Simmonds John
British Association for Adoption and Fostering, UK.
Clin Child Psychol Psychiatry. 2010 Oct;15(4):601-12. doi: 10.1177/1359104510375930.
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.
近年来，公共照料机构中儿童的心理健康受到了相当多的关注。与居家而非在公共照料机构中的儿童相比，患病率存在显著差异，而且其他不良生活方式问题也加剧了这种差异。大量关注集中在稳定且安全的安置的重要性上，这需要一系列服务的支持，包括教育、健康和心理健康服务。事实证明，识别和分类心理健康需求具有挑战性，因为儿童的遗传因素、出生前后的经历（包括虐待），与儿童保护程序、法律系统中的行动通常伴随的不确定性和延误，以及建立安全和永久安置的困难相互作用。临床需求还与儿童的年龄、他们进入照料机构的原因以及他们在机构中停留的时间长短有关。一个在法庭判决中公开报道的、说明了许多此类问题的案例，被用作探讨在为特定儿童制定安置计划时，该儿童理解和领会自身经历的复杂性的基础。这些案例被用于探究制定临床方案（如美国最近公布的那些方案）的困难。特别强调了儿童及其照料者在建立新的家庭关系时所面临的问题，这些关系要处理儿童从原生家庭继承的问题，尤其是当这些问题在起源上具有创伤性和冲突性时。
