Adverse Childhood Experiences; Can You Change The Hand That’s Dealt?
Trauma Informed Care and Nurturing Partnerships with Families To Strengthen Relationships, Increase Resilience and Improve Outcomes for Children
Chapter Summary and Key Points
Numerous studies are increasingly exposing relationships between childhood trauma and health-damaging behaviours, and poor health and social outcomes in adulthood (Davidson, Bunting et al, 2012). It is clear that momentum regarding awareness and training in relation to trauma and Adverse Childhood Experiences (ACEs), is rapidly developing across Northern Ireland (Felitti, Anda, Nordenberg et all, 1998).
ACEs are stressful experiences occurring during childhood that directly harm a child e.g. neglect, or sexual or physical abuse, or which affect the environment in which they live e.g. growing up in a house with domestic violence or substance misuse. (Bellis et al 2017).
This chapter will explore the specialist work undertaken with vulnerable children and families at The Salvation Army’s Thorndale Parenting Assessment Centre in Belfast, with particular focus upon ACEs, relational trauma and how the interventions of voluntary sector social work services can begin to buffer some of the toxic stress and reduce the impact of such ACEs by developing resilience with the service user group.
The following key points will be included:
How voluntary services are best placed to consider preventative early intervention enhanced by increased ACE aware practice.
How this increased insight can lead to reparation and healing by making best use of close relationships and direct therapeutic interventions with families to begin to reduce or buffer against many of these stressors.
In addition to core relational-based practice, this chapter will look at ways in which voluntary organisations and professionals can provide effective services based on nurturing parenting and the development of resilience, along with the provision of scaffolding services and a Team around the Family approach (Kendall, 2010).
The importance of Trauma-Informed Environments and Reparative Relationships. (Treisman, 2016)
The Salvation Army is an international movement and part of the universal Christian Church, that exists to ‘save souls, grow saints and serve suffering humanity’ (Gowans, 2000). Inspired by faith, The Salvation Army engages in an integrated mission of physical, emotional and spiritual health and well-being for every person. With approximately 90 services across the United Kingdom and Ireland territory, The Salvation Army works at the frontline with some of the most marginalised individuals in society. Across fields of homelessness, mental health, addiction, criminal justice, older people’s services, anti-human trafficking, and family and childcare, many of these service users will have experienced high levels of adversity and trauma. This chapter will provide detail of how the specialist parenting support, intervention and social work assessment service at Thorndale Family Centre, strives to deliver an organisational priority of transformation, aiming to bring about lasting change within people’s lives.
Thorndale is a complex of self-contained accommodation with 24-hour staff availability, intervention, support, monitoring and supervision provided on a needs-led basis. Families are referred by statutory Family and Childcare teams, and a comprehensive parenting capacity assessment requested when there are significant concerns regarding standards of care being provided for children, family dynamics and relationships, parental motivation and level of insight. At Thorndale we work with the referred family for a minimum of three months, providing education, intervention and comprehensive assessment.
These children and parents are most likely to have experienced a range of adversities and traumas throughout their lives, and concerns will be at the level where consideration is being given to whether the children require alternative long-term care outside their birth families. Where such decisions are being made, it is essential that our care, support and social work intervention is finely tuned and highly skilled, is delivered in a trauma-informed manner, and from a position of an advanced understanding of the impact of ACEs and trauma upon a child, and indeed a parent’s life.
Working under the legislative framework of The Children (Northern Ireland) Order 1995, and the principle that parents should be supported to exercise their parental responsibility, Thorndale is concerned with helping families live together safely and well, by enhancing and improving parenting skills, family dynamics, and promoting well-being. With the welfare of the child being paramount (The Children (NI) Order, 1995), we are therefore required to strike the appropriate balance between children’s needs and rights, and parent’s rights and responsibilities. We work within, and try to make sense of, the interface between parenting capacity, family relationships and functioning, and children’s well-being. Our assessments are child-centred in that whilst the focus of our support and interventions is to assist parents, it is essential that we keep assessing whether this is leading to sufficient improvement in the capacity of the parents to respond to each of their children’s needs (Munro, 2011). This, at times, requires difficult judgments about whether the parents can change quickly enough to meet the child’s developmental needs.
Registered and regulated by The Regulation Quality and Improvement Authority (RQIA), the Parenting Service is led by a team of experienced social workers and support workers. Following referrals from the five Northern Ireland Health and Social Care Trusts (HSCTs) and also from TUSLA (The Republic of Ireland’s Child and Family Agency), Thorndale can then provide a bespoke package of tailored support for families to safely remain together whilst essential improvement is made with regard to the care afforded to the children.
Evidenced-based methods, models and social work interventions along with a team around the family approach, teach, support and enable parents to develop improved insight into their lives and areas of difficulty. This enables them to subsequently make the necessary changes within their lifestyles and family relationships as we aim to promote resilience for both parents and children. Our purpose is to provide a safe, supportive, enabling and nurturing environment, with specialist support, assessments and interventions at times of greatest need. This then promotes resilience so that children are assisted to fulfil their potential, and their families are supported to begin to deal with past trauma, and effect change within their parenting and family lifestyle.
Adverse Childhood Experiences are increasingly being recognised for the significant impact they have upon children and adults. Children who experience these types of traumas and adversities in their early childhood, are not only affected at the time, but can suffer the consequences and impacts well into their adulthood (Young Minds NHS England, 2017).
The concept and impact of trauma is not new knowledge within social work, however this ever-growing body of ACEs research (Bellis, 2017) is revealing more about the long-term impacts that adverse experiences and events during childhood have on individuals’ life chances. These ACEs such as abuse, neglect and dysfunctional home environments have been shown to be associated with the development of a wide range of negative outcomes during adulthood across a range of domains including mental health, social functioning, physical health, offending, employment, and harmful behaviours including alcohol misuse, drug use, risky sexual behaviour, violence and crime (Felitti et al, 1998). In addition, ACEs have also been linked to diseases such as diabetes, mental illness, cancer, cardiovascular disease, and ultimately to premature mortality (Bellis et al, 2014). As the number of ACEs increases, so does the risk of negative life outcomes. Spratt (2011) stresses the central idea of ‘multiples matter’, in that the greater number of adversities a child encounters, the more likely it will be that they will go on to experience poor outcomes as an adult.
One of the key strategic drivers from The Salvation Army’s research ‘The Seeds of Exclusion’ (2008) was to identify families in need and at risk and provide effective early intervention programmes of support, to address the antecedents of poor relationships and family experiences, as these can ultimately lead to people developing multiple needs and becoming excluded from society. Many of these individuals are those currently being supported by The Salvation Army services across the United Kingdom and Ireland - adults living with homelessness, chronic health needs, alcohol and substance addictions, mental health challenges, complex traumas, and broken family relationships and connections.
The ‘Making not Breaking’ Report (The Care Inquiry, 2013), stresses that relationships with people who care for and about children are the golden thread in children’s lives. The quality of a child’s relationships is the lens through which we assess and understand what we need to do. In order to feel psychologically safe, we must have trusted relationships and live in an environment in which we feel cared for. This is essential as reparation and well-being cannot fully happen if a child does not feel safe (Treisman, 2016).
The Department of Health Social Work Strategy ‘Improving and Safeguarding Social Wellbeing’ (2017), highlights ‘Relationships and Belonging’ as a cornerstone of social well-being. Social inclusion and participation in society can become enhanced when people have stable, supportive and trusting relationships, and when they feel cared for, secure and protected by those close to them. If these crucial relationships with children and families are not adequately established, then it could be argued that any subsequent involvement and intervention will not result in meaningful or sustainable change (Trevithick, 2012).
A greater understanding of ACEs across the sector helps create a shared appreciation of the impact of adversity in childhood (Hughes et al, 2017). This initial recognition and understanding then leads to a shift in focus to include prevention of ACEs, supporting the development of resilience in individuals and families, and ACE aware and trauma-informed service provision (Hughes et al, 2017).
The message seems clear – ideally we should aim to prevent children experiencing these traumas and ACEs in the first instance (Barnardo’s, 2014). More also needs to be done to not only react and protect children from abusive or harmful situations, but also to intervene preventatively to place greater focus on reversing the impact of these ACEs by effective engagement with children, parents and families, with targeted, reparative support and education (Hughes, 2017).
Whilst the information and knowledge relating to ACEs shouldn’t be new to us as social workers, it can however be helpful in enabling us to have a better appreciation of service users’ lives and circumstances. Being able to identify and recognise the social, emotional and health needs that parents and children who experience adversity and additional complexity may face, is vital to any subsequent intervention and effective provision.
Enhanced appreciation and understanding of previous traumas our service users may be facing, such as isolation, broken relationships or childhood adversity, requires us to make sense of these issues and events and to start to make the connections. This results in us having greater insight into the real needs and lived experiences of the children and families. However, in addition to an awareness of adversity and the prevalence of ACEs, what is more important is a deeper consideration of impact. At Thorndale it is important that we are critically reflective practitioners and consider the likely impact on the parent and the parenting capacity, and subsequent interventions that may be effective.
We do this with both rigour and also with grace, fostering hope rather than hopelessness, and through the development of respectful nurturing relationships, the use of questioning approaches, and by moving from paternalism to partnership with families (Mahon, 2017). For many parents within Thorndale, this is the first time they will have had the safe space and opportunity with support to reflect upon their own situation and consider their parenting from different perspectives. It is important that we help parents understand the adversities they have been living with, and how these same experiences may impact upon their children if we do not intervene to change that narrative.
The NSPCC (2016) publication ‘Looking After Infant Mental Health in Northern Ireland: our case for change’, stresses that whilst it is known that when children experience abuse or neglect, then their health and future development can be profoundly negatively impacted, change can however happen. This research suggests if they are given safety, stability and the right support early on, then they can begin to recover from this trauma (NSPCC, 2016). Safe, loving and effective care is crucial, suggesting that stable relationships really do matter, and therefore more needs to be done to help birth parents learn to care better for their children, and to meet their needs more holistically. (Crittenden, 2008).
When high quality caregiving is combined with added interventions with the child, then this can further positively affect children’s development and well-being (Luke, Sinclair, Woolgar, and Sebba, 2014). Given the compelling evidence with regard to the negative impact of ACEs alongside the evidence that there is hope, and that we can intervene to reduce and counteract these detrimental impacts (Bellis, 2014), it is therefore essential that the work with families at Thorndale focuses upon not only early intervention and prevention, but also reparation, healing and development in the situations where negative experiences and trauma have already occurred.
This requires us to demonstrate and develop ACE-aware practice with parents and to assist them to understand such adversities so that they can then place more meaning and context around their own life, lifestyle choices and any specific challenges they may be encountering.
Relationship Based Practice
Gilligan (2001) stresses the importance of supportive relationships for children and families whose home lives and environment are perhaps not the secure base they require. For these individuals, Gilligan (2001) suggests a scaffolding or network of supports based upon social, recreational, and professional helping relationships, as the best alternative. Protective factors that may enhance resilience begin to emerge when these supportive relationships are provided around children and adults. The degree of resilience displayed by a person in a certain context can be said to be related to the extent to which that context and environment have elements that nurture this resilience (Gilligan, 2004).
Specific therapeutic interventions are important, but at best these might be for several hours each week. What is much more significant is the availability of 24-hour support and relationships around a family. This relationship-based social work (McColgan et al, 2017) is key and central to the success of effective working with children and families experiencing adversity and trauma. Given the potential challenge, however, for the service user to be observed so intensively, it is important that we ensure that our interventions are purposeful, necessary and measured, and that we remain mindful of the power imbalance and the fear that this could create. At Thorndale we consider ourselves to be passionate about repairing relationships and also creating environments around children and families which are safe, compassionate and nurturing. Our feedback from parents at Thorndale has demonstrated that they view this as a “kinder approach”, frequently telling us that for the first time they feel listened to and accepted for who they are, rather than judged for what they have done or what has happened in their lives. This involves suspending judgment as a professional and being curious to understand parents’ situations more fully (Treisman, 2016).
At Thorndale we have the opportunity, time and resource of the residential facility to significantly invest in the establishment and development of these crucial relationships with families, but more importantly we have compassion, advanced communication skills, unconditional positive regard for people, and a belief in the potential for change within everyone. In this way we strive to instil a sense of hope. We do this with positivity, praise, recognition of emotions, affirmation and validation of our service users’ feelings.
Perry (2007) stresses the centrality of relationships within all supportive, helping and healing interventions with service users, and he promotes these consistent, caring connections to others as being central to all recovery and the cornerstone for any effective intervention. We need to support families to see and understand these connections, to develop deeper empathy for their children and their experiences, and to help them to make connections with regard to their family situation. It is notable when we hear parents say: “I never knew that before”, or “I have never thought about it that way until now”.
At Thorndale, there is more at stake if we don’t get initial relationships right. Following the initial period of intervention and assessment, it is our role to report on and make recommendations about a family’s parenting capacity and suggest future care arrangements for the children. These intensive assessments require us to work very closely with the families throughout this time. We are on site with them during every stage of this journey as they receive teaching, education, support, guidance, advocacy, encouragement, and also challenge where and when necessary. This results in us seeing first hand many of the strengths and also the deficits, and the highs along with the lows. Taking a strengths-based approach (Duncan and Hubble, 2000) does not mean we do not identify and manage risks, or highlight and address areas requiring improvement, but it enables us to practice with families using a positivist approach. By being ACE aware and Trauma Informed we will move from asking “What’s wrong with you?”, to “What happened to you?”. This conveys greater understanding and nurturing, rather than blame and shame.
At Thorndale, our close working relationships and our use of practice approaches, models and tools such as Signs of Safety (Turnell, 1999) and The Family Model (Falkov, 2013) with families enable us to be in a position to take families from primarily being motivated to no longer have social services involvement, to a position of truly understanding why change is essential for the wellbeing and safety of their children. In this way we are not simply assessing parenting capacity, we are enhancing adult (parent) capabilities to improve child outcomes. In our intentions and efforts, therefore, to improve outcomes for the children and families in our care, we must not solely focus upon reducing sources of stress in the lives of the children and families, but also strengthen core life skills, and, even more importantly, support responsive and reparative relationships for both the children and the adults.
Responsive relationships with adults can benefit children, promoting healthy brain development, and also providing the protection needed to prevent very challenging experiences from producing a toxic stress response (The Centre on the Developing Child, Harvard University, 2006). Childrens’ healthy development can be promoted, and adults’ core skills reinforced when strong relationships exist between workers and client, and when, as workers, we can support responsive ‘serve and return’ interactions between parents and their children (Treisman, 2016). These are required to help children learn to trust and that their world and care is both safe and predictable. We need to demonstrate to children that relationships are not a threat and are worth investing in, given that ‘relational trauma requires relational repair’ (Treisman, 2016).
For many of the families referred, they see this placement at Thorndale as their last chance and can therefore be fearful of negative judgements being made with regard to their parenting and coping abilities. This can lead to parents presenting as anxious, which in turn impacts upon their emotional wellbeing and can also be easily sensed by the child. Staff need to be mindful of the potential for disguised compliance from parents facing assessment (Munro, 2011) by way of giving the appearance of cooperating simply to avoid raising suspicions or allay concerns. It is essential that in addition to observing parental behaviours and listening to their accounts, staff place importance upon establishing not only the facts, but also the outcomes and impact on the child’s lived experiences.
Strong efforts are therefore required, particularly during the initial days and weeks from the key staff involved with each family, to build early positive relationships which should then hopefully enable greater foundational trusting relationships to grow throughout the placement. This is a core skill and an essential requirement for all supportive engagements and requires us to remain grounded within relationship-based social work.
At Thorndale we need to connect with children and families on a deeply empathic level, and this requires us at times to not only expose a little of our own vulnerability by way of positive self-disclosure, but to be attuned to the concept of possible shame and guilt for the parents and children we are working with. De Thierry (2018) refers to toxic shame as shame that has its origins in early childhood experiences and is compounded by the child’s experiences as they grow up. As practitioners we must become attuned to these parents or children, to slow our responses and reactions down, to listen carefully and try to understand their emotional and behavioural cues. Also, by providing them with many experiences of acceptance, kindness, support and nurture through words and actions (especially in response to negative behaviour), that they begin to understand on a deep and subconscious level what feeling valued feels like.
Thorndale provides opportunities for staff to role model positive relationships with each other and across the service. It is clear that healthy relationships between parents and their children are important, but research (Young Minds NHS England, 2017), also highlights the importance of safe, stable, nurturing relationships between parents and other adults in preventing child maltreatment.
Building further upon the positive role modelling provided by the Thorndale staff team to both children and adults, it is also necessary for us to provide education and opportunity for enhanced relationship development. Focused reflective discussion and skill building sessions with regard to healthy relationships are available to all parents, in addition to the services of an independent therapeutic counsellor offering weekly one-to-one counselling sessions, and also mediation sessions between couples or other family members as required. Additionally, anger management sessions for individuals or couples provide a safe opportunity to reflect upon communications styles, anger triggers, and then most importantly strategies to reduce anger or intervene before any initial build-up escalates.
A Women’s Aid outreach worker providing 1-to-1 support on site, is an additional source of education in relation to healthy relationships, and the use of programmes and community groups such as The Incredible Years (Webster-Stratton, 2006), Let’s Stick Together (Care for The Family, 2013), Surestart, Family Nurse Partnership (NHS), and Homestart, all enhance and promote supportive and nurturing adult relationships for parents. It is our belief at Thorndale that if safe, stable and nurturing relationships for parents are promoted and enhanced, then children too will benefit (Felitti, 1998)
Nurturing Parenting, Development of Resilience and a Team Around The Family
Whilst a wide range of specialist support services and professional teaching interventions can be helpful and, in fact, essential at critical times for many children, at Thorndale we are also encouraged by Hughes’s writings (2009) which suggest that nurturing parenting is the single most effective thing for these children. Where and when possible, parents are the best agents for change when children have experienced adversity and trauma. (Hughes, 2009).
Hughes (2009) stresses that it is the everyday interventions of parents that have the most power to transform a child’s life. If it is these interventions of the parents which have been causing the trauma, then where possible, supports and services at Thorndale aim to re-train parents, and provide safe and enabling environments for all family members, along with positive role-modelling. Children need to learn that they are safe and to learn different ways of doing and being in relationships (Treisman, 2016). At Thorndale we work with the whole family unit from a systemic approach, taking time to explore all sources of strength and support, and the dynamics and the interconnections of each of the relationships (Falkov, 2012). Within the voluntary sector we frequently have opportunities, and indeed permission from parents, to engage directly with children. This enables us to get to know children better, to truly ‘hear’ their voices whilst ensuring that we give adequate consideration to their ‘lived experiences. (Peyton, 2015)
Having an available trusting adult helps to build resilience in children (Bellis et al, 2017). The single most common factor for children who develop the capacity to overcome serious hardship is having at least one stable and committed relationship with another adult (Center on the Developing Child at Harvard University, 2017). Ideally, this trusting adult will be their parent, however many children being rehabilitated to parental care, have not yet reached the stage where they can trust their parent once again, or feel they can yet rely on them. In these situations, then the staff team must temporarily become that available and trusting adult. With time and support, this role will lessen, and the parent will take on this responsibility once again. For these children and parents, always having someone believe in them can make a real difference. For children who have experienced adversity and trauma, they need their carers and workers to be the ‘rainbow in the storm’ (Treisman, 2016).
For the majority of the families referred to Thorndale there are issues regarding attachment, family relationships, empathic care and emotional warmth within the parenting style, yet many parents will initially report the concerns as relating to behavioural difficulties. At the core of any successful intervention, is the connection between the parent and child. A major focus upon play, attention and interaction using The Incredible Years (Webster-Stratton, 2006) and Solihull Approaches (NHS, 2006) begins to rebuild or repair the relationship between child and parent, before any attention is placed upon behavior management. If a parent understands and knows their child better, then their responses to them may be more appropriate, and therefore in turn there should be less unwanted behaviours for the parent to have to manage.
These approaches have their limitations, however, and must be used when appropriate for the specific child and family concerned. Hughes (2009) argues that attachment-focused parenting is what is essential when working with children who have experienced trauma, adversity and relational ruptures. Undoubtedly, limits and boundaries are essential when managing the daily responsibilities of parenting, however it is the parent-child attachment relationship which is the key factor in the child’s development. ‘More connection, less correction’ is the model promoted with the families at Thorndale to promote the optimal development of children (Hughes, 2009).
For many parents, Thorndale may be the first time they have ever been taught something, or had this aspect of parenting demonstrated or explained to them. This may be their opportunity to learn, and it is essential, therefore, that we take consideration of individual learning styles, along with cognitive abilities to ensure our provision is appropriate and effective. By teaching parents new skills and enhancing their understanding of the adversities and disadvantages they themselves have experienced, this is an opportunity for them to attempt to reduce the prevalence of ACEs for their children, and in this way the cycle of adversity can be disrupted.
With respectful role-modelling, reflective discussions, observations of family interactions and constructive feedback, the staff team can assist parents to become more attuned to their children’s cues, encouraging them to engage in more approriate responses and better address their children’s needs. Similarly, staff are required to point out how the children may be responding more negatively to heightened emotions, raised voices or increased levels of stress or agitation. With our open communication with parents and the underpinning connection and positive working relationship, this enables us to have these difficult conversations much more easily.
In addition to the importance of foundational relationships between staff and families, the teaching to enhance and develop more effective parenting skills, and the provision of a safe and enabling environment around the families, it is important that we seek every opportunity to further build resilience for the children and families. Resilience encompasses children’s individual strengths and capabilities as well as their social and physical environments. Resilience is not an individual trait, or only something that children are born with. Rather, childrens’ interactions with their social and physical environments build resilience (Fogarty, 1994). Resilience is also dependent on the structures and policies that help scaffold children and make positive resources available. At Thorndale, therefore, we need to ensure that we have built sufficient and safe scaffolding around the children and families in our care. Scaffolding allows ‘building and development’ to progress safely (Gilligan, 1997) and it is important that children (and parents) are able to use scaffolding of support and resources when they need it. We can help young people to be resilient in the face of adversity by helping build their sense of belonging to, and acceptance by people who value them. We can also help them to be resilient by building their sense of self-esteem and self-efficacy through their accomplishment of tasks they value.
At Thorndale, we acknowledge the centrality of the importance of a comprehensive assessment of whether a child is able to remain within parental care, and whilst this has been the reason for their referral to us, we are also encouraged by Gilligan’s (1997) model of resilience. In this, Gilligan argues that achieving stability and improvement in some parts of a child’s life, can have important positive spill-over effects into others, and can potentially yield greater benefit in terms of resilience than an ‘all or nothing’ approach.
Gilligan’s (1997) model of resilience promotes the importance of ‘leisure’ activities, not only to provide a potentially enjoyable and satisfying activity for the child, but to also ensure this additional medium of access to supportive relationships. Gilligan (1997) suggests that this is an incredibly important yet relatively neglected factor when considering essential supports and interventions for children ‘in care’. Achievement in activities which the child values is another way of helping to build their self esteem, and Rutter (2009) remind us of the importance of self esteem as a vital buffer against stress. These concepts have been mirrored within programme developments across The Salvation Army for many years, with a central focus upon meaning and purpose for the well-being of our adult service users. At Thorndale, we aim to bring this back to earlier intervention, to ensure that in addition to a range of accredited and professional social work assessments and supports, that a range of activity-based interventions are available from the parenting team, and greatly enhanced by the role and involvement of the Salvation Army chaplain.
There is no one prescriptive model or over-arching ‘one size fits all’ programme which will address the needs of all families. What is important is to have a range of services, activities and support systems around these families which they can access and call upon as required. A range of effective partnerships have been developed within the new model at Thorndale to enhance the services available to children and families. The various close partnerships enjoyed with community agencies in addition to those professional services commissioned, result in a seamless multi-disciplinary service being available to the families referred to the centre.
Challenges from the Sector – Use of Accredited Models and Approaches
Managing complex services and such complex needs within the voluntary sector, requires us to think creatively and innovatively, but also sensibly and strategically. We are continually faced with significant changes within the systems and structures, shrinking resources and reduced contracts, yet all of these alongside increased expectations from commissioners, funders and regulatory bodies. Like other voluntary non-profit agencies, we have had to look for models and tools which help us align with our mission and values, whilst also ensuring that our interventions and our assessments are robust and evidenced-based. To remain current and reputable, it is essential that we are willing to respond to changing needs, trends and expectations and adapt and expand our interventions accordingly. Whilst we consider ourselves to be specialists when working with disempowered and complex families, it is essential that we are speaking the same language and offer the programmes, models and methods which are in line with best practice and developing trends within the statutory sector. Over the years, this has resulted in the Thorndale team being trained in and offering a range of accredited models, methods and interventions, including Family Outcomes Star (Triangle Consulting, 2015), The Graded Care Profile (NSPCC, 2018), PAMS - Parent Assessment Manual Software (S. McGaw, 1998), The Incredible Years Parenting Programme (Webster-Stratton, 2006), The Solihull Approach (NHS, 2006) The Family Model (Falkov, 2012), and more recently, Signs of Safety (Turnell, 1999).
Whilst there is a need to be up-to-date and using this common language, at the foundation of all of these practice approaches are core social work values. Thorndale has always striven to achieve collaborative partnerships with families, based upon effective relationships, using strength-based practice. In this way we attempt to work with families to identify and highlight the strengths and coping abilities, not just the concerns and risks. This helps to prevent the problems from overwhelming and discouraging everyone involved, and as we work to build adult capabilities to improve child outcomes, we remind ourselves that ‘what we focus on, grows’ (Treisman, 2016).
The research into ACEs (Bellis, 2017) and the impact they have upon health and wellbeing outcomes in childhood and adulthood is a clear and strong argument for social work intervention with children and families within the voluntary sector. The longer children remain at risk of harm, then the greater the chances are that their adult lives will be characterised by challenge and adversity and that their children will in turn be at risk (Peyton, 2015). Whilst ACEs negatively impact mental and physical health across the lifecourse, what is also clear is that such impacts can be substantially mitigated by early intervention initiatives, appropriate supports and reparative relationships (Bellis, 2017). Prevention of some ACESs for many children (and parents) through support and intervention is ideal, however for others who have already suffered traumatic experiences, targeted intervention can begin to build and develop resilience, and reduce the toxic impact of these (Treisman, 2016).
Keeping children safe, well and protected from harm and abuse is a core element of social work practice, a key component of social wellbeing and a cornerstone of The Social Work and Wellbeing Strategy (2017). Positive and attuned parenting not only ensures the short-term safety and wellbeing of the child, but also enables the child to develop a longer-term sense of security and stability. The child comes to trust the care and protection being afforded to them, and when they feel safe within their own homes, families and, indeed, communities then they are able to fulfill their true potential.
The most important takeaway from this chapter is that it appears that it is possible for us to support children, young people, and parents in developing resilience and enhancing their ability to cope before and after the onset of trauma. It is clear that relationships are central to the safeguarding of children - relationships with parents, children, entire families and, indeed, with other professionals. These relationships bring trust, which in turn further strengthens relationships and leads to effective communication. The Salvation Army’s vision is to serve others in a way that makes a transformational difference in people’s daily lives, building quality relationships, listening and learning from each other and making connections that can lead to lasting change (TIDE, 2016). Within Thorndale our core interventions focus upon the development of such relationships, and these allow us to start to create new opportunities and break the previous cycles of adversity.
This chapter has highlighted the importance of not just simply treating the problematic symptoms within families but taking action to begin to both ascertain and then truly understand the cause, and has provided detail of how voluntary services can build resilience, reduce toxic stress, strengthen parental buffering, promote skills development, and use our relationships and people skills to bring about positive change. We must continue to strive to ensure the parents themselves feel valued, supported and enabled – in order to examine themselves without judgment as we support them to discover more conducive ways to care for their children within a safe environment. Our children’s behaviours are communications, and as parents and professionals we need to see this as a language we must learn. Their presentations and behaviours are always communicating something to us, and we must enable parents to learn to better ‘respond’, rather than ‘react’.
Given the compelling evidence with regard to the negative impact of such adversity in childhood, it is essential that work with families within the voluntary sector strives to retain a focus not only upon early intervention, prevention or protection but also upon reparation and healing and building a narrative of hope. No child or adult has to be destined to a life of adversity given that we know that ‘resilience trumps ACEs’ (Bellis, 2017). In this way, our efforts to reduce the impact of ACEs, buffer toxic stress, develop adult capacities and build resilience, can all contribute to ‘changing the hand’ which many children within our society have been ‘dealt’.
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