Child: care, health and development 1977, 3, 357-362
A CHILD'S RELATIONSHIPS AFTER ADMISSION TO RESIDENTIAL CARE
S. N. WOLKIND Consultant Psychiatrist, Family Research Unit, The London Hospital Medical College, Turner Street, London ECl Accepted for publication 10 July 1977
Summary In a group of 92 children in longterm residential care it was found that those children visited infrequently by their mothers were less likely than those visited frequently or not at all to relate well to their houseparents. That the child's relationship with the houseparents was of considerable significance was suggested by the finding that prolonged contact with the same houseparent was associated with lower rates of psychiatric disorder and deviant behaviour in the child. The implications of these findings for child care practice are discussed.
INTRODUCTION Following the original work of Bowlby (1951) there has remained a tendency in work with children in residential care to focus on the significance to the child of the break with its natural parents. Important as this experience undoubtedly is, the quality of the relationship available to a child after its admission may be of even greater importance. It may be this that will determine a child's eventual emotional state. For most children even in longterm residential care contact with its parents does not stop at admission. This is generally regarded as both important and beneficial for the child and in keeping with the recommendations of the influential Curtis report (Home Office 1946) it has become accepted social work practice that in most cases every effort should be made to preserve the child-parent link. The actual effects of this policy for the child's wellbeing are not, however, clearly known. Regular and frequent contact with an adult (usually a parent) from outside the children's home was shown in one study to be the most important variable distinguishing the most stable from the most disturbed children (Pringle & Bossio 1960). In contrast 357
358
SN. Wolkind
to this the unsettling effect on the child of visits from difficult and disturbed parents has been documented (Bowley 1951). In particular, contact with parents who made only infrequent visits has been noted as being highly disturbing for the child (Conway 1957). Perhaps an even more important relationship open to the child in care is that with the adults who directly care for it; its houseparents. This is a surprisingly ill-researched area, possibly reflecting both that this is a sensitive area to investigate, and also a view that once a child is admitted the damage is done and httle amelioration can occur. There seems, however, little question that relationships within a group care setting can have a powerful influence for healthy development (WoUns 1974). It is therefore essential that the components of these relationships be carefully examined. In this paper some aspects ofa child's relationships after admission to care are described for a group of children in a long stay residential home.
THE STUDY
The sample comprised 92 children aged from 5 to 12 years who had been resident in a large 'cottage drive' home for at least 6 months. The children (53 boys and 39 girls) all came from an inner city deprived area. The children were examined with a standardized psychiatric interview (Rutter & Graham 1968) and the houseparents questioned with a similar instrument designed for parents (Graham & Rutter 1968), but modified to include behaviour within the group setting and relationships with the child care staff. From the results of the two interviews it was detemiined whether the child had a psychiatric disorder and if so, whether this was mildly or severely handicapping to the child in its daily life. The children attended local schools outside the home and for 89 of them a teachers' questionnaire was completed describing classroom behaviour. Children scoring above the cut off point on this instrument (Rutter 1967) were rated as showing 'deviant' school behaviour. Information on the child's background, including the length of time in the home, the reasons for admission and contacts with the family, were collected by a separate worker and were not available at the time the psychiatric interviews were completed. Details of the types of psychiatric disorders seen in the child have been published elsewhere (Wolkind 1974).
A child's relationships in residential care
TABLE 1. Contact with mother in last 6 months and reason for admission, child's psychiatric state and relationship with houseparent Frequent (Over 6) Reason for admission* (high rejection) Psychiatric disorder severe mild Difficulties with houseparents** A^
Infrequent (1-6) None
6(18%)
13(48%)
14 (44%)
12(36%) 12(36%)
1 2 (44%) 9 (33%)
14(44%) 10(31%)
4(12%) 33
10(37%)
6(18%)
27
32
V = 6.21, d.f. = 2, p < .05; **x^ = 6.44, d.f. = 2, p < .05.
TABLE 2. Length of stay with houseparents and severity of psychiatric disorder Under 2 years
2 years and over
No disorder Mild disorder Severe disorder*
10(22%) 13(28%) 23(50%)
13(28%) 18(39%) 15(33%)
A'
46
46
* Severe versus mild and no disorder, x^ = 2.87, d.f. = 1, p < .1.
TABLE 3. Length of stay with houseparents and rating on teachers scale
'Deviant' on teachers questionnaire** Non 'deviant' on teachers questionnaire N*
Under 2 years
2 years and over
25 (57%) 19 (43%) 44
16 (36%) 29 (64%) 45
*Completed questionnaires were obtained on 89 of the 92 children
359
360
5". N. Wolkind
RESULTS Contact with mother Contact with relatives other than the mother and without her were extremely uncommon and it was decided to examine only each child's contact with its mother over the 6 months prior to the interview. The contacts were divided into none, six and under (infrequent) and over six (frequent). In Table 1 contact is examined against the reason for the child's admission, the presence of psychiatric disorder in the child and any difficulties the child had in relating to its houseparents. The reasons for admission were rated as high, medium or low 'rejections'. This was based purely on the social work report of the main reason leading to reception into care and was designed to measure the degree of active rejection of the child. High rejection was rated only for cruelty or abandonment. This is found to be uncommon in the frequent contact group, but equally common in the infrequent and no contact group. There is no difference between the groups in the rate of psychiatric disorder. Difficulties in the child's relationship with the houseparents are significantly commoner in the 'infrequent' group than in either of the other two. Contact with houseparents Length of stay in the home did not in itself relate to the presence or severity of psychiatric disorder. 42% of the 38 children who had spent under 50% of their lives in the home had a severe disorder as opposed to 41% for the 54 children with over this amount. Changes of houseparent did occur, however, and it was decided to examine length of contact with the current houseparent. In Table 2 the severity of psychiatric disorder is shown for the children with under 2 years and those with 2 years or more with their houseparent. There is a trend for the longer contact group to be less likely to have a severe disorder. To allow for the possibility of bias through 'familiarity', length of contact was examined against the rating on the teachers' scale. This is shown in Table 3. The prolonged contact group is significantly less likely to receive a rating of 'deviant' behaviour. DISCUSSION A number of points arise from these findings. Despite the very limited
A child's relationships in residential care
361
information used to examine the relationships available to the child, definite associations are found between these and the child's emotional and behavioural status. Perhaps not surprisingly mothers from those families where admission followed abandonment or cruelty were less likely to maintain regular contact. The reason for admission did not in itself relate to the rate of disturbance, but it has been shown previously that in this same group of children other measures of family functioning before admission related to certain types of disorder (Wolkind 1974). The degree of maternal contact did not relate to the presence of psychiatric disorder, but the high rate of difficulties with houseparents reported for the infrequent contact group is striking. That equally low rates are found in the remaining groups suggests that neither the child's pre-admission experiences nor house parents 'jealousy' of natural parents can explain the finding. It does seem that infrequent contacts with parents may well unsettle the child and leave him unable to relate to the care staff. That the ability to relate well to the houseparents might be crucial to the child is suggested by Tables 2 & 3. It was not possible in this study to examine the attitudes, personalities or child rearing practices of the houseparents. The single measure obtained, that of length of contact does, however, seem to relate to the child's functioning; prolonged contact relating to less severe difficulties in the home and even more strikingly at school. It is possible that this finding is an artefact caused by the transfer or discharge of children getting on poorly with their houseparents. An examination of all such changes occurring in the two years before the study gave no evidence to support this. Though these findings clearly need to be confirmed by more detailed studies, they do have implications for child care practice. In families where parents do not spontaneously wish to maintain contact it may not be in the child's best interests for this to be encouraged. A finding which offers some grounds for optimism is that on length of contact with the houseparents. This would support the view that for a child who has had a disturbed upbringing in his natural family, residential care could under certain circumstances help lessen the degree of emotional disturbance. This study would suggest the best way to encourage this outcome would be to arrange for house (or foster) parents to be offered a career structure which would enable them to offer continuity of care to a child
362
S.-N. Wolkind
REFERENCES Bowlby J. (1951) Maternal Care and Mental Health. Monogram No. 2. WHO, Geneva Bowley A.H. 0951) Child Care. E. & S. Livingstone, London Conway E.S. (1957) The Institutional Care of Children, A Case History. Ph.D. Thesis, University of London Graham P. & Rutter M. (1968) The reliability and validity of the psychiatric assessment of the child IL Interview with the parent. British Journal of Psychiatry 114,581-592 Home Office (1946) Report of the Care of Children Committee. (Curtis Report). HMSO, London Pringle M.L.K. & Bossio V.L. (1960) Early prolonged separation and emotional adjustment. Journal of Child Psychology and Psychiatry 1, 37-48 Rutter M. (1967) A childrens behaviour questionnaire for completion by teachers. Journal of Child Psychology and Psychiatry 8, 1-11 Rutter M. & Graham P. (1968) The reliability and validity of the psychiatric assessment of the child. I. The interview with the child. British Journal of Psychiatry 114,563-579 Wolins M. (1974) Successful Group Care. Aldine, Chicago Wolkind S.N. (1974) The components of affectionless psychopathy in institutionalized chMien. Journal of Child Psychology and Psychiatry 15, 215-220
A CHILD'S RELATIONSHIPS AFTER ADMISSION TO RESIDENTIAL CARE
S. N. WOLKIND Consultant Psychiatrist, Family Research Unit, The London Hospital Medical College, Turner Street, London ECl Accepted for publication 10 July 1977
Summary In a group of 92 children in longterm residential care it was found that those children visited infrequently by their mothers were less likely than those visited frequently or not at all to relate well to their houseparents. That the child's relationship with the houseparents was of considerable significance was suggested by the finding that prolonged contact with the same houseparent was associated with lower rates of psychiatric disorder and deviant behaviour in the child. The implications of these findings for child care practice are discussed.
INTRODUCTION Following the original work of Bowlby (1951) there has remained a tendency in work with children in residential care to focus on the significance to the child of the break with its natural parents. Important as this experience undoubtedly is, the quality of the relationship available to a child after its admission may be of even greater importance. It may be this that will determine a child's eventual emotional state. For most children even in longterm residential care contact with its parents does not stop at admission. This is generally regarded as both important and beneficial for the child and in keeping with the recommendations of the influential Curtis report (Home Office 1946) it has become accepted social work practice that in most cases every effort should be made to preserve the child-parent link. The actual effects of this policy for the child's wellbeing are not, however, clearly known. Regular and frequent contact with an adult (usually a parent) from outside the children's home was shown in one study to be the most important variable distinguishing the most stable from the most disturbed children (Pringle & Bossio 1960). In contrast 357
358
SN. Wolkind
to this the unsettling effect on the child of visits from difficult and disturbed parents has been documented (Bowley 1951). In particular, contact with parents who made only infrequent visits has been noted as being highly disturbing for the child (Conway 1957). Perhaps an even more important relationship open to the child in care is that with the adults who directly care for it; its houseparents. This is a surprisingly ill-researched area, possibly reflecting both that this is a sensitive area to investigate, and also a view that once a child is admitted the damage is done and httle amelioration can occur. There seems, however, little question that relationships within a group care setting can have a powerful influence for healthy development (WoUns 1974). It is therefore essential that the components of these relationships be carefully examined. In this paper some aspects ofa child's relationships after admission to care are described for a group of children in a long stay residential home.
THE STUDY
The sample comprised 92 children aged from 5 to 12 years who had been resident in a large 'cottage drive' home for at least 6 months. The children (53 boys and 39 girls) all came from an inner city deprived area. The children were examined with a standardized psychiatric interview (Rutter & Graham 1968) and the houseparents questioned with a similar instrument designed for parents (Graham & Rutter 1968), but modified to include behaviour within the group setting and relationships with the child care staff. From the results of the two interviews it was detemiined whether the child had a psychiatric disorder and if so, whether this was mildly or severely handicapping to the child in its daily life. The children attended local schools outside the home and for 89 of them a teachers' questionnaire was completed describing classroom behaviour. Children scoring above the cut off point on this instrument (Rutter 1967) were rated as showing 'deviant' school behaviour. Information on the child's background, including the length of time in the home, the reasons for admission and contacts with the family, were collected by a separate worker and were not available at the time the psychiatric interviews were completed. Details of the types of psychiatric disorders seen in the child have been published elsewhere (Wolkind 1974).
A child's relationships in residential care
TABLE 1. Contact with mother in last 6 months and reason for admission, child's psychiatric state and relationship with houseparent Frequent (Over 6) Reason for admission* (high rejection) Psychiatric disorder severe mild Difficulties with houseparents** A^
Infrequent (1-6) None
6(18%)
13(48%)
14 (44%)
12(36%) 12(36%)
1 2 (44%) 9 (33%)
14(44%) 10(31%)
4(12%) 33
10(37%)
6(18%)
27
32
V = 6.21, d.f. = 2, p < .05; **x^ = 6.44, d.f. = 2, p < .05.
TABLE 2. Length of stay with houseparents and severity of psychiatric disorder Under 2 years
2 years and over
No disorder Mild disorder Severe disorder*
10(22%) 13(28%) 23(50%)
13(28%) 18(39%) 15(33%)
A'
46
46
* Severe versus mild and no disorder, x^ = 2.87, d.f. = 1, p < .1.
TABLE 3. Length of stay with houseparents and rating on teachers scale
'Deviant' on teachers questionnaire** Non 'deviant' on teachers questionnaire N*
Under 2 years
2 years and over
25 (57%) 19 (43%) 44
16 (36%) 29 (64%) 45
*Completed questionnaires were obtained on 89 of the 92 children
359
360
5". N. Wolkind
RESULTS Contact with mother Contact with relatives other than the mother and without her were extremely uncommon and it was decided to examine only each child's contact with its mother over the 6 months prior to the interview. The contacts were divided into none, six and under (infrequent) and over six (frequent). In Table 1 contact is examined against the reason for the child's admission, the presence of psychiatric disorder in the child and any difficulties the child had in relating to its houseparents. The reasons for admission were rated as high, medium or low 'rejections'. This was based purely on the social work report of the main reason leading to reception into care and was designed to measure the degree of active rejection of the child. High rejection was rated only for cruelty or abandonment. This is found to be uncommon in the frequent contact group, but equally common in the infrequent and no contact group. There is no difference between the groups in the rate of psychiatric disorder. Difficulties in the child's relationship with the houseparents are significantly commoner in the 'infrequent' group than in either of the other two. Contact with houseparents Length of stay in the home did not in itself relate to the presence or severity of psychiatric disorder. 42% of the 38 children who had spent under 50% of their lives in the home had a severe disorder as opposed to 41% for the 54 children with over this amount. Changes of houseparent did occur, however, and it was decided to examine length of contact with the current houseparent. In Table 2 the severity of psychiatric disorder is shown for the children with under 2 years and those with 2 years or more with their houseparent. There is a trend for the longer contact group to be less likely to have a severe disorder. To allow for the possibility of bias through 'familiarity', length of contact was examined against the rating on the teachers' scale. This is shown in Table 3. The prolonged contact group is significantly less likely to receive a rating of 'deviant' behaviour. DISCUSSION A number of points arise from these findings. Despite the very limited
A child's relationships in residential care
361
information used to examine the relationships available to the child, definite associations are found between these and the child's emotional and behavioural status. Perhaps not surprisingly mothers from those families where admission followed abandonment or cruelty were less likely to maintain regular contact. The reason for admission did not in itself relate to the rate of disturbance, but it has been shown previously that in this same group of children other measures of family functioning before admission related to certain types of disorder (Wolkind 1974). The degree of maternal contact did not relate to the presence of psychiatric disorder, but the high rate of difficulties with houseparents reported for the infrequent contact group is striking. That equally low rates are found in the remaining groups suggests that neither the child's pre-admission experiences nor house parents 'jealousy' of natural parents can explain the finding. It does seem that infrequent contacts with parents may well unsettle the child and leave him unable to relate to the care staff. That the ability to relate well to the houseparents might be crucial to the child is suggested by Tables 2 & 3. It was not possible in this study to examine the attitudes, personalities or child rearing practices of the houseparents. The single measure obtained, that of length of contact does, however, seem to relate to the child's functioning; prolonged contact relating to less severe difficulties in the home and even more strikingly at school. It is possible that this finding is an artefact caused by the transfer or discharge of children getting on poorly with their houseparents. An examination of all such changes occurring in the two years before the study gave no evidence to support this. Though these findings clearly need to be confirmed by more detailed studies, they do have implications for child care practice. In families where parents do not spontaneously wish to maintain contact it may not be in the child's best interests for this to be encouraged. A finding which offers some grounds for optimism is that on length of contact with the houseparents. This would support the view that for a child who has had a disturbed upbringing in his natural family, residential care could under certain circumstances help lessen the degree of emotional disturbance. This study would suggest the best way to encourage this outcome would be to arrange for house (or foster) parents to be offered a career structure which would enable them to offer continuity of care to a child
362
S.-N. Wolkind
REFERENCES Bowlby J. (1951) Maternal Care and Mental Health. Monogram No. 2. WHO, Geneva Bowley A.H. 0951) Child Care. E. & S. Livingstone, London Conway E.S. (1957) The Institutional Care of Children, A Case History. Ph.D. Thesis, University of London Graham P. & Rutter M. (1968) The reliability and validity of the psychiatric assessment of the child IL Interview with the parent. British Journal of Psychiatry 114,581-592 Home Office (1946) Report of the Care of Children Committee. (Curtis Report). HMSO, London Pringle M.L.K. & Bossio V.L. (1960) Early prolonged separation and emotional adjustment. Journal of Child Psychology and Psychiatry 1, 37-48 Rutter M. (1967) A childrens behaviour questionnaire for completion by teachers. Journal of Child Psychology and Psychiatry 8, 1-11 Rutter M. & Graham P. (1968) The reliability and validity of the psychiatric assessment of the child. I. The interview with the child. British Journal of Psychiatry 114,563-579 Wolins M. (1974) Successful Group Care. Aldine, Chicago Wolkind S.N. (1974) The components of affectionless psychopathy in institutionalized chMien. Journal of Child Psychology and Psychiatry 15, 215-220
