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	England and Wales High Court (Family Division) Decisions
You are here: BAILII >> Databases >> England and Wales High Court (Family Division) Decisions >> K (A Child: Therapy), Re [2013] EWHC 3747 (Fam) (19 February 2013) URL: http://www.bailii.org/ew/cases/EWHC/Fam/2013/B20.html Cite as: [2013] EWHC 3747 (Fam), [2013 EWHC B20 (Fam), [2013 EWHC B20

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IN THE HIGH COURT OF JUSTICE
FAMILY DIVISION
COVENTRY DISTRICT REGISTRY

		19 February 2013

1. These wardship proceedings concern a young person called Katie. That is not her real name. Katie is 16 years old. Katie was adopted in 2004. Her adoptive parents are MG ('the mother') and FG ('the father').
2. On 10^th June 2011 Coventry City Council ('the local authority') issued care proceedings. On 27^th July 2012, following a contested hearing, I made a care order in favour of the local authority. I made it clear that if I had had the power to do so I would not have made a care order but would, instead, have made Katie a ward of court. I was satisfied that in the circumstances of this case that was more appropriate to meet Katie's welfare needs than a care order. I gave the parents leave to appeal.
3. The parents' appeal was heard on 22^nd November 2012. The Court of Appeal determined that in circumstances such as those which confronted me last July, even though the local authority seeks a care order the court nonetheless has the power to make the child concerned a ward of court. The Court of Appeal discharged the care order, made Katie a ward of court and remitted the case to me.
4. The background history is set out exhaustively in my earlier judgment (Re K (Post-Adoption Placement Breakdown [2013] 1 FLR 1) and in the judgment given by the Court of Appeal (Re E (A Child) [2012] EWCA Civ 1773). Save in respect of one issue, I do not intend to repeat any of that background history in this judgment. This judgment should be read alongside the two earlier judgments. Together they form a continuum.
5. The case comes before me today for determination of two discrete issues. The first, upon which I have already heard submissions, relates to the provision of therapy for Katie. The second, in respect of which I will hear submissions later this afternoon, relates to the parents' wish to discuss the case with the media.

Therapy

6. In the course of the care proceedings I gave permission to the parties jointly to instruct Dr John Richer to undertake a psychological assessment of Katie. Dr Richer is a Chartered Consultant Clinical Psychologist. He worked in the Department of Paediatrics at the John Radford Hospital in Oxford for over 30 years. He was Head of Paediatric Psychology. In 2010 he retired from the NHS and took up an honorary post at the Department of Physiology, Anatomy and Genetics in the University of Oxford. As I noted in my earlier judgment, Dr Richer is an expert witness of the highest calibre.
7. My evaluation of Dr Richer's evidence is set out fully at paragraphs 106 to 131 of my earlier judgment. He said that Katie had suffered extreme damage as a result of her early childhood experiences. He expressed the opinion that, though imprecise, a diagnosis of reactive attachment disorder of childhood most usefully describes Katie's insecurity and its aetiology
8. Katie is in need of therapy. On 8^th December 2011, Dr Richer attended a professionals' meeting. Therapy was one of the key issues discussed. Dr Richer made it clear that Katie's need for therapy was urgent. The parents, who had undertaken their own research, suggested that the most appropriate organisation to provide therapy is Family Futures. Dr Richer has experience of Family Futures and supported a referral. There was some discussion about cost. According to the minutes of that meeting Dr Richer made the point that, for Katie, there would be a cost if therapy were not provided. By the end of that meeting the parents believed that there would be a referral to Family Futures. That referral did not happen. In the fourteen months since that meeting, no therapy has been provided for Katie.
9. The parents remain of the opinion that therapy should be provided by Family Futures. That organisation has the expertise and experience to help Katie. The local authority disagrees. The local authority proposes to instruct RRS. In coming to a view on that issue it is necessary to review the chronology of events since the hearing of the parents' appeal on 22^nd November 2012.
10. The case came before me for directions on 3^rd December. So far as is material, I directed that,

'3. The parties shall have permission to instruct Family Futures for the purposes of undertaking an assessment of the child's therapeutic needs (with the Local Authority taking the lead). A report of this assessment shall be filed and served by 8 January 2013…

5. Family Futures (through its relevant staff) shall have permission to see the Ward for the purposes of its assessment.

6. The Local Authority shall disclose to any therapist which it is considering the reports of Dr Richer (and shall obtain his views as to their suitability) and shall have permission to disclose the report of Family Futures…

7. The Local Authority shall file and serve the details of any alternative therapeutic provision which it intends to take to Resource Panel before it does so in the form which the Panel will consider.

8. The Local Authority shall file and serve a statement detailing the outcome of its Panel consideration by 17 January 2013.'

11. Katie met with Family Futures on 10^th December. Soon afterwards she expressed her unwillingness to have information shared with her parents. That information was passed on to the local authority's legal department on 21^st December and they, in turn, passed the information on to the parents' solicitors on 3^rd January 2013. The parents immediately indicated that they were content that the Family Futures' report need not be shared with them. On 8^th January Katie was informed of her parents' decision.
12. On 9^th January Family Futures submitted their initial report. Their final report was received by the local authority on 17^th January. The local authority remained – and still remains – of the view that RRS is the more appropriate provider of therapeutic services for Katie.
13. As I have already noted, my order of 3^rd December required the local authority to seek Dr Richer's views as to the suitability of any therapist proposed by the local authority. In an e-mail to the local authority dated 20^th January, Dr Richer said,

"…I can see little in RRS which specialises in the very difficult attachment problems that Katie presents. Only one of the CVs mentions any significant work with looked after children and that does not sound extensive. I can only repeat that Family Futures seems the appropriate place, and suggest that Katie needs to be persuaded that this is the way forward."

14. On 22^nd January the local authority received a letter from Katie in which she complained that it had been agreed that she would see the Family Futures report first and yet when she was spoken to on 17^th January 2013, it became apparent that her social worker had received the report but she had not. The letter states that she will not be working with Family Futures.
15. That same day, RRS provided the local authority with more information on three therapists who work for them. The parents' solicitors asked that this information be passed on to Dr Richer for his comments and that he be asked what experience the suggested therapists have in treating reactive attachment disorder in 16 year old girls that have not been treated yet.
16. There was a further directions hearing before me on 23^rd January. By then details were available of the costs estimates of Family Futures and RRS. There was a significant difference between the two. Family Futures estimated their costs at £49,780. RRS estimated their costs at less than £17,000. The difference is not accounted for by differences in charging rates but differences in the work proposed. In other words, comparison of the two gross cost figures was not a like-for-like comparison of costs. Those costs have now been revisited. Family Futures have now made it clear that their first year costs would be £22,520 – still more than RRS but not that much more.
17. The local authority now very fairly says that the difference in costs is not the key factor which prompts the local authority to propose to instruct RRS rather than Family Futures. They make the point that in the Midlands, RRS is a highly respected provider of psychological services, both reports for the court and therapy for those who come before the courts. I know their work well. I have a high regard for their work.
18. The local authority also makes the point that if one compares the CVs of the workers proposed by RRS with those from Family Futures, the comparison is a favourable one so far as the proposed RRS workers are concerned. In so far as it may be appropriate to determine this issue by comparing CVs, I have the benefit of Dr Richer's assessment of those CVs and do not need to bring my lay skills to bear in making that comparison. In an e-mail to the local authority dated 4^th February, Dr Richer said,

"…I have sympathy with RRS who have not (I assume) met Katie and so can only talk mainly in generalities.   I am afraid that the piece you sent me from RRS told me very little of substance.  Apart from a general claim to competence plus a sense of who they would see and some general comments about approach and some specific comments about adoption, attachment, etc., all of which many people in the field could write, I can discern no sense that they are familiar with the specifics of these problems. It seems to boil down to 'trust me'.  As I have said, I do not know them.  I may be being unfair, but what I have seen does not, I am afraid, tell me that these people would definitely be able to help.  They may, but I cannot tell it from this.

I turn now to Katie's sad letter.  She reveals the depth of her problems, her anger and bitterness, her immature, confused, "teenage" attitudes, her egocentric distortions…Colluding with such behaviour in younger children is damaging to the child.  However it is not so easy to place boundaries around a person of Katie's age.  Greendale is to be congratulated for at least keeping in Katie's good books, no mean feat and one which may have involved some compromises.

Having said both of these things, I am aware that the way forward is very difficult. If those who know the RRS people personally, feel they can offer something then that would be the way to proceed, as long as that decision was not based on cost grounds (I note your comment about the LA regarding RRS as offering a 'more cost effective package').  The big question is about effectiveness.  Ineffectiveness in more costly in the long run."

19. On 14^th February further material was sent to Dr Richer for comment. In an e-mailed reply, he said,

"I am afraid, if that is the correct phrase, that they simply confirm my previous opinion that Family Futures would be the safer and more effective place for Katie to receive treatment. Family Futures, of course, have the benefit of having met Katie and are more able to address the specifics of her situation, but they do so in a way which speaks of significant sensitivity to the problems in hand.

Let me step back a second and mention what one looks for in a situation like this, when one tries, as it were, to 'read between the lines'.  When people write in such a way that one feels they are focussed on the specific problems, that they have both confidence in what they do and can say what positive things others have said about that, but also realism and humility with the ability to be self critical, then one is more inclined to have confidence in them.  But, at the other end of the scale, when people simply state how qualified they are and talk in vague generalities, then confidence is not so easily generated.

You mentioned the kind offer from RRS to discuss this and, I am sure rightly, think that Family Futures would be willing to have a conversation.  However I am not clear what benefit would come from this, what extra reliable knowledge I would obtain.

I want to emphasise that I am not being critical of RRS, but simply am of the opinion that, on the evidence I have, Family Futures would be safer, more effective and, in the end, less expensive."

20. There is a third point made by the local authority and it relates to Katie's disquiet at the fact that she did not receive a copy of the Family Futures' report at the same time as the social worker and that, as a result, in her letter dated 22^nd January she has said she will not work with Family Futures. Whilst at one level that could be seen as a cogent reason for finding an alternative provider it is clear that Katie's difficulties are such that no matter who the provider of therapy there is a high risk that she will become disenchanted with that person or organisation, whether for good reason or for no reason, and threaten to disengage. The fact that she has said she will not work with Family Futures does not mean that she will work with RRS. So the local authority identifies a relevant concern but perhaps not one which, on closer analysis, is as persuasive as may first appear.
21. So which of these organisations should provide therapy for Katie? Should it be Family Futures or should it be RRS? At one point it appeared that the local authority's view was immovable and that notwithstanding any view expressed by the court it would not agree to Family Futures being instructed. On behalf of the local authority, Mr Messling has confirmed that the local authority will follow the wishes of the court even though it is accepted that the court in wardship does not have the power to compel the local authority to provide therapeutic services or to direct who should be the provider of those services. It was refreshing to hear that that is now the case.
22. It was also refreshing to hear that the parents are willing to contribute towards, or, as I understand it, even to pay for the whole of the costs of Family Futures. That, it seems to me, is not only evidence of their conviction that Family Futures is the right provider but also of their determination to do their very best for their adopted daughter notwithstanding the difficulties outlined in my earlier judgment. Whilst I acknowledge their offer there is a risk, accepted by all parties, that were Katie to discover that her parents were paying for, or even contributing towards, the cost of therapy then there is a real risk that she would disengage. So the offer has been made but in my judgment should not be accepted by the local authority – or at the very least, not until after the therapeutic work has been completed.
23. The reality is that whereas RRS are highly regarded in the region in which they practice, Family Futures has a national reputation for its expertise and experience in dealing with children and young people suffering from the kind of attachment problems from which Katie suffers. Their reputation and skill is vouched for by Dr Richer. They have met with Katie and have begun to form a relationship with her, albeit that the relationship has suffered a setback as a result of the oversight in not promptly providing her with a copy of the interim report. Although Dr Richer has no personal experience of the work of RRS he has seen the CVs of the proposed therapists and has made the response set out earlier in this judgment.
24. The time left for providing Katie with therapy whilst she remains a ward of court is rapidly diminishing. There must not be any more delay. Given her history, set out fully in my earlier judgment, Katie not only needs but also deserves the very best. In the light of all of the evidence before me I am in no doubt at all that therapy provided by Family Futures represents Katie's best chance of entering adulthood with at least some of the scars of her childhood having been healed. I am reinforced in that view by the position taken by the Children's Guardian who, on balance, is also in favour of Family Futures being engaged to provide therapeutic services for Katie.