The making and breaking of relationships: organizational and clinical questions in providing services for looked after children?

The mental health of children in public care has received considerable attention in recent years. There are significant differences in the prevalence rates compared to children living at home and not in public care and these are added to by other adverse lifestyle issues. Considerable attention has been focused on the importance of stable and secure placements supported by access to a range of services including education, health and mental health. Identifying and classifying mental health needs proves to be challenging as the child's genetic inheritance, pre- and post-birth experiences, including maltreatment, interact with the uncertainty and delays commonly associated with child protection processes, action in the legal system and the difficulty in establishing secure and permanent placements. Clinical need is also related to the age of the child and the reasons they came into care and the length of time they remain. A case illustrating many of these issues, publicly reported in the court's judgement, is used as the basis for exploring the complexity for the identified child in understanding and making sense of their experiences as placement plans are made for them. These are used to explore the difficulties in establishing clinical protocols such as those recently published in the USA. Particular emphasis is given to the issues faced by children and their carers in establishing new family relationships which address the child's inheritance from their family of origin especially where these are traumatic and conflicted in origin.