Main Looked After Child Review

Any illnesses or hospital admissions since last review? Yes. If yes, details

Li continues to have health issues nocturnal enuresis, blood in urine and unpleasant odour. He has been seen by health professionals for appointments related to this. Since last review Li has refused to be seen by any health professionals regarding the issues raised above. Carol has tried to reason with Li on this however he is adamant in his decision.
Update: This continues to be an issue for Li and recently his self harm began to escalate, where Li would wake up in a pool of blod and asked children at school to smash his hand with chairs etc as to break it. Li was admitted to Woodlands Adolescent Unit on the 1 st May 2012 and remains here. Li voluntarily admitted himself initially, but then had to be sectioned as tried to discharge. In the prior to the CPA Meeting, Li’s section was removed and he remains in their care on a voluntary basis.

Highlight any other outstanding health/developmental needs/issues not referred to above and whether any changes are needed to the current health care arrangements

Issues raised above.
KCC Redaction
Carol remains being paid a professional fee as Li’s carers. This will be reviewed after the next CPA in June when the future care plan is considered once more.

Have there been any change~ in school/nursery since last review? Yes. If yes, details including date of change

Li is currently in Woodlands in Staplehurst, this means that Li is not being currently schooled by Ellington and Hereson School. The following arrangements regarding future plans in terms of exams is as follow: RE exam on the 31 st of May, can be deferred to next year and either go for half or full GCSE. Deferring DT till next year. and he will have 2days intensive learning to complete this.

Highlight child/young person’s achievements in school since last review (both academic and non academic achievements)

Li continues to do well in Geography, History and DT. Li is doing well in Science, Music and Photography. When discussing interests further with Li when he puts his mind to things he is a very creative person, just lacks the motivation to explore this further. Li is good at ICT and enjoys using the computer. He has a strength in this area and it is important that this is perused so that this can help Li to develop his skills.

Update: Li has been engaging well in activities and schooling within Woodlands. Li feels he needs more stimulating as he often becomes bored.

Highlight any concerns or outstanding issues regarding child/young person’s education, learning, language and social development and whether there need to be any changes to the current arrangements for child/young person

Li talks of Bin Laden and blowing up important building relating to American security. There was concern of this been terrorism like behaviour but it is clear that there is no religious, political or belief led views and more the actual act of blowing things up. This has been discussed with Kent Police following the school raising an alert. Alamgir Sheriya from Kent Police is meeting with Li 18.04.2012 to discuss the above  issues as he is currently apart of a new programme working with young people like Li to look at their focus or interests in radicalism and put this focus toward something positive. Lie for e.g producing a computer game, being apart of focus groups etc. Li is currently proving difficult to engage, however it is hoped that he will take this as a
great opportunity. Update: This is no longer of concern and the police are not involved. Li has a lot on his plate and needs space to focus on his well-being. Concerns previously raised are now being addressed and explored in Woodland House.

Where appropriate, has life story work been completed? No. If no, when will this be done and by whom?

Li Harris is starting to question his past and is aware that I would need to do this work with him. He is resistant to this as wants to complete on his own but is too vulnerable at this time.

Comment on quality of the attachment between child/young person and carers

Li appears to have a very stable, positive and good relationship with Carol and John Thomson. However there are times when Li will test the boundaries and has recently said to Carol such comments as “well I will leave this placement then”. I have worked with Carol so that she understands this is Li’s way of communicating he is angry or upset and that it is not possible as these comments have surprised and upset Carol. Other then this it is fantastic that Li has been with Carol as long as he has and this evidences that Li’s relationship with his carers is good. Often Li communicates better when things are humoured. Carol has a great sense of humour and often Li is laughing with her.

Highlight any other changes/issues regarding emotional/behavioural development

Li talk of Bin Laden has become much more which has caused concern for the school particularly.  Update: This is not the case now, however this issue has not been ignored and interventions are currently in the process of being implemented. Li continues to experience nocturnal enuresis and Carol has recently found items in Li Harris’s Bed Author Redaction Relates to the thing This has continued and the blood is often excessive. This is causing a strain on his relationship with Carol as she has to be demanding in order for him to clean up after himself. Li denies he is doing this to himself. After Li, Carol and I had a discussion about his self harm and the impact on the future and future relationships with Li he went through a period of two weeks of no nocturnal
enuresis or bleeding, however once things became difficult at school this restarted. Update: issues raised in other panels.

Highlight any issues/concerns regarding child/young person’s sense of identity, social presentation, religion, language, culture, sexuality, disability, gender

Li still has a very small network of friends and appears to struggle with peer relationships. There is a concern that his health issue particularly the unpleasant odour may cause him to be a target for bullying. There are also issue in respect of Li’s relationship with his father, although this has lessened. Update: Li has made it very clear to me that he does not like his father and does not
want to see him. Li continues to have contact with his family and this is maintaining links. He often has a difficult relationship with Brother and through Facebook have been extremely aggressive and verbally violent about one another, when asked about this Li says this is just a joke. Work is need to be done with Li around how he see’s himself. He lacks self-esteem and find compliments hard to consider. I am working with Li on this. Li has recently stated that he is gay. Li did this on Facebook and Carol has spoke to him about being careful as people will use this against him. He should be allowed to discuss things yes, but to ensure he doesn’t leave himself vulnerable to others. Update: Li is struggling with his history and quite where he belongs in the world and his family. I will when Li is ready consider life story work with him.

Comment on stability of this placement and whether it is meeting the various needs of child/young person including any cultural, religious, linguistic, disability issues. Highlight strengths of placement as well as any areas of concern

The placement remains stable and secure. This remains to be the case, however Li is presenting with defiant behaviour and this has had a strain on his relationship with his carers. Carol is worried about Li’s attitude and that he will not be able to function as an adult out of their home. UPDATE: Li is now at Woodland House. Initially Li was extremely unhappy to be there and wanted to leave. He felt that his need to self-harm was heightened and that he was angry and unable to distract himself. Now he is more willing to engage. It is unclear whether this was to drop the section or whether his intentions are true to deal with his self harm.

Comment on the quality of relationship between CYP and carers/residential workers and other CYP in placement

Li is trying to make friends with the unit, however can be quite introvert. When visiting Li at the unit, he in fact was greeted by a number of children and young people in the unit.

What is the contingency plan in the event of this placement breaking down?

Work would be undertaken by social worker and fostering social worker to resolve issues. If this was irreparable, Li’s needs considered and appropriate placement matched for him to move on to.#

Comment on quality of the relationships/attachment between child/young person and members of birth family

Li maintains a relationship with his mother. He is almost protective of his siblings and likes to know they are ok. Update: Li states he has a lot of family and enjoys talking to me about them. He is
very open about his thoughts regard his father and states that he still maintains and relationship with his mother.

Details of current contact arrangements, comment on how these are working and any changes needed. Include details of any S.8 or S.34 Orders

Li has unsupervised contact with his mother every Tuesday. This continues to be going well and Li’s mother communicates well with Carol. Li has indirect contact with all his other family members.

Summary of review discussion

CHILD/YOUNG PERSON’S PARTICIPATION IN THE REVIEW PROCESS

Li met with the IRO before his review as he has now been an inpatient at woodland hospital since May 1 st. He had just been told that he was no longer on a section 2 but seemed to understand that this did not mean he was returning to his foster carers but that he would have more freedom.

What is the child and young person’s understanding of their Care Plan?

Li understands that the care plan is to remain with his carers. Li has said during previous meetings that he has no intention of returning to live at home. He has found his loss of freedom very difficult in particular his lack of access to computers. He was also a little worried about falling behind with school work

If appropriate, have arrangements been made for an independent person to speak on behalf of the child/young person?

He had seen a solicitor last week to appeal the decision about detention under the MHA.

HAVE THE DECISIONS REACHED AT THE LAST REVIEW BEEN ACTED UPON? Record which decisions have not been acted upon and why?

1 There is a good network of professionals that support the care plan and meetings should not drift- ongoing
2 The next meeting is 22/05/12- change of circumstances
3 Referral to sixteen plus- ongoing
4 Social Worker to undertake life story work and consider writing a life letter- this should be discussed in conjunction with current treatment
5 Social Worker to undertake pp2- this wil be more important as part of safe care plan when Li is discharged from hospital
6 Social Worker to follow up request about contact- ongoing
7 Care plan will need to be updated because of changes in education and contact. IRO to be informed within 10 days- ongoing

WHAT HAS BEEN THE EFFECT OF ANY CHANGE IN THE CHILD AND YOUNG PERSON’S CIRCUMSTANCE (SINCE THEY BECAME LOOKED AFTER) OR SINCE THE LAST REVIEW? IF THE CHILD HAS HAD AN UNPLANNED PLACEMENT, HAS THEIR BEEN A DISRUPTION MEETING? BRIEFLY OUTLINE

Li was admitted to woodland Hospital as a voluntary patient on 1 /05/12. Due to increasing concerns about the risk his self harming posed to his health, Li was placed on Sec 2 of the MHA on 10/05/12 as he was requesting to discharge himself. On 21/05/12 the section was rescinded but dr Garrett stressed that this decision had been
taken because of the level of Li’s cooperation but that if this was not sustained the staff do have a duty of care to prevent him leaving.

SOCIAL WORK INTERVENTIONS SINCE THE LAST REVIEW: Are the frequency of visits meeting statutory requirements and the needs of the
child/young person?

Yes since Social Worker has been allocated to Li.

ASSESSMENT:

Is the care plan/pathway plan based on an up to date assessment which identifies the
child’s needs and takes into consideration their wishes and feelings?

Yes

Other assessments undertaken?

CAMHS are involved and a review took place at the end of April There is also a summary of need prepared by the nursing staff and a psychological report prepared by Oliver Sindall that should be read in conjunction with this report.

THE CARE PLAN

Does the care plan meet the needs of the child? Yes
Does the care plan meet the needs for permanency? no
Does the Placement Plan address all the child’s needs within the Placement? Will need to be updated
Does the Health Action Plan address all the child’s Health needs? The IRQ has not read the latest report that was completed on 22/09/11
Does the PEP address all the child’s educational needs? Yes
Is there an agreed contact plan which meets the needs of the child? yes
Is there an appropriate contingency plan? Another foster placement would be needed but this placement is stable at present
Identify where the child’s needs are not being met and if there is any delay? Are all the
Pledge commitments for the child being provided? Yes
If Some or No please state what actions are being taken to meet those not being met.

CARE PLANNING:

Identify any changes, services or actions needed to meet the child’s needs: Placement- Carol had written a detailed report. For the review last month” Li, we feel has made great progress in certain things. He has matured and remains to grow incredibly fast. However he has been a little more confrontational, probably due to his age …. We like Li and have a great relationship with him but he is so complex we worry deeply … He still uses the same “I don’t know” as an answer when he can’t be bothered to explain something. His hygiene would be non-existent if we weren’t
behind him all the time …. He still spends the best part of his time isolated to the confines of the bedroom, “Horizontal” if we let him.” Li seems very settled in the placement and the carers report that he rarely gives problems in the foster home. He knows the boundaries and likes the confines of his own room, rarely spending time with the family. He spends a lot of time on the
computer, including the internet that the carers monitor. He does not like noise or theme parks but will go for a bike ride. Respite care is part of the plan as he does not
enjoy holidays and enjoys the time he spends at Stan and Annette’s. The IRO suggested that this arrangement be built into the care plan. When he had respite recently he apparently “loved it” as did not shower and spent all night on his phone and laptop. John and Carol are committed to caring for Li but have been worried about his behaviours. They have visited him and phone each day. He has been asking them to bring biros to him which they have not done.

Health- Li is an inpatient and his needs are being assessed. He still bed wets sporadically although overall it has lessened .. He was discharged by Dr Sarmah
before the last review. The iro has not seen the health assessment but.overall he is a healthy boy .. Last dentist was July 2011 and will be due at optician in January 2012 Li has agreed to see a Author Redacted “The Thing” and it is hoped that he will allow himself to be examined. Dr Garrett explained that he may need some mild sedation as his anxiety will be high.

Emotional and Behavioural Development- April notes” Li continues to be reviewed by Dr Nairac but Neil Johnson attended today. Li knows that he functions better when he takes equasym and is loathe to manage without it. On the odd day when he has missed taking it his behaviour is very different and all who know him feel that this benefits him. He has also been prescribed sertraline for anxiety. Li has had twelve sessions with Neill Johnson. He says that he has helped him and wants to continue seeing him. Neill explained that there would be a review next week and whilst Li has
talked to him about the way he is, he has not been willing to address the self-harming behaviour. Neil commented on his low self esteem but inflated ideas about his competence in
certain areas. He fantasises about decoding and makes exaggerated claims that will leave him vulnerable. He was visited by Alam Gir Sheriyar from the police following his involvement on some
inappropriate sites on the computer who wanted to introduce a service. This should be part of the network discussions as Li’s needs are so complex. He has said that he is “gay” and wants to consider his identity and why he has grown up like he has. He has however been asking questions about what happened before he came into
care and would benefit from life story work. The IRO reminded Social Worekrs had gathered chronologies from all agencies that might be helpful.” See reports discussed above . He has seen Oliver four times “Throughout our sessions Li has been very good at thinking about his inner conflict. He has ben able to identify that there is part of him that wants to talk and get help and the other half that is frustrated by the loss of freedom but also overwhelmed by the fear and anxiety of talking about very emotive and difficult subjects.” He has been exploring his family background with a genogram The details of the self harming are restricted to his immediate care team but medical assessments will probably also be needed.

Education- Li is in year 10 at Ellington school .The educational statement is in place but the IRO has not seen a copy .Mrs Downes brought the progress report for term four. He had achieved 97 .2% attendance. There was some concern for effort or behaviour in certain subject and Li ‘s latest fixation is to be a web designer but he has lost all interest in ict as a subject at school. Yesterday there was a meeting at school to address this as Li says that the time scales for GCSE in this subject are to pressured. He will take it as a subject but not as
an option. He has a poor relationship with the science teacher and has only recently been allowed to return to the class. Li has to hand his phone in at school and at home because he is not responsible enough to manage it himself without these external controls. Li was head butted at school, causing him to black out momentarily and had injuries to his head. Li is unable to judge the consequences of his behaviour . Mrs Downes said that he does have three friends who are quiet, nice boys. Update- Li receives two hours education a day and Jacky Cador was present to liaise
with the head teacher about providing extra work, as required. The priority however is
to address his mental health needs
Have the views of the Child/young person, parents, other significant adults, carers,
and other professionals been taken into consideration? Yes

Other issues April review -“The foster carers were very complimentary about the social worker. “she is on the ball, answers all calls and keeps appointment times. Her relationship with Li in such a short space of time is impressive Her approach to him is calm, caring and understanding. Such a shame he has to move to 16 plus this year.” Li is in touch with Brother on Face book but some of their conversations are no appropriate and Carol is aware of their communications. Li has seen Youngest Brother and seemed reassured that he is ok and not visited regularly but has mentioned seeing an uncle again. Life story work is needed and it may be that a break from Camhs is needed to address this and then resume the counselling work with Niall. This will need to be discussed at
his CAMHS review. A date was set for the next network meeting as given his complex needs it is important that all professionals work closely together. The self harming behaviour continues to cause concern as Li’s pain threshold seems high and he will not talk about it or allow any examination. It is likely that infection will occur that will require treatment at some point particularly as his personal hygiene can be poor. A placenment plan part 2 needs to be revisited and this was arranged for 22/04/12 Li has made steady progress but will need continuing support through to adulthood. Li has a freedom pass and Social Worker knows about referral for NI number” Dr Garret explained that Li would be in hospital for some time and made arrangements to liaise regularly with his foster carers. Li is now allowed leave and carers will visit on Sundays and take him out. It is more problematic because of
distance and as they have 2 younger children also in their care. The IRO explained that it was a requirement to have a lac review within 28 days and it was unfortunate that a representative from the district was not present but given that all the information was available then a further meeting did not seem to be in Li’s best interests. She will record the CPA meeting as a lac review and arrange an early lac review. Li will not be discharged without a meeting to make a safe care plan.

Decisions And Recomendations

1 Li to remain in hospital to continue the work around his self harming behaviours.
2 Hospital staff to communicate regularly with the carers
3 Foster placement to remain open as the carers have a continuing important role.
4 Li’s views about confidentiality to be respected and he does not want any of his  family to know any details
5 Social Worker to talk further with Li about contact with mother and how this cab best be facilitated.
6 School to consider whether additional work is appropriate and to liaise with Jacky Cador as needed.
7 Social Worker to update care plan