368 Chapter 42
on a daily basis for privileges such as watching more TV, phoning friends
and other rewards that motivate the particular child. Foster carers are
supported with daily phone calls and weekly meetings with other foster
carers and professionals. There is a separate individual therapist for the
young person, a therapist who works with the birth family (even where
there is no prospect of return home, there are inevitably issues to resolve,
such as what happens during contact visits), and a skills trainer to help
the young person learn to act appropriately when out in the community.
In the USA, this approach has been proven effective with psychiatric in-
patients being discharged, and with antisocial young people. It is being
introduced for fostered young people in the UK, where a trial has shown
that it is effective for very disruptive young people.
Because some fostered and adoptive children are very disturbed, their
parents can get desperate, especially when sensible mental health ser-
vices are lacking. Under these circumstances the fosterers or adopters
may fall for plausible but non evidence-based approaches to assessment
and treatment. Often these may take the form of so-called ‘attachment’
checklists which attribute almost all symptoms and behaviours to an
attachment problem; at other times rare and exotic new syndromes are put
forward as the answer. In both cases, inappropriate, sometimes harmful
and sometimes very expensive treatments can be touted – as further
elaborated in Chapter 17 on attachment disorders. In the USA, there have
been six deaths from such ‘treatments’. At a less severe but still worrying
level, statements made in the Adoption and Fostering Clinic of one of the
authors include:
If they have a tantrum, don’t speak English to them, just gibberish.Remove everything from their room while at school, replace with uncooked pasta,
raw potato, cold baked beans in their slippers etc. and do not explain why.Never let them out of your sight, even to the loo (or for a clinical assessment).Baby her every night, no words just baby talk and re-enact the birth, push her out
from between your legs – that she hates it proves it’s important.Never use time out or sanctions, think of all they’ve been through.You can restrain them for hours – at the retreat, some kids may be restrained
through the night in shifts.Issues in selecting adoptive parents
These can be harder to select than foster parents, since in the majority
of cases, there will be no evidence of the prospective adopters’ skills in
parenting because they have not been able to have children. Research