Bromely Mencap Childminding service case Studies
Case Study 1
A is a 5 years old little girl from a black African background. She has global delay. A is
able to sit and crawl unaided but is unable to weight bear in the standing position. She
has little eye contact and is unable to communicate. She is not toilet trained. A has
limited fine motor skills and is therefore unable to feed herself. She is able to hold a
handled cup with lid to drink if it is placed in her hand.
When A was 2 years old the family were assessed by the Disabled Children’s team for
Short breaks and were informed of the Bromley Mencap Childminding Networks as an
option for providing this service. The Senior Coordinator met with the family and A’s
Mother was introduced to and chose the childminder who she thought was best able to
provide the flexible service that the family wanted.
At this time A was unable to sit unaided and had very limited fine motor skills. She was
able to reach for objects but was unable to grip or hold anything without hand over
hand. In order to ensure that we were able to meet A’s physical needs we consulted
with the Occupational Therapists and Physiotherapists at the Phoenix Resource Centre
who provided support for A. They advised that she should have the same specialist
seating for use at the childminders home as she had at her own home. We obtained
funding for an hydraulic based chair that could be in the lower position to enable A to be
at eye level with other children or elevated in order that she could be seated around the
dining table to be included in mealtimes and activities. The chair was on wheels
enabling the childminder to easily move A from room to room or out into the garden.
The Physiotherapists also provided our childminder with one-to-one moving and
handling training to ensure the safety and comfort of both A and the Childminder. This
one-to-one training continued into the Phoenix Pre-School where the Childminder
visited A’s class to discuss ways and means of adapting activities and resources to aid
her development. This support has continued with both the Childminder and the Senior
Childminding Coordinator attending Multi Agency and “Next Steps” meetings; working in
partnership with other professionals and agencies to ensure that A’s development plan
was consistent.
As A has grown we have obtained further funding to provide a mobile hoist to ensure
her comfort and safety, this would also prevent the childminder from sustaining any
injuries from lifting A. We have also obtained funding for a specialist car seat harness
and an appropriate board to enable the childminder to transfer A from her chair to the
car.
A now attends one of the boroughs special schools. In order that the family can
continue to use the home based service that they have grown to trust and rely on the
childminder collects A from school 2 evening a week. We continue to work in
partnership with the school to ensure consistency of care.
Case study 2
A1 is 7 years old boy from a white British background he has global delay and a
chromosome deletion; he also has challenging behaviour. His sister E who is 5 years
old also has global delay, a chromosome deletion and no speech. Both parents have a
learning disability.
2 ½ years ago the family were assessed by the Disabled Children’s team for Short
breaks and were informed of the Bromley Mencap Childminding Networks as an option
for providing this service. The Senior Coordinator met with the family and introduced
them to a childminder who would be able to provide Shortbreaks one Saturday a month
for both children enabling them to stay together.
The children quickly settled and the family formed a bond with the childminder. Even
though the two families lived close to each other the childminder would collect the
children from their home having helped the parents to get them washed and dressed.
She would also ensure that they had an evening meal before taking them home.
We worked closely with A1’s pre-school to help their parents understand the need for
consistency in order to further the children’s development and manage their behaviour.
It was recognised that our service had become a valuable support to the family. We
were later asked if the childminder would extend her service by also providing Short
breaks for another son aged 18 months. A2 also had no speech or communication,
challenging behaviour and was also being tested for chromosome deletion. A2 was not
yet old enough for pre-school and was left without any interaction from other children or
stimulation from his parents for most of the time. He would also get upset when the
childminder left the family home with his siblings. It was agreed that the childminder
would provide Short breaks for all three children 1 Saturday a month
Six months ago the children’s mother was admitted to Kings College hospital where she
gave birth to a fourth child who was severely physically disabled and required
immediate surgery. During the time that she was in hospital in order that the father
could spend time with his wife and to ensure the children could stay in the family home
the childminder provided additional care before and after school each day.
The children’s mother left hospital and the baby was placed into the care of the local
authority.
In order to help the parents during the mother’s recovery the childminder was asked to
help with taking and collecting the children from school daily. During this time she also
provided them with an evening meal.
The children’s mother has now fully recovered and although the baby will remain in the
care of the local authority the three other children remain at home; they continued to
thrive with support from the local authority and the childminder who now provides Short
breaks two Saturdays a month for all three children.
Case Study 3
B is a 4 year old little boy from a Nigerian background. He has global delay, ADHD and
delayed social and communication skills. He also suffered from ‘night terrors’ and was
awake most nights. His mother is a single parent with no relatives living in the borough.
Because of his challenging behaviour his Mother had isolated them from other young
families. They spent most of their time inside the house.
When B was 2 years old the family were assessed by the Disabled Children’s team as a
family in crisis. B’s mother was informed of the Bromley Mencap Childminding Networks
as an option for providing her with Short breaks. The Senior Coordinator met with B
and his Mother and after speaking with Early Support professionals who knew the family
it was decided that B needed to be cared for by a Childminder on a one-to-one basis in
order that she would be able to give him her full attention.
A Childminder was found who would be able to provide Short breaks 2 hours a week on
a one-to-one basis. Through Early Support the Childminder worked closely with a
Portage worker and B’s Mother to ensure that consistent behavioural strategies were
put into place.
At this time B refused to feed himself or eat from a spoon; meal times consisted of him
wandering around the room while his Mother used her fingers to put food into his mouth
from her own plate. The Childminder was asked to provide Short breaks over a lunch
time to enable her to concentrate her time on teaching him to sit at the table and feed
himself. She started the process by encouraging him to sit on her lap at the table and
over a few weeks using hand over hand taught him how to feed himself.
Through lots of praise and encouragement B progressed to spoon feeding himself as he
happily sat beside the childminder at the table. During this time the Childminders
chatted to him about his favourite toys and programmes on the TV which also
encouraged his speech. B’s mother was invited to join them for some meals in order
that B could see that his Mother knew he was now capable of sitting at a table and
feeding himself.
As the bond developed between the family and the childminder the hours were
extended to give the childminder additional time to be able to take B to toddler and
music groups where the Childminder could continue to developing his social and
communication skills which have greatly improved. He is now speaking in short
sentences and better understands boundaries.
B now attends a unit attached to a mainstream school where he has started to make
friends. He continues to go to the Childminder one Saturday a month where he joins in
activities with her family including trips to the park and soft play area. Through
continued support from the Childminder the family are no longer isolated as his Mother
now feels able to take him out to meet with friends, trips to the park and even shopping.
As B’s Mother’s confidence as a parent has grown she has also obtained part time
work.
Case study 4
S is a 3 year old little girl from a white British background. She was referred to our
Childminding Network for Short breaks when she was 16 months old. She was born 6
weeks prematurely with Sclerosis of the Liver, gall bladder and bile duct; it was hoped
that in time she would become strong enough to undergo a Liver transplant. S was
prone to nose bleeds which if they lasted longer than 10 minutes an ambulance was to
be called. She also had a heart murmur, global delay and no speech. She was fed by
gastrostomy tube as she had a phobia with eating and touching solid food. She would
also become very distressed when she saw other people eating. She only drank
nutrient milk.
The Senior Coordinator met S and her Mother who was a single 18 year old young
woman living alone in Social Housing. After meeting with Early Support professionals
who knew the family it was decided that S needed to be cared for by a Childminder on a
one-to-one basis in order that she would be able to give her her full attention. A
Childminder was found who would be able to provide one-to-one care one day a month
for eight hours, she was also informed the severity of the little girls disability and
understood that she could become terminally ill at any time. The Childminder also
received one-to-one training and competency from the Community nursing team to
provide gastrostomy feeding and administer medication.
The Senior Coordinator and Childminder attended multi agency meetings to discuss the
best way to support S and her Mother. They worked closely with the Speech and
Language therapist, Dietician and Portage worker both at the Childminder’s home and
the child’s home to develop consistent strategies to encourage S to overcome her
phobia to solid food. After 4 months S started to eat soft foods from a spoon and would
feed herself melt in the mouth finger foods. She continued to receive nutrients via her
gastrostomy tube.
Six months ago S underwent an emergency liver transplant. As her mother had formed
a great trust and bond with the Childminder after she was discharged from hospital the
Childminders hours were extended to give her Mother an additional break. For a few
weeks S was quite poorly and needed lots of additional attention she was taking 6
different medications, 3 of them anti rejection medicines. This caused severe hair loss,
and skin irritations and she was waking many times each night.
Although she does have ups and downs, S is making a good recovery. She is eating
well and putting on weight. She has had her gastrostomy tube removed on a trial period
to see how she responds. If she loses weight the tube will be put back but if her weight
is steady she will carry on without it. She has started speaking and enjoys playing; the
childminder is now able to take her to the park and soft play areas.
The Childminder has now also introduced S and her Mother to toddler and music
groups which they all attend during the week giving S the opportunity to mix and interact
with other children and develop her social and communication skills. This also gives her
Mother the chance to meet other young Mothers and make friends.