Children in Care and Care Leavers

Interpersonal Trauma


Before you look at this page, if you haven’t already, please have a look at our page on:

Trauma Basics


Alternatively, if you prefer to watch a video…

We also have a short video:

What is Trauma?


Children and young people who have been in the care system for more than 24 hours are known as 'Children in Care'.

Some of the reasons for children and young people to be placed in care:

• The child is assessed to be at risk if they remain within the family home, typically a court-made legal order

• The parent has agreed to the child being placed into care as they are unable to look after their child due to their own ill health, mental health issues, or the child has a disability and requires respite care

• The child could be an unaccompanied asylum seeker


Trauma originates from the Greek word ‘wound’


Interpersonal trauma occurs when an individual experiences multiple traumatic events that are caused by other human beings which are repetitive over time. It is where a person has been hurt by another person, they are then wounded by the experience. This can be childhood abuse, neglect, parental mental health, witnessing interpersonal violence (domestic abuse) or witnessing parental drug and or alcohol use.


Children in care and care leavers are a significantly vulnerable group who have experienced interpersonal traumas which is why care proceedings were put in place to remove them from their birth parents.


Children can remain in the care system until they are either adopted, return home, or turn 18 and are then known as care leavers. Local authorities in all the 4 nations of the UK are required to support children leaving care from the age of 18 until they are at least 21. Care can continue with a foster family, in a children’s home or supported housing services, or under another arrangement as agreed by the local authority.


In 2018/19, there were approximately 102,000 children in care in the UK. The total number of children in care in the UK has increased every year since 2010. In the last five years the population of children in care in the UK has increased by 10%. However, it is important to note that this UK-wide trend is not reflected in all four nations.

(NSPCC, 2021)


Care Leavers

Around 10,000 young people in England leave the care system every year on their 18th birthday.

Care leavers make up 25% of the homeless population.




Impact for children and young people:

For children in care and care leavers, they initially experience their traumatic life with their birth families, then additionally they experience the trauma of being removed from their families, friends and all that is familiar to them.

They may experience ambiguous loss which is a loss without a clear understanding for the loss.


Many children are not told why they have been removed from their family homes and placed in a foster placement. They may search for answers which further delays the process of grieving which results in unresolved grief.


The young people then have stressors from multiple foster placements or care homes.


Repeated instances of neglect, abandonment, and abuse during their early life can cause negative effects on cognitive development, neurological development, and psychological development as well as impacting in their development of attachments to others as they grow and mature.


Due to the prolonged period that these traumas are experienced and if untreated by psychological support, trauma then becomes post-traumatic stress disorder.

This can begin from infancy!


For more detailed information about trauma, post-traumatic stress disorder and symptoms, please visit:

Understanding Trauma


If the trauma is unresolved as the child/young person grows, the adult self is then left with the trauma and trauma symptoms.


Adverse Childhood Experiences (ACEs)

ACEs are distressing experiences that cause acute stress, anxiety, and trauma in early childhood.

These experiences limit the development of children and young person’s life and therefore, their future life.

ACEs contribute to poor life-course health and social outcomes in a UK population.

That ACEs are linked to involvement in violence, early unplanned pregnancy, incarceration, and unemployment suggests a cyclic effect where those with higher ACE counts have higher risks of exposing their own children to ACEs.

(Bellis et al., 2014)


For more information on ACEs:


Placement Breakdowns

There will now be additional stressors, additional traumatic experiences. Many children are moved repeatedly which are now additional stressors, additional traumatic experiences. Simple things like a change of routine, or a change of breakfast cereal. Children are expected to adapt, this is a constant challenge and stressful. For children who have experienced ACEs will also have difficulties attaching to adults from their experience of poor parental attachment. Who can I trust to keep me safe? Children then become reluctant in forming relationships for fear of losing them, but additionally, they do not trust adults as in their experience, they are not reliable, and they are unable to keep me safe.


Changes in social worker

This can then be exacerbated by the continual change of a social worker; one child has reported having 16 different social workers

Meanwhile, more than 20,000 – just over one in four – had to deal with two or more changes of social worker over the same period. Over the 24 months covering 2016-17 and 2017-18, more than half (55%) of children saw their social worker change twice or more, while for 32% it was three or more times.

Children spoke of how important it was to have a constant social worker and said frequent changes could be distressing and made life feel more chaotic.

(Community Care, 2019)




Many children in care have previous experiences of violence, abuse, or neglect. This can lead to them displaying challenging behaviour and having problems forming secure relationships.

Some find it hard to develop positive peer relationships.

The care system can struggle to provide effective management and interventions to address these problems.

(Bazalgette, Rahilly, and Trevelyan, 2015)



A Negative Behaviour Cycle

A cycle of behaviour is formed. A traumatised child’s behaviours can be seen negatively, especially when an adult is not aware of trauma behaviours.

Additionally, patterns of attachment can also create behaviours which can been seen as disruptive.

There is then an association between problematic behaviours and placement disruption.



wounded - rebellious – defiant - ambivalent behaviours – rejection – wounded – defiant – ambivalent behaviours - rejection,the cycle continues

If this cycle continues, a child’s pattern of attachment can be perpetuated by continual placement disruptions in preference to stability and developing relational repair.


Attachment is an emotional relationship whereby



are reciprocal. It is where you feel safe.


When children have not experienced positive attachments from their birth parents, this can impact on subsequent relationships which can also negatively impact on their behaviours. To understand more about relational attachments, please watch this video:


What are the consequences of poor relational attachment?



Patterns of Attachment


Characteristics of Attachment (John Bowlby):


• Proximity maintenance: The desire to be near the people we are attached to.

• Safe haven: Returning to the attachment figure for comfort and safety in the face of a fear or threat.

• Secure base: The attachment figure acts as a base of security from which the child can explore the surrounding environment.

• Separation distress: Anxiety that occurs in the absence of the attachment figure.

(Bowlby, 1979)


Secure Attachment Style

As Children

SeparatesfromparentSeeks comfortfrom parents whenfrightenedGreets return of parentswith positiveemotionsPrefers parentsto strangers


As Adults

Have trusting,lastingrelationshipsTend to havegoodself-esteemShare feelingswith partnersand friendsSeek outsocial support



Insecure Ambivalent (resistant) Attachment Style


As Children
May be waryof strangersBecome greatlydistressed whenparents leaveDo not appear comfortedwhen parentsreturn


As Adults

Reluctant tobecome closeto othersWorry that theirpartner does notlove themBecome very distraughtwhen relationshipsend


Insecure Avoidant Attachment Style


As Children

May avoidparentsDo not seek muchcontact or comfortfrom parentsShow little or nopreference for parentsover strangers



As Adults

May have problemswith intimacyInvests little emotion insocial and romanticrelationshipsUnwilling or unable toshare thoughts orfeelings with others



Disorganised Attachment Style

At Age 1

• Show a mixture of avoidant and resistant behaviour

• May seem dazed, confused, or apprehensive


At Age 6

• May take on a parental role

• Some children may act as a caregiver toward the parent


As Adults

• Depressed and anxious

• Erratic behaviours

• Outburst

• An inability to understand the world around them

• Unable to understand the behaviours of others

• Poor self-image

• Self-hatred


It is important to stress that a pattern of attachment is not an attachment disorder!


Attachment Disorders


Reactive attachment disorder (RAD)

Refers to a consistent and pervasive pattern of behaviour in which a child shows extremely withdrawn behaviour, particularly a marked tendency to not show attachment behaviour toward caregivers (not seeking proximity when distressed, and not responding when comforted), accompanied by a general lack of responsiveness to others, limited positive affect and/or episodes of marked sadness, fearfulness or irritability. The diagnosis requires that there is clear evidence of pathogenic care, such as severe neglect or repeated changes in caregivers (for example, through multiple foster care placements or institutional care), and the difficulties should be evident before the age of 5.


Disinhibited social engagement disorder (DSED)

Refers to a marked and pervasive tendency to not show appropriate cautiousness with respect to unfamiliar adults and a failure to be sensitive to social boundaries. Examples include going off willingly with a stranger with no hesitation, overly familiar verbal and physical interaction with a stranger and limited or absent checking back to a caregiver when in a new place. DSED is only considered when there is clear evidence of a history of pathogenic care.

(NICE, 2015)


Pathogenic care is a form of care from a primary care giver (parent).


Impact for Foster Carers

Empathic foster carers experience challenging behaviours along with children who have attachment difficulties and subsequent demanding behaviours which can then impact on their emotional wellbeing, feelings can become overwhelming by what they see and experience. It is essential that foster carers are provided with a full history of their foster child which provides an insight and an understanding that their child did not have a comforting, loving, safe and secure home, The child can feel lost, distrustful and feel angry. For those children who are traumatised, their trauma behaviours can be extreme. Experiencing a traumatised foster child can create burnout or vicarious trauma for the foster carer. Follow this link to support foster carers wellbeing:


Separation from Siblings

In most cases, all attempt is made to keep siblings together in a placement. When this is not possible, siblings will be separated.

Contact is then organised; however, this is also an additional trauma; the initial separation, the initial loss, is then compounded by the separation again at the end of contact.

Children in care typically have contact with at least one family member.

The Children Act 1989, section 34(1) requires that local authorities promote and support contact between children who are looked after and their families unless it is not in the best interests of the child’s welfare.

Family contact can be for some, challenging and the impact can also be traumatic.


• for more than a third (37%) of young people, contact was unreliable – i.e., the parent did not turn up or was consistently late

• some young people experienced inappropriate amounts of contact

• safety was a concern, particularly where contact was unsupervised

• replay of negative relationships – many young people had unresolved attachment difficulties that were re-enacted during contact

• contact could diminish the influence of the foster carer

(Moyers et al, 2006)


Children in the care system are more likely to run away or go missing than children who are not in the care system. Why?


   They want to return home to their family    They are unhappy in their care placement    Needing control where in placement they have none



Reunification – Returning Home

International and national legislation require social workers to try to return children from care to live with their parents (United Nations, 1989; Department for Education (DfE), 2015).

Leaving care is carefully planned for permanent residency.

Children who went home on a care order were less likely to re-enter care.

Providing ongoing support promotes re-unification for both the child and the person who will hold parental responsibility.

Note, there are options for whom will hold parental responsibility and provide a home for the child leaving care:

Options can be:

ReturntoparentsReturnto oneparentGrand-parentsFamilymemberCareleaverSpecialguardianshiporderAdoption


The adoption route is typically for younger children, for those entering care post 7 years old, re-unification will be their only route out of care.

A study focused within one local authority found that one-third of children (36%) had been reunified, with adolescent entrants being the most likely age group to return home.

Three quarters (75%) of reunified children had a stable reunification,

(Neil, Gitsels and Thoburn, 2019).


What Impacts on a Stable Reunification?

Primarily, that the child has resolved their trauma thus they are emotionally and psychologically stabilised.

Additionally, that the home they are returning to is stable and provides a loving and safe environment with no triggers from previous abuse or neglect.


Gottman’s 4 ‘Types’ of Parents and Their Effects on Children


 The Dismissing Parent

• Treats child’s feelings as unimportant, trivial

• Disengages from or ignores the child’s feelings

• Wants the child’s negative emotions to disappear quickly

• Sees the child’s emotions as a demand to fix things

• Minimizes the child’s feelings, downplaying the events that led to the emotion

• Does not problem-solve with the child, believes that the passage of time will resolve most problems

Effects of this style on children: They learn that their feelings are wrong, inappropriate, not valid. They may learn that there is something inherently wrong with them because of the way they feel. They may have difficulty regulating their own emotions.


The Disapproving Parent

• Displays many of the Dismissing Parent’s behaviours, but in a more negative way

• Judges and criticizes the child’s emotional expression

• Emphasizes conformity to good standards of behaviour

• Believes negative emotions need to be controlled

• Believes emotions make people weak; children must be emotionally tough for survival

• Believes negative emotions are unproductive, a waste of time

Effects of this style on children: Same as the Disapproving style.


The Laissez-Faire Parent

• Freely accepts all emotional expression from the child

• Offers little guidance on behaviour

• Does not set limits

• Believes there is little you can do about negative emotions other than ride them out

• Does not help child solve problems

• Believes that managing negative emotions is a matter of hydraulics, release the emotion and the work is done

Effects of this style on children: They do not learn to regulate their emotions. They have trouble concentrating, forming friendships, and getting along with other children.


The Emotion Coach (parent)

• Values the child’s negative emotions as an opportunity for intimacy

• Is aware of and values her or her own emotions

• Sees the world of negative emotions as an important arena for parenting

• Does not poke fun at or make light of the child’s negative feelings

• Does not say how the child should feel

• Uses emotional moments as a time to listen to the child, empathize with soothing words and affection, help the child label the emotion he or she is feeling, offer guidance on regulating emotions, set limits and teach acceptable expression of emotions, and teach problem-solving skills

Effects of this style on children: They learn to trust their feelings, regulate their own emotions, and solve problems. They have a high self-esteem, learn well, and get along well with others.

Taking the concept of the parent being the emotion coach, the parent holds their deepest feelings of love and empathy for their children.


Unfortunately, this does not come naturally to all parents. Which are you?



Bazalgette, L., Rahilly, T., and Trevelyan, G. (2015). Achieving emotional wellbeing for looked after children. National Society for the Prevention of Cruelty to Children.

Bellis, M. A., Lowey, H., Leckenby, N., Hughes, K., and Harrison, D. (2014). Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of public health, 36(1), 81-91.

Bowlby, J. (1979). The Bowlby-Ainsworth attachment theory. Behavioral and Brain Sciences, 2(4), 637-638.

Brodie, I. (2014). Running away, going missing and sexual exploitation. NSPCC.

Department for Education (2018a). Children looked after by local authorities in England: Gide to the SSDA903 collection 1 April 2016 to 31 March 2017, March 2017.

Moyers, S., Farmer, E., and Lipscombe, J. (2006). Contact with family members and its impact on adolescents and their foster placements. British Journal of Social Work, 36(4), 541-559.

Neil, E, Gitsels, L, Thoburn, J. Returning children home from care: What can be learned from local authority data? Child and Family Social Work. 2020; 25 548– 556.

NICE (2015). Children's Attachment: Attachment in Children and Young People Who Are Adopted from Care, in Care or at High Risk of Going into Care.

United Nations (1989). Convention on the rights of the child. New York: United Nations.



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