Storing up trouble: NCB report exposes major failures in the system

In September 2017, the All-Party Parliamentary Group for Children (APPGC) launched an inquiry into the causes and consequences of varying thresholds for children’s social care. The Inquiry’s findings are published in the report ‘Storing up trouble: a postcode lottery of children’s social care’.

This vital document exposes major failures in the system designed to support families and children. The main concerns raised:

• Thresholds for child protection or enabling access for support are often too high and thresholds vary significantly between local authorities
• Children in need of a child protection plan are, in 2/3 of cases, being left vulnerable to continued abuse or neglect
• Only a “small proportion” of resources is spent on early help and family support
• Families and children in need experience a high turnover of social workers assigned to them

A persistent theme in the report is that support often comes very late, i.e. when a child is at risk of being taken into care. This increases cost to the state and delays the opportunity to relieve suffering. “Tolerance” for early help is “based on resources” – there is simply not enough capacity in the system.

One major conclusion that we can draw is that short term failure to offer appropriate services leads to long term increased cost and more children suffering the impact of developmental trauma and needing more complex services later on.

The report acknowledges (without specific reference) that there is often a combination of Adverse Childhood Experiences present for children in need of early help.

Help us help children and adults recover from early developmental trauma – a right acknowledged by the United Nations and signed by the U.K. under the UN Convention on the rights of a child.

Turning Children’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 “Turning Children’s Lives Around” – overcoming the impact of childhood adversity through therapeutically focused integrated care.

The presentation focused on the Five Rivers model of ‘trauma and attachment informed care’ 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 “three key strands” (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 ‘transform children’s lives’ by minimising the impact of their traumatic experiences as they develop’.

Concluding the talk, Richard made an important point to the audience, that ‘the integrated model provides the glue and a shared understanding helps people to connect’. 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 person’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 ‘Turning children’s lives around’ 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 – 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.

 

What will the journey look like for the survivors of Rotherham?

What will the journey look like for the survivors of Rotherham?

In order to comprehend the recovery journey for a child such as those in the recent sexual exploitation cases in Rotherham, this paper shall paint a picture of the journey for a child victim from the point of disclosure.

The first disclosure

For a child to disclose abuse of any nature, it takes immense courage and usually requires them to have a relationship with an adult that they know cares for them deeply. In the context of this trusting relationship, a child may feel able to question the events in their life that are causing a sense of confusion and pain and if the listener is actively listening rather than being dismissive, the child may begin to disclose a few crucial details. These details are often mentioned with tension and nervousness to test the adult, to explore if that adult will respond or dismiss with mocking, blaming words. If the exploration is facilitated gently in a warm and respectful environment the child will feel safe and believe that the adult will ‘make things better.’ Sadly, for many children, they test the waters in conversations with trusted adults to find that they probably won’t be believed- or worse still- they will be reprimanded for any suggestions that another adult has done anything so awful. For many children, the right environment to share their concerns was never facilitated and shame and fear silenced them, often for years.

Disclosure to appropriate professionals

Following the initial disclosure the child then has to find the courage to speak to many different professionals about the events that are too horrific to share. Trauma shuts down the broca area of the brain that is responsible for speech and language, so to ask a traumatised person repetitive questions about the most awful experiences that words would struggle to describe, can further re traumatise a child unless there is great effort made to enable them to feel a sense of safety. The use of small hand held toys to enable them to squish, fiddle or puzzle while they speak softens the clinical questions of a professional who needs details in order to fulfill their role of protection of children and prosecution of the perpetrator. A warm, engaging, empathetic approach can make the difference between the child remaining in a state of shock and horror or feeling understood and cared for. The need for forensic medical examinations exacerbates the stress levels of the child, but a caring adult bringing reassurance can reduce the horrific intensity of the traumatic invasion.

Facing the everyday world

Often a whirlwind of appointments and professionals can materialise and then stop just as suddenly. The child is often left to ‘get on with life’ as if nothing has happened. School seems like a different world, full of noise and chaos; laughter and innocence. The child can feel dirty, different, ashamed, awkward and isolated in the midst of the happy faces. Panic can rise quickly and without warning, for example when a teacher shouts, because that angry face resembles other abusive adults shouting commands or sly manipulating requests. Flashbacks, panic attacks, the sound of internal screams all become things to be managed whilst attempting to avoid being told off for fear of more anger and pain. If the school grasps these challenges the smallest things can transform the child’s experience. If the child has a teacher greet them kindly, warmly and say something gentle such as ‘if you need some time out, if you need to chat, if you need to find somewhere safe, just come and find me in room 2 and I’ll/ or Miss R  will be there for you.’ If the child could find school to be a place of understanding, with staff who are kind, non-judgemental, accepting and with genuine warmth, this can lower the stress levels of the child immediately which in turn reduces the intensity and quantity of trauma symptoms that develop to enable the child to survive.

A child needs support

The CPS Guidelines on Prosecuting Cases of Child Sexual Abuse recognizes that children need support.

‘Children and young people who have been the subject of sexual abuse are likely to require a very high level of support. The police will be responsible primarily for facilitating this, although they will not be responsible for delivering emotional or psychological support.’

The DSM-5 lists the reasons that emotional support will probably be needed. Trauma symptoms could become part a child’s narrative having experienced traumatic, abusive experiences that render a child powerless. These symptoms range from dissociative reactions such as flashbacks, persistent avoidance of stimuli associated with the traumatic event, avoidance of or efforts to avoid distressing memories, or external reminders that arouse distressing memories, thoughts or feelings closely associated with the traumatic event(s). The child could experience frightening dreams, marked physiological reactions, persistent and exaggerated negative beliefs or expectations about oneself others or the world. Persistent negative emotional state, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, persistent inability to experience positive emotions, irritable behaviour and angry outbursts, reckless or self destructive behavior, hypervigilance and so the list goes on.

These symptoms generally do not subside with time. They can become more entrenched as behavior patterns that protect and enable a child to survive in the harshness of a world that would allow such horrific things to happen to them. The CPS guidance ‘Provision of Therapy for Child Witnesses Prior to a Criminal Trial’ is clear that the best interests of the victim or witness are the paramount consideration in decisions about therapy. There is no bar to a victim seeking pre-trial therapy or counselling and neither the police nor the CPS should prevent therapy from taking place prior to a trial.

The United Nations Convention on the Rights of the Child (UNCRC) 1989 says that is essential ‘to take all appropriate measures to promote the physical and psychological recovery and social reintegration of child victims of violence’.

Therapy as an essential intervention for recovery

The NSPCC report in 2001 discovered an estimated 55,000 children who have been sexually abused received no therapeutic support each year due to a short fall in the availability of therapeutic services. Yet it is recognized that;

Long term therapeutic work for children who have been abused is a necessary and important way of helping with issues of confused feelings, including those of boundaries, intimacy, anger, abandonment, control and lack of control.’ (Murphy. J. 2001.p123)

Children need a safe place to process their experiences in an environment that doesn’t rush them and gives them time and space to go at their pace. The three phase treatment plan of most trauma therapy intervention begins with the stabilization and safety phase and this can take time as the children learn how to build trust with another adult having had that trust shattered through the abuse experience. The focus is on building safety for the child and often the first piece of work is identifying and reflecting on the very concept of ‘safe’. Often therapeutic provision stops at this stage and doesn’t allow the time to progress into the processing of the experiences to enable the memories to be become part of the child’s narrative, with emotional appropriate language and an understanding of the experience. The feelings of shame, guilt, confusion, distrust, powerlessness and negative belief patterns need to be processed. The final stage is the rebuilding and future focused work where the child no longer feels their identity is the abuse experience but rather has a greater and richer sense of who they are in the world. This can take years but prevents long term mental and physical health challenges in their future.

Other helpful recovery aids

Every child benefits from supportive, warm, genuine, kind adults who are safe, playful, curious and affirming. Children also find recovery is faster if they develop hobbies and interests that build resilience, such as sport, music, or art based activities experienced in safe, group times. They need their basic needs met of exercise, rest, play, healthy food, positive routines and a sense of belonging to a family and a community.

Recovery is possible

We need to prioritise the recovery journey for children who experience trauma. A recovered child is a child who is confident, at ease and has a voice. For this to happen there needs to be an increased investment into therapeutic services for children, increased parenting support projects and increasing training for professionals such as social workers, police, doctors, barristers and teachers on the impact of trauma on a child.

Betsy de Thierry

Founding Director of the Trauma Recovery Center (www.trc-uk.org) and trustee of IRCT (www. irct-uk.org)

Rotherham CSE and need to provide trauma recovery

A large-scale national disaster is being unveiled by the media across the UK, following the launch of the Rotherham Abuse Inquiry report released on 26th August 2014. No one knows the true scale of child sexual exploitation (CSE) in Rotherham, but the current conservative estimate is approximately 1400 children sexually exploited over the full Inquiry period from 1997 to 2013.

What is noticeable in the media is that once again the primary focus is not on the children, or on the emotional impact to them. The focus doesn’t seem to be acknowledging that each individual who was raped, assaulted or coerced into behaviour that terrified them has faced, or now faces, years of recovery from trauma. The focus in the media is not on the need for the victims to easily access trauma therapy that can help them process the horror, shock, shame, torment and pain over the coming years. We need to fight for a child centred focus.

Trauma recovery takes time. You cannot rush a person into psychological recovery. Each child has to listen to their own voice recounting the horror that they hope to forget, and explore the shock and deep sadness of what could have been. Every person has a right to emotional support as they face interviews, questions, their own memories, flashbacks and nightmares. But where is this support? How do people find it? Who will finance it?

As the child and their families wrestle with the shame, shock and horror of what has been experienced, there needs to be support in place; offering a listening ear and a shoulder to lean on as they process the trauma. But most victims will not be able to find appropriate professional support or – worse – won’t be able to afford it.

‘Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering.’ (Levine and Kline 2007;3)

 Central and vital questions need to be raised about the response to this national tragedy. Who is going to finance the trauma recovery for these victims? Who is going to ensure that it becomes a priority for the police and other frontline practitioners to understand how to identify the signs of abuse and the complexities of CSE?  Who will finance the recovery from trauma for the families, teachers and friends of those who have had to listen to and support the victims?

Despite being British, we need to acknowledge that human kind is not in-built to ‘just get over it’ or ‘forget it now and move on’. Neuroscience has shown that our minds and response to trauma is complex. Unprocessed trauma can lead to a host of physical complications, depression and anxiety, difficulties with concentration, learning and working, and long term relational challenges amongst many other symptoms.

We believe that we need to communicate clearly that justice is not just the perpetrators being arrested and prosecuted; it is also the facilitation of the right to recover from the traumatic experiences.

Attachment Aware/Trauma Informed Practice in School

I am very fortunate that my office is three doors away from the school counsellor.  I say fortunate because I am able to speak relatively regularly to her, and not only gain incredible insight from her comments but also to recognise and celebrate the unique and positive impact she has upon the school community.  I am proud that she, and our attempt to support children through difficult times, is not hidden away in a cupboard or as an adjunct to the ‘SEN zone’ or similar.  It is on a main thoroughfare of the school, and easily identifiable by all students as a very important place.

In one of our semi-regular conversations, the counsellor spoke to me about a year seven girl she had been supporting.  This student had recently lost a younger sibling, and was now enduring the terminal diagnosis of a step-parent.  As a school, we had mobilised the troops to support her and her older sister, and the school counselling service is a big part of that.

‘I’m so glad I came to Trinity’, the young girl had said.  She continued, ‘I was so worried that I would have to change when I came to high school, but here, everyone just makes sure that you fit’.

When I reflect on how we support children through traumatic episodes, but also help them recover from trauma, this statement has a special resonance.   We can never expect that the ‘mainstream’ school approaches of numbers on the doors and bells on the hour will suffice.  We have to consciously cushion our support around the child, and, for a short time at least, prioritise their recovery over all else.  Of course, the journey towards a Trauma Aware School is a slow one, and the goal of a child centred approach influencing curriculum and pedagogy must not be lost sight of.  The work we are developing alongside the Virtual Headteacher is key here and rightly identified as a local and regional priority.

In the interim though, my focus is on leading a school in which we are proud of the vocal, open and deliberate way that we discuss our support for children.  It is a central platform of our school ethos, cannot be divorced from my personal convictions and, of greatest importance, is the best way to support children and young people in a school setting.

I see the IRCT as being key to this.  It is only through effective research and discussion by committed professionals that we can achieve meaningful and lasting change that will support all children, but particularly the most hurt.

Chris Gabbett.

IRCT Trustee
Principal – TRINITY CATHOLIC SCHOOL, Leamington Spa.

IRCT Best Practice Forum – Launch Day

Lord Francis Listowel, IRCT Patron, opened the Forum by welcoming members. He stressed the importance of the Forum members to join the IRCT to share good practice and he ably articulated the personal element of working to ensure that recovery is available to all children who have experienced trauma.

Stephen Bell, Chair of the IRCT Board then offered a reminder of the moral imperative of not only recovery work, but also of knowledge-sharing and dissemination of this best practice to the wider workforce.

To that end, Dr. Janet Rose, Principal Lecturer at Bath Spa University, presented on her work in building “Attachment Aware Schools”, tracking the three strands of attachment, neuroscience and emotion coaching. Her work focuses on addressing unmet attachment needs of children by equipping schools (both primary and secondary) with appropriate whole school policies and practice. Some of the more keys ideas to the programme include:

Introducing emotion coaching as a contrast to behaviourist theories of practice…transforming how we perceive student behavior in a practical way.

Encouraging empathy with the emotional state of children no matter the behavior while also maintaining standards.

Appointing an attachment lead/trauma lead for each school’s senior team

Using Pupil Premium funding to support the training for all school staff and developing consistency for support/canteen/duty staff who have contact with children.

Dr. Rose reminded the forum that the imperative for schools, and the child-centred workforce at large, is to help students heal from trauma, and not simply deal with the manifestations of that unresolved trauma. Her inspirational work has already produced positive initial data and outcomes and she shared feedback from a primary student who explained the effect of the new approach in his/her school as helping to “Stop the volcano in (my) tummy”. A worthwhile exploration/reminder of the power of a teacher to make a difference and, in a wider sense, of the role all of us can play in transforming the sense of self for vulnerable children.

Following on, Betsy de Thierry, Director of the Trauma Recovery Centre, spoke on Working with trafficked children and sexually exploited children. She began with a view of the general focus on awareness raising and the push for “rescue” of children in such traumatic situations, asking what happens when children get “rescued”? How are they best supported? What are we rescuing them to?

Betsy discussed her practice centred on therapy, training and creative work to aid recovering children as well as support for parents/carers/families while raising a number of provocative points. When discussing therapeutic mentoring, de Thierry asked what is the equivalent of the first aid level of access for children who have come through trauma? Again, for professionals working with students caught in or removed from such exploitative situations, we must ask and, more importantly, we must ensure we all know:

What is the road to recovery?
What does it look like?
How do we build consistency and attachment for these young people?
What is the difference between CSE v. Trafficking?
Further, what is the difference between Complex trauma v. trauma?

So, as the session came to a close our moderator, John Diamond (CEO of The Mulberry Bush Organisation) led a reflective discussion through the need for commitment for this sort of work, and explored some of the key recovery links between the efforts of our two speakers, including the focus on enhancing the children’s workforce through:
empowering professionals to heal
establishing a base level of empowerment/knowledge for all involved (including volunteers and foster carers) in supporting children who have experienced trauma.
Reducing negative emotions and feelings of being “de-skilled”
Building empathy, passion and consistency

With the points raised, questions asked and ways forward discussed, the forum was an excellent lead-in to the launch of the IRCT as well as a catalyst for the work we have begun.