Article by Jenny Kenrick, Looking At Practice Issues Surrounding The Experience of Care Proceedings for Babies

Article by Jenny Kenrick, which looks at ways in which the Voice of the Baby can be better heard in care proceedings and contact between birth parents and their children improved.

Contact with birth parents– The Voice of the Baby

The purpose of this article is to think about practice issues in the light of current research, with the aim of reflecting on how infants in proceedings may be helped while having contact with birth parents.

The research on which this article is based was originally published in Adoption and Fostering. (Kenrick 2009)  (Kenrick 2010). Since then some of the findings have been taken up, leading to some changes in practice.

Tags: Children, child welfare, adoption, care proceedings, health, mental health, psychology, contact, separation, foster care, carers, research, voice of the child, babies

(June 2013)

Table of Contents

 1.      Concurrent Planning

2.      Contact

       2.1 The legal context in the UK in which decisions about contact are made

3. Aim of the Study and core data

4. Results

      4.1 The impact of contact on infants

     4.2 Behaviour before and after contact, handovers and reunions

      4.3 Disruption of old attachments: the importance of thinking about the impact of moves and of handling                transitions for babies

5. Children born to drug and/or alcohol misusing parents and the impact of detoxification 

6. Implications for practice

7. Conclusion

 

1.      Concurrent Planning

Concurrent Planning was developed in the 1980s with the specific aim of reducing drift for young children in the care system, with numerous care placements, before they were permanently placed.  Concurrent Planning was chosen to describe a scheme in which both rehabilitation to birth parents and adoption would be worked on concurrently, with intensive resources deployed for each alternative.  Meanwhile the child would be cared for by foster carers dually approved as prospective adopters, while at the same time having regular and intensive contact with the birth parents.  The underlying assumption of the scheme was that the child would be rehabilitated if, as a result of that extensive support and the learning experience during supervised contact, the parents could show that they would be able to care for their child safely.  Adoption would be the fall back position.  The scheme has been seen as a win/win situation for the child.  The Coram Adoption Services Concurrent Planning Project was developed from 1999. (Monck et al. 2003)

The advantages of Concurrent Planning could be seen as:  early placement and fewer moves. These are being promoted in the government’s latest adoption policies with a scheme called Foster to Adopt, which differs from Concurrent Planning in that it does not also promote and support the possibility of rehabilitation.

2.      Contact 

What is contact?  There is an assumption that when a child enters the care system contact with birth parents should be promoted in the hope or expectation that the child will, if all goes well enough, return home to live with them once more.  Intensive contact has been increasingly promoted in order that birth parents and baby or child will be able to establish or continue an assumed intensity of attachment.

But already we are entering troubled waters.  Are we talking about rights?  Article 8 of The European Convention on Human Rights tells us that, ‘Everyone has the right to respect for his private and family life.’  If it is indeed about rights, are they the rights of the parents – often eloquently argued by lawyers in court – or of the baby?  Are they necessarily the same?  The Children Act 1989’s core principle is that the needs and welfare of the child are meant to be paramount in all proceedings.  Additionally there is Article 12 of the UN Convention on the Rights of the Child which tells us that as a child, ‘You have the right to say what you think should happen when adults are making decisions that affect you, and to have your opinion taken into account.’

It must be argued that the plans for a child, including contact, should start from consideration of the child’s needs, based on knowledge of child development and the welfare implications of decisions made.  However, experience of proceedings may lead one to think that in some cases the voice of the child may be the one that is least heard, especially the voice of the non-verbal baby.  And of all of those involved in proceedings the baby is the most vulnerable. Babies entering the care system are a particularly vulnerable group.

2.1  The legal context in the UK in which decisions about contact are made 

In 2003 Mr Justice Munby passed a judgment (Re M) which has had continuing impact on contact arrangements for babies:  ‘If this is what the parents want, one will be looking to contact most days of the week and for lengthy periods……Contact two or three times a week for a couple of hours a time is simply not enough if parents reasonably want more.’

This judgement, together with that of Mr Justice Bodie in Kirklees, has led to widely accepted practice that infants up to 1 year of age in proceedings should be having 4 to 5 contact visits a week – with parents and often additionally with members of the extended family.

The impact of these legal structures can be examined in relation to what we know about the welfare and developmental needs of the infant and very young child.

Common sense and research findings tell us that the fewer changes of primary carer an infant or a very young child has to experience, the better for meeting his developmental needs, specifically his emotional needs.  Studies in child development (Stern, 1985 Brazelton, 1991) and in infant observation studies (Shuttleworth, 1989, Murray and Andrews, 2000) have conclusively demonstrated how immediate for the new born is the attachment to, and knowledge of, his primary carer, usually the birth mother.  The infant has been shown to be born with a motivation and the capacity to relate to carers and thus to his social environment (Stern, 1985. Trevarthen, 1979).

Psychoanalytic theory provides a description and explanation for human emotional development with a particular emphasis on the theory of thinking (Bion 1967) and of the mind.  Relevant to the present study is Klein’s description of the Depressive Position (Klein 1935, 1940), a time between 3 and 6 months in the infant’s development when he begins to realise that he can both love and hate his mother or parents in contradictory and complementary ways.  This ambivalence is a major developmental achievement, (Miller et al 1989).  By the time the infant is 5 to 8 months old shifts can be observed: the infant may begin to display anxieties, frequently at times of separation and reunion.  His mother may describe him as becoming clingy.

Developments in Neuroscience have demonstrated the experience-dependent maturation of the brain (Perry et al 1995) and the neurobiological basis of interpersonal relationships, subjective experience and the developing mind (Trevarthen, 2001).  Studies have focused on the interactions between infant and care giver in the first year of life.  Schore (2001) refers to the infant’s need for intimate relationships and companions in the growth of brain and personality.  He emphasises the link to attachment theory and the infant’s dependence on interactive relationships – the basis also of the psychoanalytic view of development.  Bowlby (1969) drew attention to how an infant’s ‘capacity to cope with stress’ corresponds to specific maternal behaviours.  Dozier et al, (2001) and Steele et al (2003) explore this issue for children in foster care and adoption.

All these studies of early years focus on the importance of  interactive relationships, especially in the first year of life, for the formation of a secure basis for the physical, emotional, social and neurological development of the growing child – of his mind as well as of his brain.

For the vulnerable group of babies in proceedings the most favourable conditions for development are likely to have been compromised: even before birth, by drug and alcohol misuse in the mothers, then by neglect, domestic violence, mental ill-health and so on.  These are some of the reasons why children enter the care system in the first place.  Once in care there may be moves and separations, and so further losses of important attachments.  There is too much potential for compromised development, and particularly for a lack of continuity and thus of security of interactive relationships.  All of this will have an impact on the developing brain and above all on the mind of the infant.

Can research help to provide some evidence base to support these most vulnerable of children in the earliest and most crucial and vulnerable period of their development?

3.      Aim of the Study and core data

26 families who had adopted children through the Concurrent Planning Project at Coram agreed to be interviewed. Of the 26 families, 4 had not had any contact with birth parents.  One carer where the child was rehabilitated to birth parents, one of two rehabilitated children in the period covered, was also interviewed.  One family had adopted two children with Concurrent Planning.  Thus the study follows 27 children who were placed with concurrency carers and were all adopted by the time the interviews took place.

It is important to emphasise that although this was a study of infants in Concurrent Planning, it is possible to draw wider conclusions from these results when thinking about the emotional experiences of and the planning needs for infants in the wider care population.  Although these results are centred on infants, some will of course be relevant to thinking about contact issues for older children.  It is to be hoped that the voice of the non-verbal infant may emerge and that attention may be drawn to how he communicates his emotions and needs to dedicated parents and carers.

4.      Results

4.1 The impact of contact on infants

Firstly, we look at infants who became distressed during contact.  Paula, the concurrency carer of Joe, a boy placed at 3 ½ months, described how after 2 months of twice weekly contact, at approximately the age of 5 ½ months, Joe began to become much more distressed during the contact visits.  Paula could hear him getting more worked up and crying in quite a different way to any that she had ever heard: it was different in quality.  Increasingly his distress would show as she left the room.  She saw the birth mother trying to comfort Joe by jiggling him, she thought much too vigorously, and being unsuccessful.  It became the practice after 10 minutes of inconsolable crying that she would return to the contact room and would comfort Joe until he was more relaxed.  Then she would leave the room again.  When Joe again became more distressed she would have to return.  She described her anguish while listening to him crying, wanting to be with him, to help him and knowing that she had to wait until it was time to go back.

This description is one amongst many from the study which focuses on the particular difficulties of the child at 5 ½ to 6 months in separating from his primary carer.  This is something that is seen in most families as a normal, if difficult, developmental stage, usually between 5 and 8 months, when there is tension in the child between dependence, separation and individuation (where a child begins to differentiate himself from others around him).  It is important to think of all the issues around contact in relation to what is known about ordinary child development and the developmental stages of infants and young children.

4.2 Behaviour before and after contact, handovers and reunions

Several of the carers noticed that the children were much more clingy after contact and might need a very quiet time for the next 24 hours to settle down.  The carers complained that if contact was very frequent, 3 or 5 times a week, there was no time for recovery after the contact because they had to be on the road again the next day.  They felt, almost all of them, that the babies needed to have more of the quiet time at home that most babies in ordinary families could expect to have, to settle into routines that suited them, and to play.

Tony’s concurrency carer, Vince, felt that Tony, who was placed at 4 weeks after withdrawal from methadone, took the 5 times weekly contact with his loving birth mother well; rather he suffered from the lack of interaction with his carers during the long car journeys, up to 2 hours each way.  By the time they got home it was bed time and the only quiet times together were at weekends.  Vince felt strongly that a child that has been withdrawn from drugs needed calm for his optimum development.  Paula felt that after contact when he was reunited with her, Joe was pleased to see her.  During the return on public transport he often slept after visits, or cried on the journey, but his feeding and sleeping were never disrupted.  Once home he became relaxed quite quickly.  However, she had noticed subsequently that when he found himself in a new place or a new situation he became much more anxious than she would have expected.

The importance of interactive interpersonal relationships in the development of all babies has been emphasised already.  Some carers reflected on the interaction between the carers and the child that is central to the impact of the whole process on the child.  Ruth, the carer of Joanna placed at 6 weeks, wondered if the way that Joanna often cried as they arrived at Coram was because of her own stress communicating to Joanna, or whether there was something, particularly as time went by, that Joanna really did not enjoy about the contact.  She said that for herself it was difficult because she was handing Joanna over to a homeless, ill looking mother.  During one contact at 4 ½ months Joanna cried inconsolably for 1 ½ hours.  Coram then phoned Ruth to come back and look after her.  She found Joanna almost on the edge of fitting with everybody very worried about her.  The birth mother, rather significantly, did not come to the next few contacts as it had had a huge impact on her that she had not been able to comfort her child.

Zeta, the carer of Milly, was placed direct from hospital at 4 weeks following withdrawal from methadone, and took Milly for her first contact with the birth mother after a sleepless first night in her new home the very next day.  She thought that during the early contacts Milly seemed to be searching around everywhere with her eyes and thought that this was a sign of Millie’s anxieties. The hyper-alert and vigilant responses in the anxious child come to mind here.  After contact she noticed that Milly seemed very restless, cried more and could not sleep that night.  She did not feel that at the point of separation from her Milly showed much difficulty.  However on reunion she could see Milly’s anxiety – sometimes Milly would fall asleep when she returned to her not having slept at all during the contact session.  Attachment studies demonstrate the impact of separations and reunions. Moreover, this child experienced an interruption of her routine.

Richard seemed to show no emotion when handed to his mother and then seemed overjoyed when Lila, his concurrency carer, came to collect him.  Lila was worried about the impact of this exchange on the birth mother.  She also noticed that as he got a bit older Richard was quite difficult to manage in the taxi on the return journey and would throw himself around.  From the age of about 6 months she said he would not look at her at all on the way back in the taxi, or for at least an hour or sometimes longer after they returned home.  He actually turned away from her.  Two more 6 month olds in the study also turned away from their carers.

Some of the carers did wonder about the experience of the children when they were having contact with the birth parents.  One said that the birth mother changed the baby more often than was necessary.  Another thought the birth mother did not know how to feed the baby her bottle and that must have been why the baby was always so hungry and tearful after contact.  Another concurrency carer reported that the birth mother, having heard that the child loved her bath, had given her one, but the child had screamed.  It must have been such a different experience from the bath at home.  This was a particular example commented on in interview by the contact supervisor, who is a crucial figure in all of the contact at Coram.

4.3 Disruption of old attachments: the importance of thinking about the impact of moves and of handling transitions for babies

Here the first foster carers come across as terribly important, firstly because they had established routines with the babies when they came to them, very often straight from hospital.  For these routines the concurrency carers were enormously grateful.  Some of them were aware that at the point of separation and coming to them, the infants were actually being separated from their existing primary carer, the first foster carer.

Albert, for example, described how Charlie, when he was placed at 6 months, although apparently happy in the day time, became distressed at bedtime and could not sleep.  Albert also felt that more time had been needed for Charlie to begin to feel more settled with them before beginning regular contact with his mother.  These were older carers and they found it extremely difficult on the very next day taking this child by public transport on a train to contact.  Charlie cried all the way.  They felt very exposed as new parents, not knowing what to do.

When Jill cried throughout the journey from the foster carer’s to the concurrency carer’s home Una, the carer, said it would have been strange if Jill hadn’t minded the change in her life. All the smells and routines would have been different in her new home.  Tina, who was placed at 7 weeks with Bella, did not feed or sleep at all for the first 24 hours; she just stared at everything and everyone around her.

When newly placed James seemed to sleep both day and night his concurrency carer became so anxious that she called her GP.  She later realised that this was the child’s response to separation from his attachment to his foster carer and she thought that sleep was his defence, his way of cutting off from the pain of his experience.

This leads onto a theme that emerged from many of the carers’ narratives: how long should children and their new carers be given to get to know one another and settle, following the move from foster carer or hospital before contact starts?  The moves one sees with older children often happen very quickly because there can be a fear that something will break down if the move is not immediately put in place, and that the child might not wish to move.  This can sometimes happen with moves from foster carers to adoptive or prospective adoptive carers: everybody is frightened the child might say no. These children are having to make a major separation and it is particularly devastating for infants.  So perhaps it may be possible to generalise here by thinking about the needs of young children in the care system at such moments. It may sometimes be beneficial to slow down the process of moving.

For the concurrency infants there’s a significant accumulation of events just at the time of the beginning of contact.  First, they are having to separate, normally from their first carer who took them on as tiny babies from hospital.  Secondly, there is the move to the new concurrency carer, where everything is new – carer, smells, home, everything.  Thirdly there is the start of contact with journeys.  And then there is the contact itself where everything is yet again different.

5.      Children born to drug and/or alcohol misusing parents, and the impact of detoxification 

Babies who are exposed in utero to the ingestion of drugs – cocaine seems to one of the most damaging, along with alcohol – are likely to be more irritable from birth and more difficult to soothe.  When not soothed, their cortisol (the stress hormone) levels are raised.  Over time this can lead to some significant impairment of brain development, which can be worse when combined with continuing inadequate levels of care.

These babies then are much less resilient when it comes to contact, because they have already been subjected to stress in utero (in the womb).  Special thought needs to be given when systems may be set up that would be stressful to any babies, such as the interruption of routines; strangeness and strangers; or when routines may be interrupted by contact schedules that have more to do with the convenience of the adults than with the needs of the babies.

Out of the total of 27 children in this study, 18 had been born to drug misusing parents and many had had to go through a detoxification in hospital at birth.  The quality of the cry of one of these children is unforgettable.  It is the cry of a traumatised infant.  One infant spent 3 ½ months detoxifying in hospital.  When the infant was a long time in hospital the carers often expressed great concern what that experience might have meant to the baby.  One said, ‘I hate to think of her being alone as she had to go through it.’  Another, ‘I wish I had known about her earlier so that I could have been with her.’  Of course they are right.  Going through detoxification in hospital highlights what can be thought of as one of the common factors in trauma – going through an experience alone, an experience which the child is not able to process for himself.  Also, however dedicated the staff are in the hospital the infant would have had many changes of carer and of having to fit into routines that were not theirs but those of the hospital.

Some of the carers still saw what they believed to be the impact of detoxification and possibly of pre-natal exposure to drugs; in jerkiness and in states of unexplained distress, slow weight gain, diarrhoea, recurrent infections, difficulty in feeding especially in tube fed babies, and so on.  One child was described by her carer as seeming to long to be held; but she was unable to accept close physical touch for many months. When she was bathed, cuddled, being dressed or undressed she would cry out, the carer said, ‘as if in pain, as if it really hurt her.’  The long term impact of the earliest experiences for babies is a major area for research in itself.

6.       Implications for practice

If care decisions are going to be made either before the birth of a child or very soon after, it would be very helpful if the foster carers, or concurrency carers, if that is going to be the way forward, could be identified early.  This is so that they could actually visit the child while going through a detoxification and then they could follow through so there is continuity when the child leaves hospital.  There are already some areas where this is happening.

Questions leading to this research study were about continuities and discontinuities for the babies.  Where there is continuity, as can be found in Concurrent Planning, one wants to promote it; when continuity is not present, there then one wants to find and extend any possibilities because certainly it makes a difference to the babies.

The first continuity to emerge is that with the concurrent planning babies the same dedicated carer always took the infant to contact.  The experience of infants in care in general, usually in foster care, is that they may sometimes be taken by their own foster carer to contact.  But very often, because the foster carer is looking after other children, they will have unfamiliar escorts who will take them to what may be a highly charged contact.  They will then bring them back without very much communication of what the infant might have experienced.

A second continuity was that at Coram there was the same contact supervisor, who supervised all the contacts whenever possible for the babies.  As well as having an educative function for the birth parents, this continuity provided a huge protection for these babies.  The contact supervisor was supported by the Coram social workers.  She also had authority to intervene to help both the baby and the birth parents. For example, if the baby became distressed and particularly at time when the birth parents could not respond to gestures from the infant, then she would make suggestions.  She would point out what was happening: ‘your baby was really looking at you; your baby really wants you to help her.’  But she was also available if the parents were unable to respond to the baby, she could actually pick up, hold and relieve the baby’s distress.

It should not be necessary perhaps to emphasise that the quality of the contact experience is all important for these babies.  Contact should not be allowed to become, as it has sometimes for many babies in care, yet another abusive experience.

A third continuity lies in the babies themselves, who very quickly recognise who is their primary carer: the primary carer being normally the person with whom a baby spends most of its time.  This touches on a very confused area for the infants:  how to make sense of the different demands and different expectations that come about with contact. On the one hand birth parents genuinely want to maintain and develop the attachment with their babies and are being helped to make changes in their own lives to help them to do so.  Then there are the concurrency carers who are developing a new relationship with these babies and the babies with them.  These are attachments that develop slowly and at their own rate.  But how does the baby make sense of these different sets of people around them, all perhaps with some expectations of lasting relationships with them?

This leads to a more general question about how frequent does contact need to be to maintain the earliest attachments between infants and birth parents, while not interfering with the developments of firm attachments with their carers – who are becoming very rapidly after placement the primary carers?  For infants do at a very young age establish what one might call a hierarchy of attachments.

An important reference here is to an Australian study by Humphreys and Kiraly, called “Baby on Board” (2009).  During the course of the Coram research, Humphreys and Kiraly were working in much the same area at the same time. They emphasised that based on their study it was the quality rather than the frequency of contact that mattered to the babies.  They also established that higher levels of contact do not necessarily lead to higher levels of reunification with birth parents.  That was a very significant finding and not something that could be concluded from data in the Coram study.  But it is worth bearing in mind for anybody concerned with contact and the impact of contact on infants and young children.

Generally what is important is that the babies do have a proper chance to form attachments with a secure experience of care giving in the foster homes.  They are then more likely to have within them some trust in the capacity of others to care for them, and in their own loveability.

A lack of continuity may be greater for those children who are not in Concurrent Planning Placements, and finding a way to minimise any disruptions is of particular interest.

Firstly there are the journeys themselves, which are especially disruptive when it comes to establishing new routines, where those journeys are long.  With the concurrent placements these could be up to 2 hours in the car because of all the blockages in central London traffic.  These journeys can be especially difficult for infants who have been through detoxification, who particularly need the calm of not being jiggled and pushed in and out of their routines all the time.  Humphreys and Kiraly also commented on the constraint for babies of being strapped in car seats for long periods on journeys.

In the UK there is some indication that there is change in practice in the courts about recommendations about frequency of contact.  In December 2010 Judge Munby remarked that when he was presented with evidence from research, as he felt he had been by this study, then practice should or could change.  In some areas it would seem that the needs of the child in relation to frequency of contact are being more actively considered alongside those of the parents who may be requesting more intensive contact.

A further point is that these babies are not given a very long time to settle in their new homes before contact starts, before they are ‘on the road’ as one of the carers called it, sometimes the very next day.  Then there is little chance to establish new routines in their new families. The babies are having to fit in with adult needs and routines, and not their own. They have less opportunity to establish that secure base already referred to, which often comes from enough things being and remaining the same in their lives for as long as possible.  There is also very little time for that sort of falling in love that happens, and that babies need to happen, with the people who are looking after them.  Thinking could usefully be applied the possibility of allowing longer between placement of the baby and the start of contact arrangements, particularly for those babies who have been through detoxification. It has been suggested that medical advisors could be encouraged to write to that effect to social workers and to Courts.

Another issue is that there are periods in the general life cycle and development of very young children which are more difficult for babies.  Here in the under ones it was the 5 to 8 month period.  With older children there will be other phases that need to be thought about and that need to be explained to the birth parents, who can become extremely upset, for example when the baby seems to turn away from them. They need to be helped to see that this may be something that a baby of this age may be doing anyway.

An important finding to emerge from this study is a particular need to pay attention to transitions.  That is, the move from one placement to the next, from foster care to permanency, from initial foster carer to concurrent planning carer in this case.

7.      Conclusion

For all children in proceedings, and especially for the very youngest, when setting up and carrying out contact arrangements with birth parents, great care has to be taken for all concerned.

For birth parents supervised contact can be experienced as a judgemental and even persecutory experience.  ‘They judged you.  Social Services have no faith in people like me.’ ‘Once it’s drugs they give up on you, don’t believe you can do it.’  Many of these parents are still leading chaotic lives.

Carers have no part in the legal process. But as the primary carers they are the people who know the babies best, and know the impact on them of contact arrangements.  They are responsible for promoting the well-being of the babies and the possibility of their developing secure attachments.  These are attachments which the babies will take internally, within themselves, to new placements and throughout their lives, and which can be experienced later as hope in relationships and trust, so often lacking in children who have had multiple placements.  In Concurrent Planning it was the carers who carried huge uncertainty in the process – ‘you have to keep a lid on your expectations.’  There is a huge advantage in Concurrent Planning that the carers had in most cases, 22 out of 26 in this sample, had an opportunity to develop a relationship with the birth parent.  Consequently they will be able, as the children grow up in their care, to give a truthful picture of birth parents to the children, not just that from a social work file. One carer said of a known violent birth father, ‘I wish I had been able to meet him so that I would have had something more to say about him to my child.’ The carers should have as much support as possible in their delicate and crucial role of helping these children to thrive.

Then there are the babies, the babies in this sample under the age of one year.  A baby of this age does not use words for communication, but needs a mother, a parent, a carer, who is capable of receiving his emotional states and of reflecting and trying to make sense of them for him.  Then he will be protected from becoming overwhelmed by fears and confusions, and of falling into states of nameless dread or catastrophic anxiety, of pure terror.  Infants negotiating the vagaries of contact are a very vulnerable group by definition.  They need the assurance of dedicated and thoughtful caring with as much experience of continuity as is possible for their well-being and optimal development.

REFERENCES

Bion WR, (1967)  Second Thoughts. London: Heinemann.

Brazelton TB and Cramer BG, (1991) The Earliest Relationship: Parents, Infants and the Drama of Early Attachments, London: Karnac Books.

Dozier M, Stovall KC, Albus KE and Bates B, (2001) ‘Attachment for infants in foster care: the role of the caregiver state of mind’, Child Development 72: 1467-1477

Humphreys C and Kiraly M, (2009) Baby on Board: Report of  the Infants in Care and Family Contact Research Project,Melbourne: University of Melbourne.

Kenrick J. (2009) ‘Concurrent Planning: A retrospective study of the continuities and discontinuities of care, and their impact on the development of infants and young children placed for adoption by the Coram Concurrent Planning Project’. Adoption and Fostering. 33:4 pp 5-18

Kenrick J. (2010) ‘Concurrent Planning 2: The roller coaster of uncertainty’. Adoption and Fostering. 34:2 pp38-49

Klein M, (1935) ‘A contribution to the psychogenesis of manic-depressive states’, The Writings of Melanie Klein vol 1, Hogarth.

Klein M, (1940) ‘Mourning and its relation to manic-depressive states’, The Writings of Melanie Klein vol1, Hogarth.

Miller L, Rustin M, Rustin M, Shuttleworth J (eds), (1989) Closely Observed Infants, London: G Duckworth and Co Ltd

Monck E, Reynolds J, Wigfall V, The Role of Concurrent Planning: Making Permanent Placements for Young Children, London, BAAF, 2003

Murray L and Andrews L, The Social Baby, Richmond, Surrey: CP Publishing, 2000

Perry BD, Pollard RA, Blakely TL, Baker WL, and Vigilante D, ‘Childhood trauma, the neurobiology of adaptations and ‘use-dependent’ development of the brain: how “states” become “traits”, Infant Mental Health Journal, 16, 1995, pp 271-291

Schore AN, ‘Contributions from the decade of the brain in infant mental health: an overview’, Infant Mental Health Journal 22, pp 1-6, 2001

Shuttleworth J, (1989) ‘Psychoanalytic theory and infant development’ in Miller L, Rustin M, Rustin M, Shuttleworth J (eds) Closely Observed Infants, London: G Duckworth and Co Ltd

Steele M, Hodges J, Kaniuck J, Hillman S and Henderson K, ‘Attachment representations and adoption: associations between maternal states of mind and emotion narratives in previously maltreated children’, Journal of Child Psychotherapy 29, pp 187-205, 2003

Stern DN, The Interpersonal World of the Infant: A view from Psychoanalysis and Developmental Psychology, New York: Basic Books, 1985

Trevarthen C, (1979) ’Communication and cooperation in early infancy: a description of primary intersubjectivity’, in Bullowa M (ed), Before Speech: the Beginning of Interpersonal Communication, New York: CUP.

Trevarthen C, (2001) Intrinsic Motives for Companionship in Understanding: Their origin, development and significance for infant mental health, Infant Mental Health Journal, 22 (1-2).

Additional reading

Child development and neuroscience:

Music, G.  (2011) Nurturing Natures. Hove: Psychology Press

Infant Contact:

Humphreys, C. and Kiraly, M. (2011) ‘High frequency contact: a road to nowhere for infants’. Child and Family Social Work, 16:1 pp 1-11

Schofield, G. and Simmonds, J. (2011) ‘Contact for infants subject to care proceedings’. Adoption and Fostering. 35:4

Adoption and Children in transition:

Hindle, D. and Shulman, G.(eds.) (2008) The emotional experience of adoption. Routledg

Hunter, M. (2001) Psychotherapy with young people in care. Brunner-Routledge

Kenrick, J. et al. (eds.)(2006) Creating new families: therapeutic approaches to fostering, adoption and kinship care. London: Karnac

Kenrick, J. (2000) ‘Be a Kid”; The impact of repeated separations on children who are fostered and adopted. Journal of Child Psychotherapy,26:3. Pp393-412

Lanyado, M. (2004) The presence of the therapist:Treating childhood trauma. Brunner-Routledge

Loxtercamp, L. (2009) Contact and truth: the unfolding predicament in adoption and fostering. Clinical Child Psychology and Psychiatry 14:3 pp423-35

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Author Information

Jenny Kenrick, child psychotherapist

E Mail: jenny.kenrick@btinternet.com

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