Case studies and activities

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Jack is of dual heritage – his father is white British, and his mother is white/African Caribbean British. He has no brother or sisters. The plan for him is to be adopted. 

Jack’s parents met at a day centre for people recovering from mental health conditions. His mother has a diagnosis of schizophrenia, and his father has bipolar disorder. His parents’ relationship lasted only a few weeks and Jack’s father left the area before he was born. Jack has never met his father who does not want to be involved in his life. 

Jack’s mother was in her mid-30s when he was born. She had been living with schizophrenia since her late teens. Her condition is quite disabling; she has had several admissions to psychiatric hospital over the years. She has not been able to work, but when she is well, she attends local day services where she has made friends and enjoys art and craft activities. When she is unwell, she becomes very withdrawn and stops looking after herself. She finds it difficult to accept help; her paranoid feelings make her suspicious of other people and she tends to shut herself away in her flat and not answer the door or her phone. She has no history of violent behaviour towards other people and is supported to live in a flat by the mental health community support team.

Pause for reflection: How might Jack’s mother's mental health condition affect her ability to maintain a relationship with Jack over time?

His mother experienced a period of severe mental health challenges in the latter stages of her pregnancy, and Jack was born in a mother and baby unit in the psychiatric hospital. He was born at 35 weeks gestation weighing 5 ½ pounds and was transferred to the special care baby unit at the general hospital where he stayed for one week. 

After one week Jack was well enough to be discharged and he was placed with foster carers whilst his mother remained in the psychiatric hospital. His mother was quite unwell for three months after Jack’s birth, and it was not felt to be a good idea for him to be taken to visit her. When well enough however she was interested in hearing updates and seeing photos provided by Jack’s social worker. 

When Jack was three months old his mother moved back home to her flat. Jack remained in foster care but was taken by his foster carers to have contact with his mother twice a week at the local family centre for an hour and a half. Jack’s mother came to these meetings reliably. She was always pleased to see him and enjoyed holding him and playing with him. She did not however feel confident in doing any more than this on the visits. For example, if Jack cried or his nappy needed changing, she would give him straight back to the foster carer. She seemed overwhelmed by the idea of looking after a baby, and at planning meetings she insisted that she was “not well enough yet” to think about having Jack to live with her. Jack seemed reasonably content on these visits with his mother until he reached the age of six months. He then became clingier to his foster carer and somewhat fearful of strangers, and he often cried when passed to sit on his mum’s lap. 

Pause for reflection: What steps would you take to consider everyone’s needs when developing the contact plan for Jack? 

As there seemed no realistic chance of Jack been cared for by his mother, a plan to place Jack for adoption was put forward. Jack’s mother has said that she would not mind if he were adopted as she knows she could not cope with looking after him and she wants him to have a good life. But she has two reservations. Firstly, she is worried that she will not be able to have any contact with Jack if he is adopted, and she says that she needs to know how he’s getting on. Secondly, she is worried that Jack might think that she doesn’t love him if she signs the adoption papers. Jack has been in the same foster placement since being discharged from hospital. He seems to have a secure attachment to his foster carers and is meeting all his developmental milestones.

Ava (age 7) and Rory (age 3) 

Ava and her younger brother Rory have lived with foster carers for 18 months and the plan is for them to be adopted. The children were removed from their parents following an incident where Rory was injured. He was taken to hospital by his parents who reported that he had accidentally fallen out of the back of his dad’s van while playing. The doctors believed the injuries were inconsistent with this explanation and suspected that Rory had been hurt by one of his parents.  

Children’s Social Care have been involved with the family for some time due to concerns about the children’s welfare. An initial referral was made three years ago by Ava’s nursery school because she often appeared unclean, and her speech was very delayed. Additionally, the police had been called to the family home several times due to loud arguments between the parents while under the influence of alcohol. There were also concerns about Ava taking on a caregiving role for Rory, feeding him and changing his nappy, and the home conditions being poor. Despite these concerns, criminal proceedings against the parents are not being taken. 

Ava and Rory’s parents are adamant that they love their kids and would never do anything to hurt them. They say that they are admittedly not “house proud” but were trying to improve. They feel more support from Children’s Social Care, such as helping with cleaning or financial help, would have been better than criticism. The social worker’s view is that the parents do genuinely care about the children and are not deliberately cruel, but notes they have little understanding of the children’s needs and have misused alcohol. 

Since entering foster care, both Rory and Ava have shown significant improvements in their physical health and growth. In terms of their emotional health, both children initially appeared withdrawn and frightened, but under the care of their experienced foster carers they have continued to make progress. Rory is now meeting developmental milestones and is a happy child who is attached to his foster parents. Ava still experiences social, emotional and behavioural challenges, particularly at school, where she finds it difficult to get on with the other children. She has started to form an attachment to her foster carers. This attachment has been assessed as being quite anxious. 

During the ongoing care planning and legal proceedings, the children have had supervised face-to-face visits with their parents once a week at the family centre. Ava often asks about her parents and looks forward to seeing them. The interactions between Ava and her parents are enthusiastic, sometimes described as “over the top”. The quality of interaction between Ava and her parents however is not good. The contact worker has observed that their parents find it difficult to talk or play with Ava and Rory meaningfully during their visits, and after a while they end up talking to the contact worker about their own needs. After the visits, Ava is often sick in the car and has nightmares. She has not expressed a desire to stop the visits, but through some “wishes and feelings” work she has said that she would like to see mummy and daddy “a little bit”. Rory shows no interest in his parents during their time together and prefers to stay close to the contact worker. 

Pause for reflection: What are the benefits and challenges associated with face-to-face contact, considering the past interactions and the parents’ history?  

Potential adoptive parents have been identified for Ava and Rory, and the placement order hearing has been scheduled. The adopters, a lesbian couple, have had quite a positive attitude toward keeping in touch with the birth family from the start of their contact with the agency; they believe it is important that children know their life story to help form a healthy self-identity. They are open to face-to-face contact with the birth parents if it is in the children’s best interests. Looking at Ava and Rory’s situation and history, they are uncertain about what would be best and would like guidance from the professionals.  

The birth parents oppose the adoption but have said they would like to continue seeing the children at least once per month if it does go ahead. There are varying opinions amongst the professionals involved with the family regarding the suitability of face-to-face contact. 

Pause for reflection: How can the adoptive parents be supported to facilitate keeping in touch in a way that supports the children's best interests? 

Begin by writing about your immediate reactions to Ava and Rory's story. What emotions did you feel when you first heard about them? Consider your feelings about the birth parents' situation, the children's current foster care experience, and the potential adoption. 

• How did the details resonate with you on a personal level? 
• Were there any aspects that particularly troubled or concerned you? 
• Did you find yourself empathising more with one party (the children, birth parents, foster carers, or adoptive parents) over another? Why do you think this could be?

Reflect on how your professional training and experiences influence your judgment. Consider the potential for biases that might affect your decision-making. 

• What past experiences with similar families do you bring to this situation, and how do they shape your perspective? 
• Are there any personal beliefs or values that might be influencing your thoughts on the best course of action for Ava and Rory? 
• How do you balance empathy for the birth parents' situation with the need to prioritise the children's best interests?

Consider the dilemmas inherent in planning post-adoption contact. Write about the conflicts you see between the various options and their potential outcomes. 

• What concerns arise when considering keeping in touch with the birth parents? 
• How do you balance the birth parents’ expressed love for their children with the potential harm ongoing contact might cause? 
• What principles are guiding your decision-making process, and how do you apply them?

Imagine Ava and Rory in the future, reflecting on their childhood and their relationships with both their adoptive and birth parents. Write about how your decisions today might shape their future understanding of their identity and family. 

• How might different keeping in touch arrangements influence their emotional well-being and self-identity as they grow older? 
• What are the possible long-term consequences for the children if they maintain, or do not maintain, contact with their birth parents? 
• How do you envision the role of the adoptive parents in supporting the children's understanding of their life story? 

Reflect on your role in this situation and the support you need to make informed decisions. 

• What responsibilities do you feel most strongly about and how do you plan to uphold them? 
• What additional information, resources, or support would help you make the most informed and balanced decision for Ava and Rory? 
• How do you plan to communicate your findings and recommendations to the other professionals involved in the case, and how will you advocate for what you believe is in the children’s best interests? 

• Taking the journey toward a trauma-informed approach to Family Time and Staying in Touch. While maintaining relationships with the people important to adopted children can be extremely beneficial for their long-term mental health and sense of identity, it can bring up trauma responses and behaviours that may be unexpected. The resource features guidance for adoptive parents and practitioners to help support children to navigate continued relationships in a trauma informed way. 

• Understanding and responding to trauma expressions. Staying in touch with birth relatives can bring up trauma responses and negative feelings for children in the moment, even though it is often in their best interests long term. The resource helps adoptive parents and practitioners to understand how trauma expressions may manifest themselves and offers guidance to help regulate children's nervous systems when having a trauma response.

• Words Matter: Trauma sensitive language with children. Has been designed to help adoptive parents and practitioners understand how adopted children's trauma may sometimes be seen as anti-social behaviour. The resource features guidance on how to speak with children and avoid negatively charged language.