Concerns for the Client’s Well-Being

Jeni being only 10 years has undergone a lot in life and is physically advanced for her age as well as appears self-conscious about the appearance. Most of her life has been in foster care, and she has lived with different families. At age 7, she was unfortunate to experience the death of her carer, and this was a traumatic experience for her. While currently, she is living with a permanent family, she has trouble making friends in her new school and often eats lunch by herself. She does not want to attend school and cannot articular the reasons, and while she was previously performing well in school, she is currently withdrawn and fails to complete her homework. There are several issues that concern Jeni wellbeing that are present in this case from trauma to trouble in school and reluctance to engage in school.

One of the major concerns for Jeni is the trauma she faced at age 7. The fact that Jeni is in foster care is an indication that she has undergone tremendous loss from disruptions of daily routine, change of surroundings and loss of family members. At age 7, the loss for the carer is a profound loss for her. Loss is a central theme in foster care, and such losses must be validated, acknowledged and grieved for one to heal (Oates & Maani-Fogelman, 2019). However, children grieve in a different way from adults. At her age, Jeni understood the carer as her parent, and thus the loss is a big blow. This was also compounded by the previous loses, which led to her being in foster care.

A traumatic event such as that experienced by Jeni can have long term consequences. As argued by Dye (2018), the exposure to multiple and adverse traumatic events which are most common of interpersonal nature and during early on-set of life can lead to complex trauma. Complex trauma in children increase symptom complexity and is related to impairment with dissociation and physical awareness and affect interpersonal attachment, regulation and behaviour control. Cumulative trauma during childhood is the greatest contributor to symptom complexity. Early childhood trauma affects attachment relationships negatively, especially when the cause of the trauma is the caregiver. Exposure to trauma alters the interrelated brain circuits as well as the hormonal systems that regulate stress.

Theories on attachment have postulated that the interpersonal experiences during childhood affect the attachment system, which provides the working model on which future relationships are developed. Thus, early childhood trauma under the care of a caregiver can be detrimental to the attachment of children (San Cristobal, Santelices & Miranda Fuenzalida, 2017). Biologically, a trauma that is interpersonal or chronic, can increase distress and posttraumatic stress disorder. Traumatic event activates the stress response system, which in turn has effects that are both emotional and behaviourally similar to PTSD (De Bellis & Zisk, 2014).

The basic aim of the stand-in care system is to improve the environmental and family conditions that can interfere with the normal growth of a child. However, research has continuously shown that foster children have behavioural, social and emotional problems. Children entering the foster system face challenging tasks of forming new attachments to the caregivers. Several studies have supported the relationship between secure childhood attachments with later developments. Recent research has thus profoundly concluded that foster children differ from the normal development in all areas and have a high risk for emotional, psychological, behavioural problems as well as special needs (Bîrneanu, 2013). Antisocial behaviour, for example, is a developmental trait with its onset being during childhood and can continue into adulthood. In addition, children who have undergone foster care are at high risk of depression, substance abuse, delinquency and anxiety.

For Jeni, she has experienced trauma over the years and lost her carer at age seven. As per the discussion above, this could have triggered stress and PTSD and considering that she had to move from one family to another, she might not have received adequate help to overcome the loss and trauma. This could have affected her behaviour and attachment tendencies which could explain why she has lived with different families. The emotional and social well-being of children in substitute care is first jeopardized by the conditions that led to removal from home and then exacerbated by the experiences once in care (Szilagyi, Rosen & Rubin, 2015). Moving from one carer to the other means moving from one school and environment to the other. This denies the child a chance to lasting social binds with carers and friends at school. The constant moving from one environment to another and residing with different families could thus have affected the social skill of Jeni and her ability to become attached not only to one environment but to friends and schools.

The behaviour changes, as observed with Jeni, can also affect her well-being. Jeni was good at school but currently on many instances does not want to attend school. She has previously performed well in school but now even fails to complete her homework. She has been moving from one family to another but now is living with a family permanently. While Jeni is enjoying her new home life, she has anxiety making networks at school. She feels that other students are mean to her, and she is withdrawn. Jeni’s ability to socialize and make friends has been affected by her various movements. Research in child development has shown that kids need predictability, reliability and attachment to a thoughtful adult to be able to thrive. This is more applicable in the case of foster children who have undergone trauma leading to and up to their removal from home. Secure attachments for such children are only assured through stable placements and translate to effective transition to out of care without delay.

Jeni, however, has not had a consistent and predictable adult to get attached to since she has moved from one family to the other until now. This, combined with the trauma she has faced over the years, could have affected her inability to get attached to anyone and the lack of skills to make friends. Again, she might not understand that she is now residing with a family permanently, and she is afraid to get attached only to move again. The fact that she has been with different families suggest behaviour challenges. Among the main reason for placement problems is behaviour challenges. Based on the initial trauma of moving away from home and the subsequent trauma of increased placements. A study by Rubin et al. (2011) found that foster kids with several placements have an estimated 36% to 63% likelihood of developing behaviour problems than children with lower number of placements. The longer a child spends in placement increases the number of placements. Multiple placements also contribute to academic difficulties, struggle to develop meaningful attachments and delayed permanency outcomes (Rutter & Sroufe, 2012).

Jeni is thus in need of emotional and social support to be able to improve her well-being. She has become reserved, tired and unwilling to engage in school. She is physically progressive for her age, and the fact that she is conscious of her appearance can explain why she is getting having problems connecting with other children in school. To improve her wellbeing, she needs to receive the relevant help to ensure she is able to form meaningful attachments and form long-lasting friendships with her schoolmates. She is unable to articulate why she does not want to attend school, and it is significant that she is able to process and articulate such issues. Improving Jeni’s wellbeing is significant in shielding her from the later onset of problems associated with emotionally deprived people as well as delinquent behaviour commonly found in foster children. Her psychological, emotional and social needs have to be met to address her trauma and losses which have affected her through her life. Losing a carer at age seven and then continuing to be placed with several other families is emotionally depressing for a child and can contribute to PTSD and depression, which contribute to antisocial behaviour.

Impact on future development if issues not addressed

The issues facing Jeni require to be addressed to ensure that they do not affect her future development. Most of the childhood issues faced by children affect their adulthood in different ways. Jeni is facing several issues from trauma-related psychological, social and mental issues as well as behavioural issues such as being antisocial. Facing these issues as a child increases the risks of advanced problems in adulthood as well as developmental problems.

One of the major issues facing Jeni Trauma-related issues such as depression. Childhood depression has been seen to be very common and very treatable. Depression affects one in every thirty-two children. For children such as Jeni who have undergone a rough childhood with traumatic events, getting depressed is common. The problem is that as opposed to other behaviours or feelings which can fade with time, depression has to be treated. Jeni is also facing behavioural issues such as losing interest in school though she was performing well before as well as becoming withdrawn. She does not want to attend school but cannot articulate why. All these issues if untreated will affect her development in the future.

One of the major consequences of failing to improve Jeni’s well-being is that she will experience academic decline and failure. Academic learning is a significant factor in life. Jeni has faced trauma over the years, which has affected her mental health and behavioural changes. Jeni is also facing attachment issues, and while she was doing well in school, she no longer takes pride in education, as explained by her reluctance to attend school. If the condition continues, Jeni will fail in her academics which will, in turn, affect her self-worth. Research has shown that students who fail in school acquire a low self-concept. This is because failure in school damages their self-image and often initiate self-dislike and lowers self-confidence (Chohan, 2018).

Considering that Jeni is already declining school attendance, failure to address her needs can lead to total school shutout where she totally declines to attend school as she grows up. The problem is that the lack of academic excellence has been connected to several other issues in Australia. Engaging in formal education from childhood is very significant in Australia. This is because completing school or so the tertiary level qualifications increases employment opportunities as well as offering relatively higher earnings. Poor school enragement and poor attainments in school can contribute to poor outcomes such as social exclusion, unemployment and poverty. At age ten, Jeni is finishing her formal education and will join employment or full-time education until age seventeen. If her behaviours persist and she chooses not to continue with tertiary education, she risks facing social and developmental problems in future such as poverty and social exclusion.

Another effect of low academic education is low health outcomes. Research has widely connected low education outcomes with poor health. People with higher education achievements have higher incomes and are often spared from the stresses that convoy extended social and economic hardships. People with low education achievements commonly have fewer resources such as social support, self-esteem, and sense of control over one’s life. In addition, education both in the classroom and outside build skills that foster traits such as perseverance, conscientiousness and self-control. Furthermore, educated people commonly have wider social networks, and such networks are significant for emotional, psychological and financial support. The failure to address the wellbeing of Jeni can deny her the chance to revert back to performing well in school and increase her chances of facing social, economic and psychological hardships in future.

Childhood trauma is also associated with substance abuse. Grice et al. (1995, cited in Moustafa et al., 2018) found that over 60% of individuals with drug use problems experience high rates of juvenile trauma. Just a single childhood trauma increases the risk of developing alcohol addiction by seven times when compared to those who faced zero trauma. In terms of relapse for drug and alcohol users, childhood trauma is a likely predictor, especially in the case of alcohol overuse. This is because the early life stress as a result of the trauma initiates an anticipatory behaviour and psychological responses that are way beyond the Individuals adaptive capacity. As a coping strategy, individuals can turn to drugs and alcohol and end up being addicted (Moustafa et al., 2018). Early life stress is also associated with lifetime anxiety. A study by Lähdepuro et al. (2019) revealed that experiencing emotional, physical or low social-economic status as a child is associated with anxiety problems in adulthood. Bönke et al. (2019) also argue that early life stress alters stress reactivity and increases the risk of developing psychopathological conditions later in life.

Jeni has faced emotional trauma as a result of losing a carer as well as moving from one family to the other, which disrupted her routines, friends, environment and bond with families and other children. Childhood bond with other children and adults is significant for development, and the lack of it is emotionally exhausting for children. failure to addresses the early life stress being faced by Jeni can thus lead to her becoming a drug abuser later in life or developing lifetime anxiety which will, in turn, affect her level of wellbeing and health. The fact that there are other issues facing Jeni exacerbate her risk of abusing illegal drugs as well as dependence on alcohol. Drug use is commonly associated with recidivism and low health outcomes which worsen the situation.

Jeni also has attachments issues which explain why she has issues making friends in school. She has been into different schools while living with different families, and the experience has made her physically advanced than her age. However, she has problems interacting with other children at school, and she is withdrawn and isolated, which can explain her unconscious fear of going to school. Attachments disorders are common for children who experience problems with emotional attachments. Jeni portrays hesitancy in social interactions as well as portraying a detached behaviour. Children who experience attachments problems can develop two types of disorders later in life, including Reactive Attachment Disorder (RAD) or Disinhibited Social Engagement Disorder (DSED). Children with RAD fear to interact with other people more so due to trauma involving adults in the past. They do not seek comfort from caregivers when stressed or upset and portray little emotions.  Symptoms of RAD include withdrawal, avoidance, and avoiding physical contact. Its effects include depression, poor self-esteem and challenges in scholastic environments causing children to drop out of school. RAD, when left unattended to, can cause relationship difficulties in life and more susceptible to negative feedback and peer pressure (Malekpour, 2011).

Most of the issues facing Jeni are interrelated and have causality. Depression as a result of early life stress can decrease academic excellence which then leads to low life outcomes such as low social-economic status which then increases stress and exacerbate the depression. with increased depression, one turns to drug use and alcohol as a coping mechanism and end up in jail, setting the ground for recidivism and poor health outcomes, just to mention a few issues. Thus, in addressing the issues facing Jeni, it is significant to apply multiple interrelated strategies that will address the issues as one with different elements. Addressing some issues while leaving others will not be of much help for Jeni. There is thus need for a creative therapy that will improve the well-being of Jeni and put her into a path for recovery and personal growth. Most of the issues facing Jeni are complex for her to handle to her own and very risky to be left unattended. These issues, when left to interact with each other, can devastate Jeni and curve a path to low self-worthiness and esteem.

CREATIVE THERAPY

To address issues facing Jeni, a creative therapy is required to address the interrelated problems. The aim of the creative therapy is to ensure that Jeni recovers from the trauma and is able to resume school and get attached to her new family in a way she can share her problems with them. This will require that the parents receive therapy as well as training to ensure they are aware of challenges facing Jeni and how better to approach her for positive outcomes. The therapy will thus combine elements for Jeni, the parents and family elements. If the family has other children, they will be involved in family therapy to ensure their interaction with Jeni is helpful.

Psychotherapy

Psychotherapy is a therapeutic interaction and conversations between an individual and a therapist. It can help children as well as their families, understand their problems and resolve any underlying issues. In the case of Jeni, psychotherapy will focus on helping her overcome past trauma, underlying depression or stress, attachment issues and behavioural issues. To achieve this, the therapy will combine several types of psychotherapy, including cognitive behavioural therapy, interpersonal therapy and psychodynamic therapy with the aim of addressing all the underlying issues facing Jeni.

Cognitive behavioural therapy (CBT) is grounded on the hypothesis that sentiments and behaviours are predisposed by an individual’s discernment of events. It is not the circumstance or situation that determine emotions rather how on perceives the circumstance. How cognition is conceptualised is fundamental to the cognitive model. As outlined by Beck (1976, cited in Fenn & Byrne, 2013), there are three points of cognition, including central beliefs, dysfunctional assumptions and negative automatic thoughts. Central beliefs are the beliefs about oneself, world and other people and are cultured early in life as well as prejudiced by childhood understandings. The dysfunctional expectations are the conditional and firm living guidelines that people approve. Such rules can be impractical and thus, maladaptive. Harmful automatic thoughts are involuntary thoughts that are triggered when some situations prevail and commonly centre on uselessness, low self-esteem and negativity.

CBT will be applied to formulate the causes and maintain influences of Jeni’s problems. It will be used to ensure Jeni makes sense of her life experiences aid in the mutual understanding of her difficulties. Based on Piaget theory of development, Jeni is in the concrete operational stage of development where she can logically work out issues in her head (Kazi & Galanaki, 2019). She is also physically developed at her age, and her social setting has made her more mature than her age. CBT will thus be used to help Jeni understand her current behaviours and way of thinking and equip her with the skills to change her maladaptive behaviours and cognitive patterns. The fact that CBT focuses on the present is effective in the case of Jeni in that it will help improve her current state of mind.

Interpersonal therapy is a type of psychotherapy that emphasis on an individual and his/her relationships. It is based on the basis that individual relations are the centre of emotional problems. It is thus used to address different psychological issues such as depression by focusing on major life changes and conflicts with other people.  The aim of interpersonal therapy is to improve the clients social functioning and interpersonal relationships. It provides strategies to resolve problems with four major areas. First, it looks at interpersonal deficits, such as social isolation. It then addresses unresolved grieve such as from loss of a loved one. It also helps with major transitions in life, such as moving to a new environment and finally provides the skills to deal with interpersonal conflicts (Cuijpers et al., 2016). Jeni, on her part, experienced social isolation, is withdrawn and has faced grief in the past when her carer died. He has also undergone several transitions from being away from home and the several families she has lived within different environments and finally being laced with a family permanently. She is also unable to share her emotions with her new parents. Interpersonal psychotherapy will help in addressing these issues to ensure Jeni can initiate and maintain a healthy relationship with her new parents and with other children and teachers.

Psychodynamic therapy helps patients to gain an insight into their current problems by evaluating client’s patterns over time. This is done by reviewing thoughts, emotions, beliefs and early life experiences. This helps to recognise any recurring patterns and develop a coping mechanism to change such patterns. It shows how early life experiences affect the client currently in that when faced with trauma early in life they develop coping mechanism such as denial, rationalization or repression that keep the memories, feelings and emotions in the unconscious brain (Leichsenring et al., 2014). These unconscious elements affect behaviour and can only be addressed if they are revealed. Jeni has faced many issues over the years and considering her age, it is possible that the mind pushed the issues to the unconscious part of the brain and can affect behaviour in ways she cannot explain. A good example is that while Jeni does not want to attend school, she cannot be able to articulate the reasons why, because the behaviour is influenced by unconscious elements. Psychodynamic therapy will help Jeni identify and talk about these unconscious emotions, feelings and memories to improve her current well-being.

Family therapy

Apart from psychotherapy for Jeni, it is also important to include family therapy as a strategy to meet her needs. Families are a big part of who people become in that family influence many aspects of one’s life. Family therapy helps families undergo major changes or behavioural problems. It views the problems of individuals in the larger context of family. Family therapy is based on the principle that problems can only be effectively addressed by understanding the dynamics of the group. Family therapy thus seeks to understand the dynamics of the family to effectively address the needs of Jeni. The issues facing Jeni need to be addressed in the context of the family to ensure there is effective support. In addition, to ensure Jeni gets attached to her parents and open up to them, it is significant that they play a part in therapy through family therapy.

Parenting training

Another significant strategy is parental training. Parental training is a program of  psychoeducation and education delivered to parents to help improve the wellbeing of their children. Common adult education techniques are employed such as role-play, discussions, video clips and homework, among others. Parental skills, styles and knowledge are significant for the wellbeing of the children. For Jeni, her new parents require the necessary skills to deal with her special case. As opposed to normal children who do not require specialised help, Jeni is different, and her parents need to understand how to help her cope with her new life and adhere to therapy. As argued by Mc Ginn (2017), parental training is effective for children with behavioural issues as well as anti-social behaviour, which are present in Jeni. Parental training will thus supplement family therapy to ensure the parents play a collaborative role in improving her well-being. The fact that Jeni is now living with the family permanently makes parental training significant.

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