Many of the children and young people who are looked after in foster and residential care or are adopted have complex mental health needs that are not well met by traditional mental health services. These vulnerabilities stem from an interaction between pre- and post-care experience, and often include trauma, attachment and developmental difficulties. It is now widely recognized that these children are best served by dedicated services provided by professionals with expertise in meeting the needs of looked after and adopted children. This involves effective joint working between health, education and social care services and requires supportive policies and structures at all levels of the organizations. This paper will explore the strengths, challenges and barriers of multi-agency and specialist working to meet the needs of these vulnerable children and young people.This will be illustrated with case examples drawn from a multi-agency service in Worcestershire, UK.

Group work provides foster carers with an important means of receiving support and psycho-education. It gives them opportunities to explore different ways of understanding and managing foster children. Kim Golding and Wendy Picken describe the use of two different types of groups developed by the Primary Care and Support Team in Worcestershire. The first is based on a parent-training programme. Group facilitators help carers to consider different management techniques and think about their use with the complex children they are looking after. Within these groups considerable interest was shown in attachment theory as a way of understanding the often perplexing behaviour displayed by the children. This led to the development of a second group focused specifically on their attachment needs. Routine, practice-based evaluation has been carried out and is reported here. The limited evaluation suggests that group interventions can help carers to increase their understanding of the needs of foster children and their skill in managing these children on a day-to-day basis.

Dyadic Developmental Psychotherapy (DDP) is a relationship-focused therapy characterised by a strong therapeutic alliance, empathy and unconditional positive regard. It seeks to treat the complex psychological problems of looked after and adopted children as they struggle to develop a greater measure of stable functioning in their homes. It was developed by Dan Hughes based on his extensive clinical experience of working with children and families together and is rooted in a close study of relevant theory. DDP can help children who have been hurt and/or neglected within their families in their early years by supporting them to recover from previous trauma and to experience attachment security and emotional connection within their current family. As with any developing therapy, questions have been raised about its clinical relevance and effects. One such critique recently appeared in an article by Mercer (2014) and this will be used to demonstrate how misunderstandings, misinterpretations and the selective use of case studies can lead to misguided views of this important innovation. This article particularly addresses inaccuracies in accounts of the development of DDP as an intervention for looked after and adoptive children and their families, how DDP is practised around the world and how theory underpins the model. Although a lack of evidence derived from robust evaluations is acknowledged, the authors discuss the evidence base that is currently available and plans that are in place to strengthen this.

Children with the worst early experiences present a considerable challenge for those helping them. Fostering is a vital resource in the care of these children. However, as Kim Golding argues in this paper, to be successful, fostering services need to be developed, supported and resourced to provide stable and therapeutic care. The extent of the difficulties experienced by the children needs to be recognised and services developed which can provide turning points in their development. Therapeutic options can be used that emphasise the role of the carer in the intervention, with a particular emphasis on the facilitation of secure attachment. Research and practice developments are urgently needed to explore interventions stemming from attachment theory for foster carers and the children they look after. The usefulness of attachment theory for guiding interventions with foster carers is explored, based on the experience of a specialist project set up to support carers of children ‘looked after’.

Background: The task of fostering today is a complex one and foster carers need good quality support. This paper discusses a consultation service for foster carers. Method: It draws upon our qualitative experiences to explore the important themes that have emerged during the provision of the consultation service. Results: Foster carers are highly satisfied with the consultation service, which provides them with improved levels of access to psychological advice, a different understanding of the children, and continuing support if required. Discussion: The reasons for this satisfaction, together with some of the difficulties we have experienced, are explored. Experimental research is needed to investigate the complex relationship between consultation, support, confidence and understanding for foster carers and to consider the long-term effects of consultation for the carer and the child.