The tragic death of thirteen year old Aliyah Ismail, caused by a methadone overdose in 1999, created waves of anguish through the United Kingdom. The resultant media uproar, the revelations about her life in care and descent into prostitution, and the specially commissioned report by social care worker and legal activist Maddie Blackburn, laid bare the heartbreak and misery of abused and distraught British children who live and grow up in care, away from their natural parents. The incident led to widespread distress, intense soul searching and a resolve by the British people to take better care of their young. Even today, seven years down the line, late evening visits to King’s Cross station and Camden Town, the sleazy centres of London’s grim underbelly where Aliyah lived out the last days of her short life, throw up sights of young waifs, barely into their teens, propositioning customers or melting into the shadows. Some progress has been made but much still needs to be done.
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Maddie Blackburn’s report on the incident was prepared on the express instructions of the Harrow local authorities, the body that functioned as Aliyah’s “corporate parents”, and had complete responsibility for giving her parental care. Her study focussed on Aliyah’s distressing life under the supervision of the UK’s programme for children in care and was largely an indictment of the functioning of the social care system. Soon after, Liz Davies of the London Metropolitan University carried out a serious case review of Aliyah’s case. It is the objective of this assignment to study the Blackburn report, in conjunction with other governmental and independent findings, and analyse the causal factors behind the still grim circumstances in which children in care live in the UK. The assignment covers the role of committed social workers, the essentiality of partnering between various agencies, and the individual and collective commitment needed by citizens as well as corporate and governmental institutions to bring about a sea change in the situation. British society has to do a better job of looking after its brood.
The Blackburn report, in its entirety, covers the ten agencies involved in Aliyah’s care including the police, the probation services, the local health authority and the council. While it makes 18 recommendations, the gist of the report can be distilled into four main messages. These are as follows.
- The need for child care agencies to listen to children's allegations of abuse and to improve staff's hearing and listening skills
- The need for closer inter-agency working on cases
- The creation of suitable strategies for managing older children who are beyond the control of their parents, such as secure accommodation, particularly for girls over 12
- The urgent need for a way of analysing all information on a child in care so there is a clear plan on how they should be looked after.
Sixty one thousand young children, living in care in the UK are evidence of the likelihood of history repeating itself, of the chances of new Aliyahs emerging from the doors of foster care homes and children’s institutions. A stable home environment, free of elements like discord, abject poverty, and physical, mental or substance abuse, is particularly important for the development of children. It provides security and delineates boundaries within which young people can grow and flourish. The majority of children placed in care come from environments of poverty, domestic violence and substance abuse. They are far more likely to have mental disorders and behavioural problems compared to children raised in normal private homes. Aliyah, for example, came from a broken and extremely poor background. Her father had left home when she was a baby and her mother suffered from long term mental illnesses.  The following excerpt provides some disturbing facts about the extent of emotional disorders that exists in children living under the care of local authorities.
A study of the prevalence of mental disorders in children aged 5 to 10 who were looked after by local authorities showed that they were five times more likely to have a mental health problem than children in private households. Eleven per cent had emotional disorders (compared to 3 per cent of children in private households/with their own family), 36 per cent had a conduct disorder (compared to 5 per cent), and 11 per cent had a hyperkinetic disorder (compared to 2 per cent).
These disquieting facts largely explain the enormous challenges faced by local authorities and social care workers in taking care of the children placed in care. Parents know the terrible anguish and feelings of helplessness that overtake families when children go astray and get involved in violence or substance abuse. The problems faced by the most committed of foster care families and institutions in looking after children with scarred psyches and histories of intense trauma become easy to imagine.
Grave concern has been voiced about the high rate of psychiatric disorders among children in the care system. This concern is based on observations of children who have been looked after and accommodated for a considerable length of time. McCann and colleagues, for example, looked at the prevalence of mental illness in adolescents who had been in care on average for 2.9years. Little is known, however, about the mental health of children at the time they enter local authority care.
Children who come into care have to necessarily live either with foster parents or in children’s homes. They are mostly too young to recognise their feelings, let alone express them, and need urgent and competent psychiatric care. While these children need expert treatment for mental disorders as well as supportive, comfortable and safe home environments, the current situation is often unable to provide them with either. A number of social research studies have pointed to the very significant need for making available good psychiatric care and commented on the gap that exists between actual and desired conditions. Mentally disturbed children need coordinated help from a number of quarters including counsellors, teachers and social workers. The childcare mechanism needs to be truly multidisciplinary to be effective. This is not easy, especially when three vital requirements, funding, people and infrastructure, are scarce. Efforts to provide help obviously become disjointed and ad hoc, even if they do not lack sincerity and compassion. A multidisciplinary team, comprising of social counsellors, paediatricians and psychologists, analysed the condition of available psychiatric help in 1999 and concluded that the level of assistance available for children in care had significant shortcomings.
These findings show a worrying gap in mental healthcare provision. The study shows that a considerable proportion of young children have a serious psychiatric disorder at the time they enter local authority care but are not being referred for psychological help. We believe that these findings strongly indicate the need for early intervention policies to help this vulnerable group. Furthermore, the complex needs of these children can only be assessed effectively through multidisciplinary discussion and strategic planning. 
It is surprising that the Blackburn report did not discuss the absence of medical facilities, especially in the area of mental health, available for children in care. Instead of focussing on this major deficit, stress was given to the fact that Aliyah was not sent to secure accommodation faster. The inability of the childcare mechanism to give her proper psychological attention and the consequent lack of awareness about her condition are possibly the causal factors behind her numerous shifts from home to institution to another set of foster parents, i.e, until she decided to exit and start fending for herself. In this situation it becomes difficult to accept the Blackburn finding on the failure of social workers to listen carefully to children’s allegations about physical and mental abuse, without considering the situation in totality. The failure of the staff to understand the true extent of her disturbed mental condition was probably symptomatic of the broad malfunctioning of the system rather than the fault of individual workers. The lack of basic concern for children comes through starkly when even committed activists like Blackburn feel it more important to lock up truants in secure accommodation to prevent them from causing self harm rather than to treat them for their mental disorders. There are a number of questions that need to answering on this issue. What is the methodology by which the authorities in charge of secure accommodation prevent children from harming themselves? How are they treated for mental disorders and what is the success rate of such treatment? Are these children effectively straitjacketed? Should this happen to disturbed children? The true status could have possibly been easier to study if Maddie Blackburn had analysed and detailed the medical attention given to Aliyah during her period in care.
Lack of funds and shortage of trained personnel are often cited to be the main reasons that lead to inadequate medical attention for children in care. “There are fewer than 200 whole-time equivalent posts in the NHS in the UK, and child psychotherapists are not available in many areas.”  This shortage evidences itself at times when child psychotherapists are called upon to tend to children in care.
Right across the country, children’s psychiatric units are being forced to close, or are under threat of closure. A third of children’s units in England are affected. The reasons for the trend appear to be financial pressures on primary care trusts and a move to secure more beds for adolescents. Park Hospital, Oxford which provides paediatric inpatient care, will offer only day care from around 1 April. The service is no longer taking new inpatient referrals but is honoring its current patients. 
While this grim circumstance is undoubtedly distressing for all children with mental problems, the situation becomes much, much worse for children in care. This is because firstly, these children show much greater incidence of mental disorders than those from private homes and secondly, they do not have access to families and support systems that can provide expert private medical help, especially in situations where help from the NHS is not adequate.
Apart from expert psychiatric help, children with backgrounds of broken homes, domestic violence and substance abuse also need safe, secure, comfortable and caring environments to recover from their past traumas and enter normal life successfully. It becomes the duty of the childcare system to ensure that children grow up in an atmosphere of continuity and security and that they do not need to move often between different homes or institutions “The prevalence of mental health problems tends to decrease with the length of time in a placement, suggesting, not surprisingly, that stability and continuity of care is a significant factor in a child's mental health.” The true facts are again alarmingly different. Aliyah Ismail was moved 68 times between relatives, foster homes and institutions in the few years that she remained in care. Apparently, about 230 staff and ten agencies dealt with her during her short period in care. The total lack of continuity and the constant exposure to scores of families and social workers must have created extreme insecurities in her mind. Media reports have speculated on Aliyah having told social workers about being sexually abused by her family members. This, at first sight, appears to be rather improbable. The very fact that Aliyah was moved between numerous homes, agencies and social care workers would have made it impossible for her to trust individual workers and discuss her traumas and nightmares with them. Resentment at the way her life was going would have surely prevented her from opening up, other than in passing, and led to such conversations being overlooked. It thus becomes quite difficult to accept, in spite of intense media discussion and conjecture, that some of the social workers could have ben guilty of nonchalance, bordering on neglect. The problem, then, as well as now, lies with the system, rather than with individuals.
Children are still shifted from place to place and placed under the care of different social workers.
Part of the problem is that there can be too many people in children’s lives. Too often, there is not any one person making things happen. Children need a consistent person, not to replace their own family, but to act as their one good ‘parent in care’. Instead, many have three or more placements a year and a lot of changes of social worker “I don’t know who my social worker is at the minute, it would be nice to have a permanent one.” “You get to know one then they leave 
Aliyah had five changes in 1998 alone. It is quite unsurprising that some children like her, young boys and girls with deeply troubled backgrounds and histories of neglect, poverty, domestic violence and substance abuse, could resort to instant fixes, to the use of narcotics, alcohol and drugs. In addition to the problems created by the constant movement of these children, independent reports suggest that conditions inside children’s homes have very serious shortcomings. It is estimated that a third of the inmates of these homes are subjected to sexual abuse and are looked after by unqualified staff despite their having complicated emotional and behavioural problems. They are also subjected to corporal punishment, made to go without food and water and locked alone in dark rooms. While the absence of resources and the lack of staff are infrastructural issues that can be understood, it is impossible to either comprehend or tolerate such behaviour. Resorting to drugs and violent behaviour and the development of suicidal tendencies become easily understandable in such circumstances. Theft, larceny or prostitution by drug users obviously becomes consequential and is aggravated in an environment where it is difficult to give individualised attention to the children and teenagers; that too in their periods of vulnerability and when they are in need of parental support. The issue of drug abuse, alcoholism and child prostitution needs immediate and forceful action. Coordinated work between the local authorities, the police, social workers and administrators of children’s homes should, in the first instance, ensure that the supply of drugs, inhalants and alcoholic substances to children’s institutions is totally restricted. The restriction of these harmful substances needs to be implemented with the full support of the medical, particularly psychiatric support system so that they can step in with counselling and treatment in case of withdrawal symptoms and adverse reactions.
The Blackburn report suggested that enough was not done to fast track Aliyah’s transfer to secure accommodation, the routine thing to do in case apprehensions arise regarding a child’s propensity to cause self harm. What is of relevance here is the capability of people who work in child care to judge whether Aliyah had reached a stage where she could cause harm to herself. Such judgements need to come from people who are experts in behavioural practices or at the very least from people who have received training on the subject. It is very doubtful whether Aliyah, who was shifted from home to institution every two months, was put under observation for behavioural aberrations or for detection of any signs of abnormality. While it is not the purpose of this analysis to exonerate workers who may have truly been negligent and uncaring, the childcare system simply did not have the checks required to detect such lapses early enough to take corrective action.
The role of the media is important in shaping public perception; in fact, much of the information for this assignment has also come from media reports. Its power has been recognized for several years, especially in the UK, where it has been able to cause paradigm shifts in public opinion and changed the course of events. The problem occurs when media is used voluntarily or involuntarily in such a manner that the truth ends up bent, exaggerated and different from reality. In Aliyah’s case extensive media reporting, while providing detailed information, resulted in shaping negative public perceptions of the role and ability of social workers. The role of social workers and agencies came to be questioned, and essentially noble and selfless work was looked at with doubt if not with suspicion. This attitude ends up in doing more harm than good because adverse publicity reduces interest, hurts funding and restrains volunteers from coming forward, affecting, in turn, the ability of a humane society to parent children placed in adverse social and economic situations.
When a child is placed in care the local authority becomes, as per the green paper issued by the department of education and skills, the “corporate parent”, in other words the authorities assume the responsibilities of a natural parent. In fact the obligations of corporate parents are even more onerous because of the high incidence of traumatised and disturbed backgrounds of the children under their care. The duties of a corporate parent, like that of all corporations, is carried out through various bodies, departments, agencies, institutions and individuals like the police, the medical services, local councillors, schools, social workers, independent visitors, the authorities who run children’s homes and foster parents. These agencies and individuals need to work in tandem with each other and with a fuller understanding of the obligations of a parent. Their duties include providing children with physical nourishment, good clothing, education, counselling, medical care, stability, continuity and constant support. “Like any good parent the local authority should put the needs of children first. This means that every councillor, every Director of Children’s Services, every social worker or teacher should demand no less for children in care than they would for their own children”
The need for appropriate and efficient collaborating, planning and management is of extreme importance if multi agency operating is to be successful. The childcare system is plagued with a number of problems that include lack of funds, shortage of skilled and trained workers and possibly even a lack of simple systematic working. Aliyah was able to slip through the care net and enter prostitution only because her name appeared in three different forms in the records of the local authorities. The confusion was due to a combination of her frequent movements, improper tracking by the local authorities and wrong recording.
Corporate and natural parenting differs widely in one aspect, i.e., delegation. While no natural parent would even begin to consider delegation in child rearing, other than when children need to go to carefully selected and frequently visited boarding schools, corporate parenting works through institutions. These institutions work with the help of employed, or otherwise remunerated, people and rear children with whom there has never been any umbilical contact. In these circumstances a difference in the levels of commitment between humans and that of artificial systems is inescapable, however high be the dedication of individual social workers, counsellors and teachers. The much higher level of concern and care in natural parenting, caused by love and a fierce sense of protectiveness for one’s own, can be offset only through a combination of efficiently designed systems, collaborative agency working and caring front liners. Social care workers, authorities of children’s homes and foster parents must have compassion, love and sympathy for their wards. It would not be a bad idea for the local authorities in charge of childcare to see the efforts of Mother Teresa’s Missionaries of Charity in many Indian cities. The nuns open their doors and hearts to every waif who comes their way and take full responsibility for the children under their care, until they are adopted or enter earning life. Their lack of resource is made up by abundance of love and genuine compassion. Very possibly some of the practices used by them could come in handy for implementation in the UK.
Taking care of other people’s children is not an easy thing to do. Particularly so when issues like drug addiction, alcohol abuse, mental disturbance, runaways and child prostitution enter the picture and transform already arduous tasks into virtual nightmares. It is truly a difficult situation.
These problems however do not diminish the responsibilities of the state or the childcare system to look after the thousands of unfortunate children who come into care. It remains a primary responsibility of local authorities to provide lives of dignity to children who have got a terrible deal from life, deprived of the comfort, security, love and compassion that are their indisputable rights. The number of children in care in the UK is pegged at 61,000, one for every thousand citizens. This is hardly a large number and it is the moral responsibility, not only of the local authorities and the agencies and individuals associated with the childcare system but of all normal citizens and corporations to ensure that they are provided with the privileges and dignity available to others. Lack of funding cannot be accepted, in any way whatsoever, to be a valid reason for the existing inadequacies in the childcare system; certainly not in a country with one of the highest per capita incomes and standards of living in the world. This message needs to be driven home strongly to every British citizen and corporation. It is their job to contribute, to make up the small deficits in money that can make all the difference to thousands of young lives.
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Apart from money, one of the most effective ways to deal with these children is to increase the rate of adoption. Around five to six thousand children are adopted every year in the UK. This is just not enough to make any significant difference to the children in care. Other than adoption, the children need to be looked after mentally and physically. They need to be educated and readied to enter adult life on equal terms with children from normal families. Even though the task is difficult it is not unfeasible. The introduction of better systems and coordination, greater involvement of experts with psychological and psychiatric expertise, base attitudes of compassion and goodwill, constant training and inputs for staff, a carefully drawn rehabilitation plan for each child, continuous monitoring, and necessary route changes along the way should lead to very significant changes in the levels of care. Along with these issues the local authorities need to have the strength of purpose to purge the system of its ugly elements. Issues like corporal punishment, abuse of children and usage of drugs need to be dealt with immediately and rooted out totally. This is not a difficult task, certainly not where the total numbers involved are not more than 60,000, the capacity of one medium sized cricket stadium.
The country just cannot afford to have many more Aliyah Ismails. And people need to realise this.
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 GDimigen, CDel Priore, SButler, SEvans, LFerguson, and MSwan, 1999, Psychiatric disorder among children at time of entering local authority care: questionnaire survey, BMJ, Retrieved January 19, 2007 from bmj.bmjjournals.com/cgi/content/full/319/7211/675
 Wahab, A, 2007, Psychiatric inpatient care for children is being cut back across the country, Young minds magazine 81, Retrieved January 19, 2007 from www.youngminds.org.uk/magazine/81/inpatient.php
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