Another hugely successful Best Practice Forum at the House of Lords

7th December 2018

Dr Miriam Silver, Consultant Clinical Psychologist
Author of Attachment in Commonsense and Doodles: A Practical Guide

BERRI. Improving Outcomes for Complex Children

Dr Silver has 20 years of experience working with Looked After Children both in terms of assessing needs and working with professionals trying to help children recover from early trauma. Many children in the care system suffer from complex trauma or chronic developmental trauma having experienced multiple and / or prolonged developmentally adverse traumatic events, most often of an interpersonal nature, such as sexual or physical abuse, war, domestic violence etc. Outcomes for these severely damaged have historically been very poor. 

Dr Silver has been researching and developing a means for screening children in care to assess their specific needs, enable those caring for them to develop strategies targeted to address identified needs and to monitor the childrenā€™s progress. She argues that her approach is not only successful in terms of helping children recover from early adverse experiences but is cost effective and allows service managers to demonstrate progress. 

TheĀ BERRIĀ explores five domains that influence placement and the services needed for any specific child:Ā Behaviour;Ā Emotional wellbeing;Ā Risk (to self and others);Ā Relationships; Indicators (of psychiatric or neurodevelopmental conditions). It is a simple questionnaire that can be used multiple times to monitor change and there is an automated on-line scoring and reporting system. It allows for the ability to track change over time and zoom in on specific issues.

For more information go to:

www.BERRI.org.uk

Turning Childrenā€™s Lives Around

At our latest Best Practice Forum in June 2018, our keynote speakers Richard Cross (Head of Assessment & Therapy for Five Rivers Child Care) and Alison Hodgetts (a Registered Clinical Psychologist) gave a talk entitled ā€œTurning Children’s Lives Aroundā€ – overcoming the impact of childhood adversity through therapeutically focused integrated care.

The presentation focused on the Five Rivers model of ā€˜trauma and attachment informed careā€™ and the knowledge, organisational structures and supports that are required to ensure good outcomes.

Five Rivers Child Care is a social enterprise that has been dedicated to addressing the impact of abuse, trauma and neglect for almost three decades.

The care provider has made significant investments into developing knowledge and understanding about what works in accurately identifying the needs of the child or young person. This has ensured the right therapeutic environment to meet the needs of children and young people who have experienced trauma.

Richard shared how this unique approach was embedded across Five Rivers Integrated services of Education, Care and Assessment & Therapy – and how a partnership with researchers from University College London and The Anna Freud Centre was successfully developed.

Richard and Alison further explained how Five Rivers Integrated case management maximises the use of the assessment comprising ā€œthree key strandsā€ (attachment, trauma and disassociation). The approach aims to transform and maximise the impact in responding to the emotional needs of the child or young person.

Fountain House, a Five Rivers residential facility, has developed an attachment and trauma informed residential therapeutic environment. Richard explained that this approach has demonstrated how it can ā€˜transform childrenā€™s livesā€™ by minimising the impact of their traumatic experiences as they developā€™.

Concluding the talk, Richard made an important point to the audience, that ā€˜the integrated model provides the glue and a shared understanding helps people to connectā€™. Summing up the necessary steps to develop an integrated service, he stated that the following key areas were essential to successfully delivering this model:

1. Develop a relationship-based therapeutic model
2. Capture the hearts and minds of the workforce
3. Help children and staff to understand what is happening
4. Provide training and a toolkit for staff
5. Develop a supportive culture for staff
6. Undertake a full assessment of the child/young personā€™s past experiences and current issues to identify their needs

The Earl of Listowel thanked them for their presentation and the audience then took the opportunity to ask questions.

Our Speakers

Richard Cross is Head of Assessment & Therapy for Five Rivers Child Care – an innovative and progressive social enterprise dedicated to ā€˜Turning childrenā€™s lives aroundā€™ who have experienced trauma, abuse and neglect. His focus is on ensuring the development of effective identification of need (assessment) and deliverer of therapeutic interventions that make the difference.

He is a UKCP, EAP, WCP registered Psychotherapist and Child Psychotherapist who has worked with children, young people and adults who have experienced trauma since 1991. He has sought to support the development of a range of relationally based therapeutic programs to improve outcomes for maltreated children e.g. New Zealand advanced EQUIP program (2002), Adapted SOTP for adolescents (1998) and piloted a trauma informed approach across 16 residential homes (2007 ā€“ The Sanctuary Model). He is a member of the European Society for Trauma & Dissociation (ESTD) and a member of the International Society for the Study of Trauma and Dissociation (ISSTD).

Alison Hodgetts is a Registered Clinical Psychologist who has worked with children, young people and their families over the last 10 years, both in the NHS and privately. The focus of her clinical work has been with children and young people who are fostered or adopted; providing assessments, therapy and consultation, as well as training carers, parents and professionals.

Her professional interests include Attachment Theory, Developmental Trauma and attachment-based psychotherapy. She has completed her Level 2 Dyadic Developmental Psychotherapy (DDP) training and is working towards completing the DDP practicum. Alison joined Five Rivers 12 months ago and works with the Fostering teams in the West Country.

 

Regional BPF – Teaching Traumatised Children and Young People

IRCT in partnership with Warwickshire Virtual School and Trinity School held a BPF for VSHs and Schools last Friday. It was an excellent day with three sought after speakers, who gave their precious time to talk about their work. Betsy de Thierry presented a framework for use in schools to identify what support and help children and young people who have experienced trauma will need, and demonstrated quite vividly how professionals can recognise those children who are struggling.Ā Dr Alex Hassett then gave us an overview of brain development in childhood. He moved on to explore how development of the brain during adolescence can impact on learning and pro-social behaviour. After lunch Professor Robin Banerjee presented his research on peer relationships, and how teachers can identify children who struggle to make good social relationships with their peers, and that a whole school approach geared to developing good social skills and positive relationships can help all children.

We had very positive feedback from the professionals attending; leaving us thinking we should do more BPFs like this.

Another Successful BPF

‘Just Excellentā€™ ā€˜So many experts in one roomā€™!

We heard fromĀ Ā Mark Kerr:Ā Ā ā€˜Care Past, Present and Future; a Critical Appraisal of Outcomes for Looked after Childrenā€™

Dr Matt Woolgar:Ā ā€˜Taking care of the mental health needs of looked after children: Avoiding the one size fits all approachā€™

Feedback from participants was very positive:

ā€˜Challenging and high quality presentationsā€™

ā€˜Ability to hear from lead experts and be inspiredā€™

ā€˜Evidenced based materialā€™

ā€˜Variety of professionals and other interested partiesā€™

Join us in February 2016 for the next BPF

Best Practice Forum July 8th 2015

LordĀ Francis ListowelĀ opened the event by welcoming us to the event at the House of Lords.Ā 

Dr Sean CameronĀ spoke on ā€˜The emotional warmth dimension of childcare; Empowering the carers of children who have been rejected, neglected and abused.ā€™

Ā He started his presentation by quoting Alice Millar, US Psychologist and author;

ā€˜It is possible to love a child passionately but not in the way that he (she)needsā€™.

Dr Cameron spoke about the adverse childhood experiences pyramid where heĀ  explained that the worst thing that can happen to a child is childhood rejection. He said they need parentā€™s acceptance as much as the air they breathe and the food they eat. Acceptance is culturally based but recognised immediately. He spoke about the resulting behaviour from experiencing parents rejection such as over clinginess, superficial charm, inability to share destructiveness, cruelty and teasing, persistent lying.

Dr Cameron has looked at the following areas to develop his model ā€˜The emotional warmth approachā€™: parenting style, attachment theory, CBT, PTSD and positive psychology and trauma informed theory.

He has created the 8 pillars of parenting:

1. Primary care and protection

2. Secure/ close relationships

3. Positive self perception

4. Emotional competence

5. Self management/ self efficacy skills

6. Resilience

7 A sense of belonging

8. Personal and social responsibility.

He ended with a quote from William Hodding-Carter (1907-1972)

There are two lasting bequests that we can leave our children, one is roots and one is wings.

The Pillars of Parenting is a social enterprise which offers psychological consultation and professional training to residential carers and foster or adoptive parents of older children who have been neglected and abused. www.pillarsofparenting.co.uk

The second presentation was entitled:

ā€˜The Mulberry Bush Scale: A collaborative project between practitioners and researchers to assess social and emotional development in traumatised childrenā€™.Ā 

Robin Banjeree,Ā Professor of Developmental Psychology in the school of psychology at the University of Sussex began by pointing out how important peer relationships are vital for emotional healthy lives. Ā 

Psychologists looking at social behaviour in peer groups look at being kind, peaceful conflict resolution, supporting others, leadership or aggression, withdrawal, or disruptive behaviour.

He points out that there is a strong link between mentalising and social behaviour. When a child has emotional recognition and labelling at 2-3 years they are able to have interactive play and build healthy peer relationships.

Theory of mind at age 5 leads to more co-operative behaviour at age 6 which leads to more peer acceptance and less peer rejection at age 7. Peer acceptance leads to increased academic achievement.

He explained a research project which evidences the children who have theory of mind at age 5 leading to less rejection from peers at age 7 and therefore better academic achievement at age 8.

Ray Burrows, an Art Therapist and teacher from Mulberry bush School followed with a presentation about a specific way that they have used to look at childrenā€™s emotional development. He spoke about how they work psycho-dynamically where they look at each individual childā€™s behaviour as the way they are communicating their needs. This is primarily done with reflecting and working together.Ā 

Each child has a treatment team of family practitioner, teacher, therapist, house manager, keyworker.

He explained that there were 11 key elements that they used to assess the development of the children, which include:

  1. Be able to play

  2. Build healthy and mutually trusting relationships

  3. Keep themselves and themselves safe

  4. Ask for help and make use of it

  5. Reflect on and communicate feelings rather than act them out

  6. Function app in a group

Ray BurrowsĀ handed over toĀ JasmineĀ who is a researcher from the University of Sussex who has been looking at these elements and how to ensure validity of the Mulberry Bush Scale. Three schools were used for the research, 2 mainstream schools as comparison settings and the Mulberry Bush School. Three factors that were found to be key were social regulation, emotional competence and the response to adults.Ā 

John Diamond, CEO Mulberry Bush Organisation then facilitated the plenary and the large group then reflected on the content and discussed their responses. Ā 

Stephen Bell, Chair of IRCT closed the forum and thanked those who attended and contributed.Ā 

Best Practice Forum Oct 17 2014

The Earl of Listowel, IRCT PatronĀ opened the meeting with a warm welcome and reminded us about the importance of reflection and peer discussion.

Stephen Bell, Chair of IRCTĀ then explained the vision of the Institute as an organisation committed to focussing on the recovery of the traumatised child. He said that it aims to bring the body of knowledge about trauma recovery together and then disseminate this knowledge to others who support traumatised and vulnerable children.Ā 

Presentation A

Sylvia Duncan, a clinical psychologist since 1972 introduced herself and spoke about the current speed of society that doesnā€™t facilitate enough time for thinking and reflecting. She asserted that a theme of her work and the concept of her presentation at the BPF was the importance of providing a space of containment for children and professionals to allow for reflection and thinking time.Ā 

Sylvia suggested that when we think about the impact of trauma we need to think it exists as a continuum and have an awareness that it is often the response to the trauma can be more traumatic than the event itself. The best-case scenario and worst-case scenario of trauma recovery were explored as a foundation of the exploration of the work with traumatised looked after children.

The therapeutic reā€“parenting partnership (TRP) was set up as a partnership between Kent County Council and Sylviaā€™s practice as a collaborative approach to work with looked after children from pre school to 10 years of age who had experienced multiple placement breakdowns. Sylvia shared that as a staff team they have had only one change of staff in 11 years as consistency is the vital ingredient for the success of this project. The foster carers are delighted to have the level of care that the TRP offers and at any one time there are 15 children involved in this scheme. The foster carers agree to a 2 year placement as a minimum; they have peer mentoring and meet together frequently for support. All the children are assessed by a clinical psychologist and this assessment includes an assessment of attachment strategies, relationships, behaviour, educational process and special needs.

The TRP structure aims to support the foster carers to re-parent the child by facilitating a safe entry into their care with routines, repetition and a simple, small, nurturing routine. There are monthly network meetings for each child, monthly support groups for carers and supervision with fostering TRP lead social workers.Ā  The meetings are focused on the psychological experiences and not on decision making and are aimed at progressing towards a guided transition to permanence with a transition period of authentic involvement. An example was shared of a child who needed to be nurtured like a baby when he was in year one in order to make the appropriate development and went onto make extraordinary progress including academic success.

Presentation B

Dr. Hazel Douglas, also a clinical psychologist then continued the presentations by introducing the Forum to the research that showed that the UK childrenā€™s happiness is 21st out of 21 nations. Why is that? The Netherlands were seen as the best country in raising happy children and Paul Vangeert, Professor of Developmental Psychology explained that the Netherlands is a child friendly society where there is a high focus on young children and a focus on relationships. Hazel asserted that there is not enough focus in the UK on the child and parent relationship and the major resilience factor for children in having one stable, consistent adult parent. She asserted that the systems could help but often they don’t.Ā 

Hazel continued to explore the concept of epigenetics which suggests the importance of nature AND nurture. This illustrated why relationships are the main focus of the Solihull approach. She explored how within relationships, containment is key and facilitates the ability to restore the capacity to think and helps the parent to think about their child, relate to their child, helps the child with anxiety and emotion so that the child is free to relate and helps the parent process the ā€˜oldā€™ emotions (often from trauma) so that the parent can relate to the actual child in front of them. Containment is the key to the ability to create a coherent story as it activates the brain to process it.

The aim of the Solihull approach is to increase the quality of relationships in a low cost way by supporting relationships from antenatal to late adolescence. There are currently 10,000 trained family and child practitioners who work in this field and the training is facilitated in childrenā€™s centreā€™s and schools across the UK and in many nations around the globe.

The conclusion from Dr. Douglas was that the children in the UK have the lowest rate of emotional wellbeing and a focus on relationships would be the key to changing this.

Presentation C

Dr. Alex HassettĀ then followed in his presentation, which focused on a research project involving schools.Ā  He emphasized the importance of the Solihull approach as a model for understanding and thinking about relationships and for providing a shared language and framework to help provide containment forĀ  professional worker.Ā  He explained how the Solihull approach supports the work that schools are doing around SEAL, including making the link between containment, reciprocity and learning more explicit. The approach emphasises the relationships between educator and pupils and the relational context of effective behaviour management.Ā 

Dr. Hasset then explored the impact of emotions on childrenā€™s capacity to concentrate, learn and think. The staff in schools that engage with the Solihull approach are encouraged to think and reflect about the children can be calmed down and also reflect on how teaching and learning has to take place in a containing environment. He asserted that traumatised children sometimes need specific approaches to enable them to engage in education where there is an understanding of what they have experienced and why they canā€™t always respond in a manner that is expected.

The aim is to help school staff think about brain development alongside behaviour management with a specific focus on containment and reciprocity in order to help the children learn to regulate themselves.

He then presented the results of a pilot study in four primary schools, where the Solihull approach was introduced. It saw an increase in childrenā€™s well being and an increase in teacherā€™s health and reduction in stress.

John DiamondĀ then facilitated a time of reflection and discussion about the main themes that were elicited from the presentations.Ā 

Stephen BellĀ concluded the Forum by stating that whilst we are a prosperous country there is a fundamental issue with relationship poverty.Ā  The three speakers were thanked for their insightful presentations and all present were encouraged toĀ  join the IRCT if not already members.