.

I agree. The questions concerning provision of foster carer training which need to be addressed should be:

What knowledge and skills do foster carers require, prior to taking a first placement, concerning the provision of therapeutic and safe care to the range of children and young people for whom they are approved?

How can the safety and well-being of carers be supported through training?

What additional knowledge and skills do they need to develop as they become more experienced?

The Draft Standard for Foster Care (Scottish Social Services Council, 2016) was issued for consultation just as I was completing this article. Dependent on its final form and how well it is implemented, it may go a considerable way to answering the above questions about the required nature and duration of preparation, pre-service and subsequent in-service training.

Another concern that emerged as a result of my analysis of this case was the very limited training and support provided to the ‘non-main’ (often male) carer. It cannot be assumed that this carer will never or rarely manage critical situations in the placement on their own and they need to be equipped with many of the same skills as their partner.

3. Does approval for a ‘blanket’ age range present dangers for foster carers?

A range of opinions was expressed by witnesses at the FAI concerning the appropriateness of approving carers for ‘blanket’ age ranges (i.e. 0–16 or 0–18 with stated ‘preferences’) as opposed to more limited age ranges such as 0–5, 5–11 or 12+. Sheriff Bicket (2015: 76–77) reported that:

I have come to the conclusion that it is the matching process that is crucial in this area and not the use of blanket age range approvals per se. There do seem to me to be valid reasons why blanket age range approvals may be used – they appear to be administratively less bureaucratic … [and to] increase placement availability and choice. It is critical however that fostering agencies do make a realistic assessment of the capabilities and skills of foster carers, to form a view of the ages, both chronologically and developmentally, of children for whom they could care, based on evidence.

He recommended (p. 80) that:

The system of using stated preferences within unrestricted age ranges should be discontinued. Emphasis should instead be given to foster carers’ strengths and abilities and any perceived weaknesses with regard to their ability to care for the child or children placed with them. This is especially important for newly approved foster carers.

Again, research findings in this area are scarce. Sinclair (2005) found that where foster children do not fit well with foster carer households, this is more likely to lead to placement breakdowns and Sinclair, Gibbs and Wilson (2004) found that where foster carers’ preferences are ignored, they are more negative about fostering. Careful matching should be the key to successful placements, but nevertheless, I remain very wary of policies or accepted practice that all or most carers should be approved for ‘blanket’ age ranges, particularly if they are newly approved. Many prospective carers do not have a wide range of knowledge and experience of children and young people in all age groups and especially not of troubled children and young people across the board. Approving them for 0–18-year-olds may imply that they do, particularly when agencies are under intense pressure to provide placements. There is often insufficient time when making emergency placements to undertake careful matching. Approval for more limited age ranges provides a quick reference to the ages of children where a carer’s particular strengths and experiences lie.

Some professional witnesses at the FAI suggested that age of foster children is a poor guide to their emotional development, which is often much younger than their chronological age. They considered that this was a rationale for approving carers for a wide age range of children. This assertion has some validity but fails to fully recognise that balancing the conflicting aspirations and needs of a child or young person operating at a range of emotional ages is a complex task (for instance, a young person may want to join their peers in teenage activities but not have the emotional maturity to manage this). It also fails to recognise that a 13-year-old with a normally developed adolescent body but the emotional development of a much younger child can be physically intimidating and sometimes dangerous.

Local authorities in Scotland and the rest of the UK have been under extreme pressure in the last 10 to 15 years to provide more placements for accommodated children as numbers have risen markedly. Between 2001 and 2015, numbers accommodated in Scotland grew by 90%, including the proportion of children and young people in foster care growing by 67% and those in kinship care by 348% (some of the content in this article may be equally applicable to them). As outlined by Sheriff Bicket, objections to more limited age ranges can be driven by a desire to avoid bureaucracy or to maximise the use of fostering resources. In some agencies, financial pressures may also be a causal factor. While all of these pressures are understandable, the duty of care to foster carers, as well as to children and young people, should receive much greater emphasis if foster carers’ undoubted commitment and goodwill are not to be over exploited, sometimes dangerously.

4. How much information should be provided to carers and in what format?

There was a large amount of written information available on D but this was not shared initially with Mr and Mrs McKenzie. Fostering agency policy was that this should be disclosed at a placement planning meeting prior to, or just after, the placement being made. However, this meeting never took place.

There was conflicting evidence from Mr McKenzie and the fostering agency workers about the content of the verbal information concerning D and his family provided to Mr and Mrs McKenzie prior to placement. Having interviewed both Mr McKenzie and the workers, I concluded that all were sincere and honest in their descriptions of information sharing. However, the information which was conveyed verbally to newly approved carers, excited about the prospect of their first placement, may not have been sufficiently plain or full for them to appreciate all of its meanings and complexities. Unfamiliar jargon may have been used; for instance, the description ‘anti-social behaviour’ can cover an enormous range of behaviours, from mischief to extreme violence. Whatever the reasons, Mr McKenzie described Mrs McKenzie as being ‘very shocked’ when she read D’s case records two months after he had been placed. Mr McKenzie was remarkably honest in saying that, had they had full information about D, he considered they would still have offered him a placement. Nevertheless, they cared for D for two months with incomplete knowledge and this had potential risks. It was unclear if subsequently the potential impact of D’s very troubled background on his current and future development and behaviour was fully explored with them. Sheriff Bicket (2015: 80) recommended that:

Prospective foster carers when being asked to consider a placement should be given as much information as possible in writing, in a digestible and understandable form, about the child or children . . . to inform their decision as to whether or not to accept the placement offered. Full and detailed notes should be kept of any meetings that occur when the placement is offered to prospective foster carers when such information is passed on.

Full information sharing would not only help foster carers make informed decisions about whether or not to accept a child, but also guide them in the ways they care for that child. Greater understanding of a child’s traumatic past can aid recognition that ordinary child care practices may not be appropriate. Recent research (Octoman and McLean, 2014: 153) found that out of 21 identified supports, the one rated most highly by carers was ‘knowing or being provided with accurate and up-to-date information about a child’s behaviour prior to fostering’. Full information sharing is easier in some placements than others; there may be limited information about newly accommodated children and emergency placements may preclude information being provided in a digestible and understandable form. Nevertheless, this is an important recommendation that recognises that carers are entitled, as far as is achievable, to full and fully explained information in writing. Where this cannot be supplied prior to placement, it should be provided in the following few days. It should also make fostering agencies consider very carefully before making emergency placements or placements of children about whom little is known with newly approved carers.

5. How far do we understand and meet the needs of highly traumatised children?

D was a chronically abused, neglected and rejected boy who had spent far too long in his family of origin. Once accommodated, he experienced chaotic and rejecting family contact, two placement breakdowns and too frequent and poorly planned respite care. It is crucial that social workers do not allow themselves to become inured to the truly dreadful and traumatised lives suffered by a small minority of children in our society. If appropriate learning and support is to be provided for foster carers, we need to fully explore with them and help them to appreciate what these experiences might mean for each of the children concerned and how they might be manifested both currently and in the longer term.

D was usually polite, helpful and amiable and was often described as resilient by the workers and carers involved with him. The statement that he was ‘a lovely, wee boy wanting to do well’ was frequently used. Gilligan’s (2001: 5) definition of resilience that, ‘Bearing in mind what has happened to them, a resilient child does better than he or she ought to do’ accurately described D up until the day he killed Mrs McKenzie. With the benefit of hindsight, given his extremely adverse background, it was very unlikely that D could have fully developed the set of qualities that comprise resilience. D’s superficially successful coping behaviours clearly masked very significant underlying difficulties. Gilligan (2001: 7) also stated that ‘A child who shows resilience is not invulnerable. Children cannot withstand unscathed, ever increasing levels of stress. Past a certain threshold of increasing adversity, any child is likely to buckle and succumb to pressure.’ It is important that ascriptions of ‘resilience’ are not used either to assume that young people’s problems are resolved or to afford them less help and attention than other, more overtly troubled children. Social work and health practitioners need detailed and sophisticated knowledge and understanding of both trauma and resilience. It is over three years since the SCR (Bicket, 2015: 78) recommended that:

All agencies should review practice to ensure that, where children’s unusually good behaviour is not in keeping with their experiences, carers, foster agency, health and local authority staff are alert to potential risks and have opportunities to discuss them. The focus for these reflective discussions should be any underlying reasons and possible responses.

It is questionable how far busy and cash-strapped agencies have been able to implement this recommendation. Do ‘unusually good’ children still continue to slip below the radar?

In this case, respite was used frequently during D’s first two placements. He was placed with a number of different carers often without any previous introduction. Unsurprisingly, his behaviour in respite care and in the few days afterwards was often unsettled and challenging. This led to the recommendation to the fostering agency that ‘Timing of, consistency of carers and introductions to respite placements should be made more child centred’ (Bicket, 2015: 79). While it is accepted that many foster carers need and benefit from respite, improved respite service planning and greater care and consideration are required to ensure that foster children receiving respite also benefit from the experience.

D’s two placement moves were not regarded by fostering agency workers as placement disruptions as his behaviour had not been the cause of the placements ending. This view almost certainly underestimated the impact of the moves on his feelings of self-worth and on his ability to form and sustain attachments. At a more practical level, having to adjust to and fit in with three different foster families, four different schools and three different communities a number of miles apart over a three-year period must have been a huge challenge. While the first placement move was mainly well planned and executed, the second one, to Mr and Mrs McKenzie, was not. D received little notice or preparation that after 20 months he was moving from a foster placement that he had recently stated that he loved. In regard to unplanned moves, Browning (2015: 52) suggests that ‘such losses may well undermine further [children’s] trust in parental figures, leading to aggressive and retaliatory feelings as a defence against overwhelming sadness’. Two expert psychiatric witnesses at the FAI, Drs Marshall and Kerr, pointed out that ‘The fact that [D] showed so little upset at moving from one set of foster carers to another perhaps ought to have been a warning sign that things were not as good as they seemed.’ (Bicket, 2015: 71).

D appeared to be ‘preferentially rejected’ (Rushton and Dance, 2003: 68) by his parents in comparison to his younger siblings. Such rejection can lead to poor progress in placements. According to Rushton and Dance (2003: 69):

A history of rejection is not a contra-indication to family placement, but the increase in risk argues for careful assessment and planning . . . The child’s behaviour and styles of interaction will require detailed assessment and the ways in which they interpret their history and their need for a new family must be thoroughly explored.

Such assessment and exploration did not occur sufficiently with D.

6. Can birth family contact be terminated or fully supervised when young people have access to social networking sites?

In the days leading up to Mrs McKenzie’s death, she discovered that D had made online contact with his birth family. This was against the condition of his Supervision Requirement that all family contact should be supervised. She confiscated his phone and laptop, actions that were supported by her supervising social worker and D’s social worker. There was subsequently some confusion as to whether or not supervised use of his laptop had been reinstated, with Mr and Mrs McKenzie under the impression that it had not.

The answer to whether birth family contact can be terminated or fully supervised when young people have access to social networking sites is almost certainly ‘No’, other than with a young person’s agreement. Prohibitions of contact, or a level of supervision which is significantly out of step with other young people in their peer group, may well lead to deterioration in a young person’s relationships with their carers or social worker. Unsupervised, online contact is likely to take place outside the foster home rather than being stopped. The fact that unauthorised contact is happening clandestinely may mean that the young person is unable to discuss any worries about the contact with their carers or social worker. I found Fursland (2010) and Simpson (2013) very helpful when considering these issues for my reports. Practitioners need to take account of contemporary young people’s interests and activities and accept that online contact between looked after young people and their relatives will often take place. The role for carers and social workers is to make this as safe and beneficial as possible. Counselling may need to be provided concerning the risks, but the young person should know that their carers and social worker are there to support and not criticise them if they decide to go ahead. Children’s Hearings and courts need awareness of these issues and should not have unrealistic or unhelpful expectations of termination or supervision of contact.

The future of fostering

The number of children in foster care has increased very significantly in Scotland and the rest of the UK in the last 10 to 15 years. Government, both nationally and locally, has encouraged greater use of fostering and kinship care and a reduction in the use of residential care. This is partly on the grounds of cost (and given current significant reductions in local authority budgets, the pressure to reduce use of residential care will increase) but also because when foster placements are well assessed, supported and matched, the benefits for children can be immense.

Nevertheless, the downsides cannot be ignored. This case is an extreme example of a placement that went wrong, yet many aspects of it were by no means unique. D’s background was one of chronic neglect, violence and rejection but it was not particularly unusual among looked after children. There was no evidence that contraindicated D’s placements in foster care and I do not consider that reducing the use of foster care for children in middle childhood and early adolescence is a lesson from this case. Rather, more care needs to be taken when matching children with carers, including more systematic risk assessment and providing them with full, written information about the child with whom they are to be matched. It also requires: the increased provision of pre-service training for carers, particularly regarding de-escalation and self-defence; local authorities intervening more quickly and decisively when children are living in very damaging circumstances to ensure they are accommodated sufficiently early; and foster carers, social workers, courts and Children’s Hearings embracing rather than fruitlessly resisting the impact of social networking on foster care. It is also important that much more comprehensive research is undertaken and guidance provided in all these areas to ensure that practice is evidence led.

In his conclusion, Sheriff Bicket (2015: 80) stated that:

It was not foreseen nor was it foreseeable that child D would take the life of the person who was caring for him, but now that has happened clearly it is an eventuality that has to be considered by those involved in caring for children in a fostering environment. It is to be sincerely hoped that such an event never reoccurs, and that the appropriate agencies are now alive to the tragic possibilities and will do all that can be done to ensure that that is so.

These are hopes that I share.

Footnotes

Notes

Kirstie Maclean is a Family Placement Consultant; she was previously Service Manager (Looked After and Accommodated Children) for the City of Edinburgh Council, Scotland, UK.

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