Understanding the impact of change and loss on children in care

10 June 2019

Leah CroninLeah Cronin

If you’ve ever spent more than ten minutes with a toddler it’s likely you’ve been interrogated with many questions. Who, what, why and where are frequent, so why do young children ask so many?

Children’s natural curiosity helps them make sense of the world and their place in it. Everything is new: tastes, smells, experiences and feelings. Perhaps that’s why change and loss can be so hard; just as children start to make sense of something it changes or disappears.

As adults, we recognise this and do what we can to protect children. It’s why my friend has two back-up teddies, identical to her son’s prized possession, just in case Ted-Ted is lost and quickly needs to be ‘found’ to avoid utter heartbreak for him and the family.

Impact of change and loss on children in care

In my role as a clinical psychologist with the NSPCC I work with children under five who are in care and experiencing far more change and loss than we’d ever want a child to experience. I work in the Infant and Family team in Glasgow, where we use the New Orleans Intervention Model. This model supports teams around children to decide whether a child can be safely returned home. It’s an important decision: we know that moving children repeatedly from failed placement to return home, then back into care can have a significant and long-lasting impact on their development and emotional wellbeing. This can worsen the impact of the experiences that led to their removal into care initially.

We use our infant mental health-centred approach, with an emphasis on relationships which is crucial to supporting recovery. With this approach we aim to improve children’s outcomes, return children home where safe, and make safeguarding recommendations for permanent care away from home when it is not possible.

Putting yourself in their shoes

Imagine waking up one day to a knock on your bedroom door from someone you haven’t met before. You are told to pack what you can into a small suitcase and say goodbye to your family, who are distraught, shocked and angry. Imagine being taken to a house you haven’t been to before and greeted by someone you don’t know, but who somehow knows your name and is smiling warmly at you. You are shown to a room and told you now live here. You don’t know if you’ll see your family, friends or colleagues again. You realise you forgot to grab your irreplaceable photo album in the rush. Imagine how you would make sense of this? How you would feel? How would you cope? Now imagine a young child going through this without the words and skills you have. How would you expect them to feel and act?

Red herrings and red flags

The decision to take a child into care is protective and only ever made in the most necessary of situations, but the care experience is inevitably full of change, loss and challenges for children. You might therefore expect young children in foster care, local authority care or where there are legal proceedings because of maltreatment, to ask lots of questions and behave in ways that show they are not doing well. Sometimes children do. They might cry or shout, find it hard to concentrate, or look angry, sad or scared. They might ask lots of whys and what’s or not manage to sleep or eat. These are helpful red flags that the child is finding it hard to cope with a hard situation.

But sometimes they show what I call red herring behaviours that distract from what is happening. Time and again we see little ones who have lost everything they have ever known and continue to have challenging experiences but never once clearly show it’s hard or ask ‘why?’. We see infants who won’t cry out or look for help in situations that we would expect to be scary and upsetting for any child, but instead they sit playing and smiling. We know through our work and other research that children who are maltreated can develop beliefs and adaptive strategies that prevent them from seeking help or from feeling safe enough to show when life is not feeling OK.

It’s not just the little ones who don’t know what to say

As adults, we can also struggle to find the words, it’s just so complicated. What is the right way to answer a three-year-old asking ‘Why don’t I live with my mummy?’, or to speak to a two-year-old about their beloved older sibling’s decision not to come to family contact that day. It’s therefore an understandable wish that a child who is not asking questions is simply accepting of the change and loss, or a child who seems good in a crisis is resilient in the face of challenge or too young to notice their circumstances. But the reality is usually children focus intently on the people around them and notice the changes that happen. Of course, all children can be resilient to different extents but resilience is not the same as masking what you are feeling or need.

What can happen if they don’t get the right support?

The risk of taking red herring behaviours at face value and responding as if the child is well or hasn’t noticed change and loss is that we inadvertently strengthen children’s beliefs, such as, ‘People only want to be near me if I look happy’, or ‘I have to look after myself’. Little children under five are in the normal developmental stage of ‘ego-centricism’ where they see themselves as more powerful than they actually are. This ego-centricism and the child’s tendency to fill in the blanks left in the story of their experiences can lead them to the devastating conclusion: ‘It’s all my fault’. Working with care experienced teenagers and adults has helped me understand the impact of carrying such unwarranted deeply-held beliefs and self-blame into adulthood and how it impacts on a person’s self-esteem, relationships and mental health.

While every child has different strengths and challenges, there are statistical themes that demonstrate the combined impact of early adversity and being in care. Care-experienced teenagers and adults are over represented in the criminal justice system and homelessness population, and under-represented in employment, training and school attainment. Not surprisingly, given their additional challenges, there are higher rates of difficulties with mental health and with substance misuse across the life-span of people in care. It’s unfair and saddening, as these trends are not an accurate reflection of the individual potential of each child who enters the care system.

So what can we do to support these children and their mental health?

Children in care are the same as children not in care in that they respond well to feeling safe, liked, loved, noticed, understood and held in mind by the important adults in their lives. Relationship-focused interventions that support the adults in the child’s family and helping team to tune in to a child’s experiences, recognise their red flags and red herrings, and promote a sense of safety in their relationships can have transformational outcomes.

Children can learn to show all their feelings secure in the knowledge that all parts of them will be accepted and supported. Adults can develop a sense of confidence and comfort in supporting children to make sense of their past and current situation. Healing can happen within relationships. That’s why the NSPCC provides a range of relationship-focused interventions and is developing training and educational materials to promote infant mental health; they recognise the value of early intervention and every child’s potential.

About the author

Leah Cronin is a clinical psychologist at the NSPCC and works in the Infant Family team in their Glasgow service centre. Leah works with children in care and their families, and supports teams around these families to make decisions about whether a child can be safely returned home.  

Related resources

New Orleans Intervention Model

NSPCC Learning website

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