ABSTRACT

My role as a child psychotherapist and the under-fives’ lead in a mental health service for children in care has provided a fertile context for clinical research with babies and young children in care. Originally a specialist child and adolescent mental health service providing treatment for around a hundred children each year, the service was re-configured three years ago as a screening and assessment service for all children and young people in the care of the commissioning local authority. My colleagues and I work closely with social workers, foster carers, and the children in care paediatricians and nurses who conduct statutory health assessments for children in care. In addition to screening children after they enter care as well as annually if they remain in care and consulting to social workers, the service provides brief intervention where indicated and refers to relevant services for long-term treatment. In the previous service, very few referrals were received for children under 5, and none for children under 2, whereas in the new service over a third of interventions are for infants and young children. Concerns include the cumulative adversities of foetal drug and alcohol exposure, abuse, neglect, and placement moves (Birk Irner, 2012; Needell & Booth, 1998; Schore, 2001; Wade, Biehal, Farrelly, & Sinclair, 2010; Ward, Munro, & Dearden, 2006). Some children show clear signs of emotional, relationship, or behavioural difficulties; in 294the case of others, social workers, foster carers, or adoptive parents may be concerned about the impact for later development of early trauma and disruption.