by Sophie Baker

This is the fourth installment in Sophie Baker’s ‘What I wish I had known…’ series, where she reflects on her approach to practice when she started out – and what she would tell her younger self now.

Watching Adolescence this month brought back many memories of my early career. I was struck by the powerful acting, especially in an intense scene between Jamie (played by Owen Cooper) and his psychologist, where he was shouting, swearing and knocking over furniture.

It reminded me of my experiences with Shauna, a ten-year-old girl who spent much of her childhood in and out of care and who was one of the first children I worked with.

Shauna’s mother, who had bipolar disorder, provided loving care when well. But during her low periods, she couldn’t get out of bed and struggled to meet her children’s needs. In her highs, she took risks, falling into debt and forming unsafe relationships.

During these times, Shauna experienced physical and emotional neglect in a home environment that was dysregulated, chaotic and volatile.

Each time their mother’s mental health declined, Shauna and her siblings were moved to a temporary foster home, waiting for the moment they could return to her care.

As a result of her experiences, Shauna was often oppositional, impulsive and confrontational. It also meant that it became harder and harder to find her a stable foster placement.

Looking back, the memory of one afternoon I shared with Shauna leaves me contemplating what I wish I had known during my work with her.

Children won’t always behave in a way you expect

Sophie Baker has over 20 years of experience working in children’s social care

Some of my most treasured memories of my early career were spent with Shauna. For the most part, our interactions had been positive.

However, this afternoon was different. We were sitting in my car when I broke the news that she would be moving to another carer.

Abandoned. Again.

She immediately started shouting and screaming, banging her fists against her head and the car dashboard. I could feel my heart beating in my chest as she moved her face close to mine. She glared at me and then spat on my cheek.

Shauna spent the next five minutes or so in what I can only describe as white rage.

She took out my CDs and snapped each one.  She bent my sunglasses out of shape and threw them out of the car window.

Lastly, she got out of the car and climbed on to its roof. As I tried to encourage her down, she jumped up and down, denting it in the process.

Children with trauma will struggle to regulate their emotions

I can still remember the emotional and physical responses I experienced during her outburst. Initially, I was shocked.

I had been told that Shauna got angry, but up until that point had never experienced it firsthand. I was frightened that she would not only hurt herself but also hurt me as she hurled herself around.

My heart felt like it was going to burst out of my chest, and I could feel my cheeks burning red. My hands were shaking and as I tried to calm her down, my voice was trembling. I felt helpless to calm the situation.

What I learnt over the first few years of my career was that children that have experienced trauma like Shauna often struggle to regulate their emotions and behaviours. They can have impulsive and intense reactions to stress.

If I were able to turn back time, I would tell myself that Shauna was communicating in the best way she knew how. My role in that moment was to listen and to reassure her that I would stay with her until she calmed down.

No judgement – just unconditional support.

Their anger probably feels as frightening for them as it does to you

I am not ashamed to say that I was petrified during those moments. What I wish I had known was that Shauna was probably very frightened too, struggling to recognise the huge feelings she was experiencing.

Even as an inexperienced social worker, I knew it was imperative that I stayed calm and did not get caught in any kind of power struggle with Shauna. She needed time and space to calm down.

I knew that I needed to validate her feelings and show her I could contain her (and myself!). I needed to remain a positive role model by handling my own feelings in a calm way and modelling a healthy response to stress.

That was easier said than done, but I took deep breaths and kept reminding myself that I needed to be a source of strength for her.

Work to help a traumatised child to feel safe

There are some techniques I have learnt along the way that I wish I had known then. These start with seeing beyond her immediate behaviours and asking myself, ‘What does Shauna need?’, rather than, ‘What is wrong with her?’.

Looking back, I now see I should have helped Shauna feel safe. Instead of immediately trying to calm her down, I wish I had started by reassuring her that she was safe.  She was safe with me as a trusted adult, and I wasn’t going to leave.

I also wish I had asked Shauna if there was anything I could do to help. Then and there. Did she need a hug?  To hold my hand? A drink of water? For me to put on some chilled-out music in the car? Letting her have a bit of choice and control over the situation may have helped her calm down a little easier.

In hindsight, I probably tried too hard to offer solutions to Shauna during her outburst.

I was trying to make her feel better, but offering solutions to problems in a time of absolute crisis was not helpful. Mentioning how a new foster placement could be great or that they had a dog (she loved dogs) was not an appropriate response for that moment.

Managing professional guilt

I remember the feeling of overwhelming sadness washing over me as I watched her. She was distraught.

The sensible part of me knew that it wasn’t my fault that Shauna needed to move to new carers, but I was wrought with guilt.

I felt like she had been failed by a ‘system’ that was unable to match her with foster carers who would offer her unconditional care; failed by the social workers who had come and gone over her short life; failed by me, who hadn’t been able to visit her as often as I would have liked.

I was devastated.

As I matured in my practice, I came to realise that there is a real danger for social workers to hold feelings of guilt. Much of our work relies on resources that are often lacking and can be hard to manage.

However, with good supervision, I got to a place where I felt I was practising in the best way I could and felt less guilt about the constraints of the resources available to me.

Is that good enough? Sometimes it has to be.

Most social workers in adult social care work in services that primarily focus on the immediate presenting issues faced by clients and their accompanying care and support needs, rather than in services that are specifically organised around supporting people who have experienced trauma. However, many people who are affected by trauma seek support from social care services, whether or not the service considers itself to work with survivors.

For example, issues such as substance use, mental health problems, homelessness, self-harm, being in a domestically abusive relationship or being in the criminal justice system are often symptomatic of past trauma. And there is evidence that people who are in contact with mental health services are more likely than others to have experienced traumatic events (Sweeney et al, 2018).

This is why it’s important to recognise trauma and to understand how it can influence an individual’s way of relating to their situation and how their “behaviour” is often about keeping themselves safe, because that is how they’ve coped in the past.

Talking about trauma

Despite clear evidence linking psychological distress to experiences of trauma, survivors often report that they are rarely asked about traumatic experiences (Read et al, 2007).

When asked, practitioners say that they are afraid of asking about traumatic experiences for two main reasons: that they are paying attention to the person’s immediate needs, or that they are concerned that asking about the person’s experiences might cause them distress.

These are understandable concerns, and it can be difficult to get the balance right. Not asking about traumatic events can give a message that the worker isn’t interested, or that it is too shameful to talk about, but asking in an insensitive way or at the wrong time can cause distress.

Asking about traumatic events: practice tips

• Consider the purpose of asking about the person’s experiences of trauma:
  Is it relevant to your work with them? How long are you expecting to work with each other? How will it help you to meet their needs if you know about their experiences? Does it feel ethical and safe to ask this question at this time?
• Don’t ask during a crisis:
  During a moment of heightened distress is not a sensible time to ask questions which encourage the person to revisit past traumatic events.
• Offer a brief normalising statement before asking:
  The purpose of this is to “warm up” the person to the idea that you are going to ask about some difficult experiences, rather than it coming out of the blue. The statement should include a recognition that they do not need to answer. For example, you could say: “I’m going to ask you about some experiences which you may have had during your life. The reason for this is that it can sometimes help us to understand difficulties later on. It’s ok if you don’t want to answer these questions at this time.”
• If a person makes a disclosure of abuse:
  If a person gives information about an identifiable person who has harmed them, then most agencies will require you to pass this information on to the relevant safeguarding authorities.

It is good practice to remind people about the limits of confidentiality as soon as possible in the conversation, so that they can make informed choices about how much to say to you. It can also be sensible to ask whether the person has ever spoken about it before, and what happened as a result.

If someone makes a disclosure, validate it and reassure them that it’s good that they have spoken about it. Also check out their current situation – are they safe and free from abuse now? If appropriate, it can be a good idea to ask the person what sense they have made of their experiences and how they think they relate to their current situation.

It’s important to focus on what they would like to happen next and what sources of support they can draw on. If possible, offer a follow-up contact, such as an appointment or a phone call with you at an agreed time, to reassure them that you aren’t rejecting them.

Throughout the conversation, be aware of your non-verbal communication – regulate yourself by breathing steadily, keep your speech slow and measured, and try to remain calm and still. The person speaking will be very tuned-in to your responses, and may be expecting to see non-verbal signs that you feel uncomfortable or that you will reject them.

References

Read J, Hammersley P and Rudegeair T (2007)
‘Why, when and how to ask about childhood abuse’
Advances in Psychiatric Treatment, Volume 13, Issue 2, p101-10

Sweeney A, Filson B, Kennedy A, Collinson L and Gillard, S (2018)
‘A paradigm shift: relationships in trauma-informed mental health services‘
BJPsych Advances, Volume 24, Issue 5, p319-33

If you have a Community Care Inform Adults licence, log in to access the full guide and read more on the different types of trauma and how the Power Threat Meaning Framework encourages practitioners to shift their thinking from “What’s wrong with you?” to “What’s happened to you?”

By Ellie Atkins

As a manager and safeguarding lead for a social work team in Manchester, I work with people experiencing severe multi-exclusion homelessness.

In this article, I will explore the context in which people’s struggles appear and suggest what we can do as social workers to improve the lives of some of the most misunderstood people in our society.

Cast your mind back to the Covid pandemic when ‘The Everybody In’ initiative provided hotels for people to come indoors for safety, backed by financial investment, legal frameworks and political will.

Why refuse shelter?

Despite this humanitarian response, some people refused to come indoors or behaved in such a way they could not stay in.

Why would you ‘choose’ to remain on the streets during a pandemic, when safety through hotels was being provided?”

In Manchester, this group of people met the three-tier threshold for a safeguarding enquiry under the Care Act 2014: they had needs for care and support, they were neglecting their care for self and their basic needs and were behaving in ways in which they could not be protected or indeed protect themselves.

With professional curiosity and compassionate enquiry to understand the ‘why’, alongside a research project, it became clear that the people remaining on the streets were likely to have hidden disabilities and differences that affected their executive functioning.

About executive function

Our executive functioning, which is located the frontal lobes of our brain, allows us to plan, problem-solve, inhibit our behaviour and emotions, make goals, see them through and have the ability to act out our wishes and be who we want to be.

When our executive functions are compromised or impaired in some way, this is called executive dysfunction. It can be hard to spot and slippery, because it changes, depending on the environmental, emotional and social context we find ourselves in.

I would suggest using the wheel pictured below, which sets out eight dimensions of executive functioning, to help with understanding the concept.

A wheel illustrating the different aspects of executive functioning

Some conditions are well evidenced to affect out executive functioning, such as acquired brain injury, foetal alcohol syndrome disorder, complex post-traumatic stress disorder, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and other forms of neurodivergence.

A 2022 study found that 92% of 115 people using a homelessness service had experienced trauma (Irving & Harding, 2022), whereas 48% of homeless respondents to a 2012 piece of research had acquired brain injuries (Oddy et al, 2012). This means that this group is much more likely to experience executive dysfunction than the wider population.

Focusing on safety

We can then move the power dynamic from, ‘What’s wrong with you?’, to, ‘What do you need?’, placing the onus on us as social workers to support the person to optimise their executive functioning before the Mental Capacity Act 2005 is considered or engaged in cases of significant self-neglect.

You see, executive functioning can be stabilised and optimised when we meet the non-negotiable human need to feel safe: safe in body, safe in where we live, safe in who is around us and safe in the way that people work with us.

This truly strengths-based approach, underpinned by relational social work, the power of human connection, kindness and empathy, can mean everything and costs nothing.

Beryl’s story

Can I introduce you to a lady called  Beryl? Beryl will show you how we can use the Care Act, our assessments, support planning and safeguarding, alongside the executive functioning wheel and relational social work, to enable people to have better outcomes and better lives.

Beryl had been known to our team for 10 years, as a lady with chronic and dependent alcohol addiction who said she did not want to work with services or receive help with her drinking.

When I moved our focus from her alcohol addiction and homelessness, during the Everyone In initiative, and tried to understand ‘why’ she would behave in this way, the context in which her struggles appeared started to become unveiled.

I used the Care Act provision to override a refusal of assessment when someone is experiencing, or at risk of, abuse or neglect, and a team around the person approach, to gain an understanding of Beryl’s life story.

Understanding the ‘why’

Beryl had experienced adverse childhood experiences and significant trauma; she lost her baby in a car accident, she experienced a head injury and later witnessed her partner being murdered. Beryl drank all day, every day, because she was too scared to stop.

Beryl’s behaviour became so distressing to herself and the wider public that we had to use police powers under section 136 of the Mental Health Act 1983 to take her to a place of safety and then placed her under section 2 of the MHA for a period of assessment. These decisions are not taken lightly.

Beryl was then moved to section 3 of the MHA and responded to treatment.

She states that this was the first time, in as long as she could remember, that her mind became safe and calm, enabling her to communicate in a way she wished to. It was during this time that she was diagnosed with ADHD, post-traumatic stress disorder and an acquired brain injury.

Whilst ‘labels’ may not always be helpful,  Beryl had lived with hidden disabilities, with limited quality of life, believing that she was a moral failure for her alcohol dependency.

Being who you want to be

Beryl now lives in supported accommodation, she attends Alcohol Anonymous and supports other peers in their own recovery from addiction. Beryl states that, for the first time, she has the ability and capacity to be who she wants to be.

If Beryl’s story resonates, please find out more by watching these videos about her.

Her story reminds me of what Desmond Tutu once said:

There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”

Ellie Atkins is manager and safeguarding lead for the entrenched rough sleeper social work team at Manchester City Council

References and further reading

Bramley, G et al (2015) Hard Edges: Mapping severe and multiple disadvantage, England Lankelly Chase Foundation

Grant, S et al (2016) Experiences of Homelessness and Brain Injury Sheffield Hallam University

Irving, A & Harding, J (2022) The Prevalence of Trauma among People who have Experienced Homelessness in England Oasis Community Housing

FEANTSA (2017) Recognising the link between trauma and homelessness 

Oddy, M, Moir, J, Fortescue, D, & Chadwick, S (2012) The prevalence of traumatic brain injury in the homeless community in a UK city Brain Injury, 26(9), 1058–1064

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As a newly qualified social worker, I was wracked with guilt and shame when I found myself disliking a child I was working with.

These feelings snuck up on me, a slow burner perhaps, but however hard I tried to suppress them, they were real.

Charlie* was a pre-teen living in a residential setting. During our meetings, he would interrupt me, call me a liar and other names and tell me that he didn’t want me there. I felt thoroughly disliked by him. It was painful.

How could I live with myself? A social worker who doesn’t like a child? That wasn’t supposed to happen.”

I was so full of good intentions but dreaded my time with him. Initially, I couldn’t bring myself to tell my supervisor – I was sure she would judge me and question my professional competence.

But I soon realised I needed help. My feelings towards Charlie were starting to affect my decision making.

Understanding the dynamics of our relationship

The first hurdle was admitting my feelings to my supervisor.

Once I had overcome my fear and talked to her, she handled my admission sensitively and professionally.

Exploratory supervision helped me understand that, just because I wanted to build a partnership with Charlie, it didn’t mean that he wanted the same.

He didn’t want a social worker in his life and my efforts to relate and care for him were adding to his feelings of ambivalence and hostility towards me.

My resilience was certainly being tested.

I was leaving every visit feeling hurt, offended and angry.”

And so my supervisor and I started to unpick the power presence in our relationship. I had been left feeling like Charlie held all the power, but in reality, he held very little.

As a child in the care system, he had no choice but to have me involved in his life and had little say in where he was living or in how often he was able to see his family.

Polishing my trauma-sensitive lens

By thinking out loud with my supervisor, I reflected on the importance of understanding the reasons behind his behaviours towards me within the context of the trauma he had experienced.

I came to understand that Charlie’s history of neglect and abuse was a critical factor influencing his actions and I was helped to see him through a trauma-sensitive lens, rather than a lens that was muddied by my own feelings.

He had suffered multiple adverse events in his life which had no doubt impacted his ability to self-regulate and make trusting relationships. This was compounded by the several changes in social workers he had experienced.

With the best intentions, I had attempted – and expected – to get close to him and become a mentor, when he actually needed time to trust me.”

Recognising what my job was

Making sense of how trauma was affecting Charlie helped me take a more strengths-based approach to my work with him.

Instead of concentrating on his deficits and difficulties, I changed my use of language to help him develop his sense of hope and optimism around areas of challenge, like building relationships with other people.

I focused my time with him on praising his strengths, abilities and talents, and less on areas he could improve on.  This immediately seemed to relieve the pressure between us.

I moved from an adult ‘finger wagger’ to his loudest cheerleader.”

Up until then, I had thought that his ‘uncooperativeness’ had been getting in the way of me doing my job.  However, some soul searching on my part reminded me that working with his ‘uncooperativeness’ was my job!

Leaving my professional ego at the door

I continued to use supervision regularly to ensure my work with Charlie was focused on enhancing his development of a positive sense of self.

I continued being strengths-based; using an approach which came from true belief that he already possessed the skills and strength to build relationships and manage his anger.

As a practitioner, I learnt to leave my professional ego at the door. I learnt that people will not always be thankful for my efforts and good intentions and it was naïve and self-serving to think that they would.

Accepting the complexity of relationship-based work

Admitting that I didn’t like Charlie was an important step in building my professional confidence and sense of self.

I learnt that relationship-based social work is not about immediately getting others onside; it is far more complex.

My relationship with Charlie needed to be built with an understanding of his past trauma and the organisational context at play.

As a practitioner, I also needed to work on understanding and managing the emotions and feelings he evoked in me.

As my relationship with Charlie improved, I gained the confidence to view my feelings as signals that needed attention and reflection rather than as failings.

Accepting each other

Supervision became a driving force behind learning and growing in my understanding of both of our responses to each other.

By focusing on the cause of the behaviour, rather than the behaviour itself, Charlie and I built our relationship. He began to accept my involvement more easily.

I don’t think I can go as far as to say he ever looked forward to me visiting or that he liked having a social worker.

But, over time, we came to an unspoken agreement. He was the expert on his own life and experiences. It was my role to facilitate, not fix.

Charlie had just needed help in building the confidence to believe that he was capable of his own personal growth and change.

What is shame?

Shame is a very important concept to consider as it can often be at the root of many worrying behaviours in children and caregivers that social workers might encounter.

Shame has been described as a set of intense feelings, mainly concerned with an inner sense of feeling unworthy, unlovable, useless, and worthless. People cope and deal with shame in different ways, either by internalising, externalising or denying these feelings completely.

Shame-focused coping

The compass of shame model below (Nathanson, 1992) provides a starting point for understanding shame and behaviours that can develop because of it. This model illustrates four shame coping styles: withdrawal, attack-self, avoidance, and attack-other.

From Shame and Pride by D Nathanson (1992)

Examples of behaviours associated with the four coping styles may look like this:

Withdrawal

• Presenting in a depressed state and/or isolating themselves.
• Avoiding professionals and potentially being seen as ‘non-engaging’ or ‘avoidant’.

Attacking the self

• Putting themselves down and thinking of themselves as worthless.
• Using self-harming behaviours (this includes overeating and undereating).

Avoidance

• Presenting as though they are in denial.
• Behaviours that distract from feeling emotion, such as thrill-seeking or using/abusing drugs and alcohol (including prescription drugs).

Attacking others

• Lashing out verbally and/or physically, seemingly at random times.
• Being unable to take responsibility for their own actions and blaming others for any negative outcomes.

Access the full guide for more examples of behaviours that can present from shame-focused coping styles.

Working with shame

First, we have to recognise that families who become part of the child protection system often don’t have a choice about having services involved, so may well present a defensive response. Social workers and practitioners are therefore likely to witness shame-based coping styles and behaviours. In response, it is important to:

Be mindful of the language used

• Pay attention to the words and vocabulary that you use in assessments, case notes and direct work, as these can intensify feelings of shame.
• Avoid using too many acronyms and professional jargon – ensure the person you’re supporting understands and can relate to the words and phrases you are using.
• Ask yourself: ‘How does this use of language help to promote relationship-based practice in social work?’

Be aware of bodily responses and visual signs of shame

• Pay attention to body language and somatic presentations (eg is the person avoiding your gaze?).
• ‘Safety behaviours’ may signal shame (eg turning their face away, slumped posture, blushing, their mind going blank).
• Is there a repetitive somatic symptom that the person displays when discussing a specific topic (eg when discussing interpersonal experiences are they shaking their foot, playing with their hands, etc?)?
• Pay attention to who, where, and what children look at when you ask them a direct question.

If you recognise any sudden onset of the behaviours outlined above you can:

• Think about the conversation that occurred immediately before and ask yourself, ‘did I ask a question about a particular relationship?’ or ‘were they telling me a story about a previous relationship’?.
• Consider if the locations where you are having conversations trigger shame behaviours (ie home environment, sitting opposite each other). Try creating opportunities where eye gaze can be naturally averted, and consider having conversations in a different location that may be less intimidating (eg sitting in a park side-by-side rather than directly opposite each other).

The full guide on shame includes more information about how shame can present itself throughout childhood and the life course, along with the relationships between shame, guilt and survival. If you have a Community Care Inform Children licence, log on to see the full guide and read more detailed information.

This article will help you apply an understanding of trauma, and principles of trauma-informed practice, to work with young people experiencing extra-familial harm, including child sexual exploitation (CSE) and criminal exploitation (CCE).

Recognising behavioural indicators of trauma

Recognising behavioural indicators of trauma is particularly important as the experience of trauma can make it difficult or impossible for young people to formulate a coherent account of what happened.

While no two individuals are the same, there is broad consensus that trauma responses can be categorised as avoidance (ie attempts to avoid thoughts, feelings, conversations, places, or people that remind them of the trauma) and arousal (ie hypervigilance or tense or hostile behaviour).

Common trauma responses 

The following are examples of common trauma responses among young people affected by extra-familial harm:

‘Refusing’ behaviour (avoidance)

A young person might recognise, consciously or unconsciously, that they simply are not able to regulate their emotions in a particular environment. Perhaps their survival instincts have kicked in and their bodies are protecting them from feelings of overwhelm by staying away from situations or places where they are likely to feel unsafe.

Numbing, ‘checking out’ (dissociation)

Feeling numb, checking out or dissociating (the automatic response of disconnecting and detaching from an experience when feeling overwhelmed that some can experience) are necessary survival responses when people are unable to find ways to feel safe, calm and emotionally regulated.

If we are not trauma-informed, we may assume a young person who seems emotionless or removed when talking about difficult things is communicating that they are not bothered by distressing experiences, or are perhaps lying about them in the first place.

However, their bodies might be doing them a favour and placing an important protective barrier between them and the traumatic things that have happened.

‘On edge’ (hypervigilance)

Hypervigilance can seem like the polar opposite – in terms of observable body language – to the numb, ‘checked out’ response from a young person.

However, the kinds of hypervigilant behaviours you notice are also perhaps an indicator that a young person’s nervous system is activated; they are in fight or flight mode and sitting still and being calm isn’t a safe mode for their body to be in at that moment.

Inability to plan for the future (foreshortened future)

It can be frustrating when young people are at an age that requires them to be thinking and planning responsibly for the future and they seem unable to.

However, when a traumatised young person’s body is working so hard to try and ‘find calm’ – to emotionally regulate and to stay present in the moment – thinking about GCSEs, work placements, the impact of their behaviour or how a criminal record might follow them into the future may simply not be possible.

It does not mean that it will never be possible, but when they are in survival mode, we shouldn’t expect that they have the capacity to think about the future.

Traumatic bonding

The ‘trauma bond’ they might have developed with a person exploiting them is not just misplaced affection, but one way a young person might subconsciously be attempting to manage those feelings of overwhelm.

In an abusive, exploitative relationship, in which they are continually scared or unsure of what is going to happen and what they should believe, it can be an easier survival response to cultivate feelings of safety and connection with the abusive person when they are not yet sure if it is possible to get away.

Self-harm and self-destructive behaviours

Self-harming can be an attempt to feel something different than the young person feels at the moment. This might mean that they want to stop feeling distressed, dysregulated, numb or dissociative (Edmondson, Brennan, & House, 2016).

They might also feel a need to understand the limits and boundaries of their body. The latter experience might be particularly important for young people whose experiences of physical or sexual abuse mean that they don’t trust or understand their own body’s feelings and sensations very well.

Young people engaging in behaviours that seem risky and destructive might be trying, as best as they can, to stay in the present moment. For a young person who is experiencing flashbacks, intrusive thoughts, or dissociation, doing something that is both exciting and dangerous might bring them back to the present and help to avoid them re-experiencing or thinking about past trauma.

It can also help them feel powerful when they often feel powerless. Some of these high-risk behaviours might also be attempts by young people to relive or recreate past trauma in the present as a way of trying to feel mastery or control over it.

If you have a Community Care Inform Children licence, log on to see the full guide and read more detailed information about developmental trauma, applying trauma-informed approaches in your ongoing work with young people and caring for yourself as a professional working with traumatised people.  

There is increasing understanding that traumatic events can seriously impact individuals’ psychological and physical health and wellbeing. Being trauma-informed means understanding that those in most need of services may also be the hardest to reach and least likely to engage effectively with services.

A trauma-informed approach assumes that all of us have potentially experienced trauma and therefore key principles should be applied throughout our work with all children, young people and families.

Five principles of the trauma-informed approach

The following principles are central to trauma-informed work and should be embedded in individual practice as well as service delivery. Trauma-informed social workers apply these principles in initial meetings, direct work, assessments and interventions.

Safety 

• Physical and emotional safety are key. Traumatised people may have developed an overactive stress-response system and often feel unsafe. To do meaningful work, it is essential to first make the child or adult feel safe.
• Be open and honest in explaining what is happening and why at every stage of engagement: for example, informing the family of the initial referral, making sure they understand what will happen next, the possible outcomes and practical information on when and how you will meet.
• Consider intersectionality and how to meet people’s needs for cultural safety – minority groups are often disproportionately affected by trauma, and discrimination can compound its impact.

Trust

• For individuals who have experienced trauma in the context of relationships, it can be difficult to establish trust.
• Practitioners can develop trust by implementing good personal and professional boundaries; be aware that you may need to re-establish trust each time you meet someone.
• Be reliable and honest about what you can and cannot do, while recognising and addressing the power imbalances between client and professional.
• Use a non-judgmental, compassionate approach and be responsive to the experiences of those you work with, remembering that everyone experiences trauma differently.

Choice

• Offering real choice may be challenging for both practitioners and clients.
• It’s useful to acknowledge the power differential at the initial stages of any interaction to support you in working relationally with people who may have experienced others misusing power.
• We may need to acknowledge the limits in choice around, for example, changes in staff or meeting set-up. But we should aim to constantly keep these issues in mind to establish trust.
• It is the practitioner’s responsibility to engage the individual and give them choice in how work continues. The initial meeting should consist of obtaining informed consent, explaining how information will be shared and the limits to confidentiality; giving the person options and discussing with them what they would like to happen.

Collaboration

• Collaboration means working towards a common goal or purpose. Individuals who have experienced trauma may have very little trust in their needs mattering to others or very little experience of being involved in decisions, so may need support and encouragement to do this.
• Interactions that contain a psychoeducational element – where practitioners invite people to collaborate in their recovery by sharing information – are particularly useful.
• Collaboration could involve asking someone what they need for a certain part of the meeting or visit, or identifying coping strategies that may be helpful or problematic in the longer term and discussing options for support.

Empowerment 

• The principles described above all contribute to empowering people we work with. Showing someone that they can be safe, demonstrating you can be trusted and so can they, offering choice and collaboration to someone who has never had these options, are all empowering.
• Empowerment means treating the person as an equal. This may include offering challenge (constructively, rather than judgmentally), which can enable reflection and be very useful.
• Supporting and empowering individuals to recognise unhealthy coping strategies can be a life-changing opportunity.

If you have a Community Care Inform Children licence, log on to access the full guide and read more detailed information on trauma-informed practice and how to support children and young people.

You might also be interested in:

• Trauma-informed knowledge and practice hub
• Applying trauma-informed practice in direct work
• Guide to adverse childhood experiences (ACEs)

By Leigh Zywek and Richard Devine, Bath and North East Somerset Council

In our work, we have found that many of the challenges parents faced in safely caring for their children stemmed from coping strategies the parents had developed to handle extremely difficult and traumatic childhoods.

This exposed the significant disparity between the support provided to parents and what they required. We began to feel that the parents involved needed psychological treatment.

At the same time, psychological assessments of parents in care proceedings almost always recommended psychological treatment. But nearly all said such treatment would take too long and thus fall outside of the child’s timescale.

‘If therapy had been obtained earlier, outcomes might be different’

This issue was highlighted  in a judgment published eight years ago by His Honour Judge Stephen Wildblood KC, in which he said:

“Time and time again I see a process whereby the following occurs: a) a Local Authority intervenes and begins making assessment of a family; b) months later proceedings are issued; c) an order is made for some form of expert evidence to be produced (often a psychological report); d) months later the psychological report is obtained which says, invariably and utterly foreseeably, that someone within the family needs therapy and e) it is stated that, by then, the beneficial effect of therapy would be ‘outwith the timescales for the child’.

“In this case, for instance, it would have been perfectly obvious to all that, when the mother was referred before birth, she was a prime candidate for therapy. If therapy were to be obtained at an early stage such as that there is at least a prospect that outcomes in some cases might be different.”

Researching therapy options

We undertook research into psychological therapy and discovered that the primary therapeutic approaches (mentalisation-based therapy, dialectical behaviour therapy, trauma-informed cognitive behavioural therapy, cognitive analytic therapy, etc) produced similar outcomes (Wampold & Imel, 2015, Johnson and Boyle, 2018).

Even more surprisingly, “matching the model of treatment to a psychiatric diagnosis has an insignificant impact” (Sami Timimi, cited in Johnson and Boyle, 2018).

Furthermore, two critical factors were relevant to the success of treatment: the individual’s willingness to engage with the therapy and the relationship between the individual and the therapist (Johnson and Boyle 2018, Wampold 2001).

Providing therapy to parents in pre-proceedings

We were surprised and encouraged by these findings, so much so that we felt obliged to tentatively explore providing therapy to parents involved in pre-proceedings, one family at a time.

We applied two guiding rules, drawing on our learning from the research:

1. To increase the parent’s sense of control and improve the first variable, willingness to access treatment, we would provide an overview of the different therapeutic approaches and invite the parent to choose one.
2. We would work together to identify a therapist, with care taken to ensure that, relationally, it was a good match, thus accounting for the second variable, the quality of the relationship between the patient and therapist.

We learned along the way about which parents were ready and which were not, and how to create the conditions that facilitated participation.

One parent’s story

One parent from Bath and North East Somerset Council had had her child removed at birth due to being in a severely domestically abusive relationship. She separated from her partner and, with trepidation, attended therapy.

Through this, she was able to learn that she took on a caregiving role in her childhood and, without awareness, applied this to adult relationships:

“The only thing I see myself or deem myself good at is to look after people, which is why then sometimes I tend to attract a lot of people that are troubled and try to help them [because] subconsciously that is what I feel is my purpose…but then obviously that gets me then in a situation where people will take advantage.”

Through learning about herself, and understanding unconscious patterns, she was able to develop alternative ways of relating to herself and others.

She said that accessing therapy was “one of the reasons that he [her child] was able to come home to me and be with his mum”.

She added: “[Without it] I would’ve been in the same place and they wouldn’t have given me my son back. All because there wasn’t that help. Yeah, and all it took, all it would’ve took was the therapy.”

A potentially transformational impact

Cases like this and others have shown us first-hand how therapeutic support can have a transformational impact, break intergenerational patterns and allow parents to safely look after their children.

We think this illustrates why this is so important.

We have also received support from Cafcass, barristers, children’s guardians and the courts, including Judge Wildblood,

Spreading learning

Offering access to therapy is now a staple part of our offer for parents in BANES.

We have begun working regionally with other local authorities to see if we can collectively provide therapeutic support for families in pre-proceedings.

We are keen to share our approach in the hope that, in the same way HHJ Wildblood’s remarks eight years ago sowed a seed of inspiration for us that enabled this approach to come to fruition, we can do the same for other local authorities.

References

Johnstone, L & Boyle, M with Cromby, J, Dillon, J, Harper, D, Kinderman, P, Longden, E, Pilgrim, D & Read, J (2018), The Power Threat Meaning Framework: Towards the identification of patterns of emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis, British Psychological Association

Wampold, BE, & Imel, ZE (2015), The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed), Routledge/Taylor & Francis Group

Wampold, BE (2001), The great psychotherapy debate: models, methods, and findings, Routledge

Leigh Zywek is assistant director, children and young people services, and Richard Devine consultant social worker, at Bath and North East Somerset Council 

HHJ Judge Stephen Wildblood KC is the designated family judge for Bristol and surrounding areas

By Beverley Samways

There is a large body of research that seeks the lived experiences of people who self-harm.

This has informed our understanding as to why people hurt themselves and the sorts of responses that are most effective.

The vast majority of self-report studies with people who self-harm reported that emotional distress in response to adverse experiences was a primary risk factor.

Bereavement is one of the adverse experiences mentioned in relation to self-harm.

Rhonda Lesniak’s 2010 research into the lived experiences of adolescent females who self-harmed reported that, “the loss of a loved one at a young age is common among adolescents who self-injure”.

Focus on environmental triggers

However, for someone with a severe learning disability who is hurting themselves, emotional distress in relation to adverse experiences is much less likely to be considered as an explanatory factor.

Instead, the focus tends to be on immediate ‘triggers’ in the environment: what might the individual be trying to communicate about their needs or wants, including in relation to pain and sensory processing?

This is illustrated by the standard focus in behaviour charts of what happened ‘just before’ self-injury, as the primary way of analysing why it might have happened.

Whilst immediate triggers are important to consider, the small amount of research asking people with learning disabilities about their own self-injury found that participants rarely talked about triggers.

Instead they talked about their self-injury in relation to experiences of emotional distress that often happened in response to adverse experiences, including bereavement.

The role of grief

In 2021-22, three teenagers with severe learning disabilities and a history of self-injury participated in an eight-month research project to understand the emotional factors relating to their self-injury.

Grief was found to be a significant factor for one participant, whilst there was some evidence of loss or separation anxiety for the other two.

Loss is an experience easily neglected for people with learning disabilities.

Somehow, when a person with learning disabilities loses someone close to them, the idea that their grief might need to be processed and journeyed can get lost.

If they cannot speak about their loss, where does it go?”

With no intentional support to process the feelings of loss and grief, self-injury can become an option of last resort for providing an immediate release, or numbing, of overwhelming emotion.

The need for active bereavement support

Without active support for loss and bereavement, people with learning disabilities run significant risk of experiencing disenfranchised grief, which can lead to expressions of distress through various behaviours, including self-injury.

Owen Doody wrote, in 2014: “Disenfranchised grief occurs when an individual experiences a loss but that loss is not openly acknowledged, socially supported, or openly mourned. Thereby the person experiences a loss, but has no socially sanctioned right to grieve.”

It is very common for staff to struggle to support a person with severe learning disabilities with a bereavement.

This is rarely because staff are callous or insensitive, but much more likely to stem from anxiety about how to support the person with their feelings, particularly if they have little or no spoken communication.

Challenges for staff

It is often a struggle for support staff to know whether, and how, to communicate with people with learning disabilities about bereavement.

As Robin Grey wrote (2010), “people can make huge efforts to protect the person with learning disabilities from loss in the misplaced belief that they will not be able to hold its emotional reality”.

Instead, it can feel more manageable to look for an immediate trigger than consider that a person may be expressing complex feelings in relation to the loss of a loved one.

A trauma-informed response

However, individuals with learning disabilities do grieve and they do not spontaneously recover: they need active support to work through their grief, just as anyone does. How can we respond?

• Where ordinary behavioural analysis and interventions are not adequately helping an individual to reduce their self-injury, trauma and attachment-informed specialist help should be sought to consider the role of previous adverse experiences and emotional distress, including loss or bereavement.
• In addition, where a person with severe learning disabilities is bereaved (even if it was many years ago), staff teams should be offered tailored support through workshops and reflective practice to identify atypical expressions of grief and develop the bespoke and person-centred emotional support the individual needs.

Beverley Samways is the founder of the consultancy Unique Connections, which works to improve the lives of children and adults with learning disabilities who self-injure, including through working with schools and care providers. She recently completed a PhD, funded by the Economic and Social Research Council, entitled Non-spoken stories: an ethnographic account of the emotional lives of three teenagers with severe learning disabilities who sometimes self-injured.

References

Doody, O (2014) ‘Loss and grief within intellectual disability’, Frontline, 95

Grey, R (2010) Bereavement, loss and learning disabilities : a guide for professionals and carers Jessica Kingsley.

Lesniak, RG (2010) ‘The lived experience of adolescent females who self-injure by cutting’, Advanced emergency nursing journal, 32(2)

Samways, B, Heslop, P, & Dowling, S (2022) ‘Self-reported explanations for self-injury by people with intellectual disabilities: a systematic review of qualitative studies’, International Journal of Developmental Disabilities, 1–15.

By Cassy Harrison and Jacqui Smith

The Independent Inquiry into Child Sexual Abuse (IICSA), set up in 2015 to examine a broad range of institutions and organisations and their responses to allegations of child sexual abuse (CSA), reported last October, making far-reaching recommendations to better protect children.

As social workers, we have been part of a small, psychology-led multidisciplinary team that has supported IICSA in delivering its objectives in a safe and trauma-informed way.

A core part of this was safeguarding victims and survivors, over 7,300 of whom engaged with the Inquiry throughout its lifetime. More than 700 gave evidence at public hearings or provided statements, nearly 1,800 joined IICSA’s Victims and Survivors Forum and over 6,200 came forward to share their experiences through the Inquiry’s Truth Project.

For almost one in ten of those who took part in the Truth Project, sharing their account with IICSA was the first time they had told anyone about the abuse they had experienced. Some spoke of having waited a lifetime.

“I am 65, and the Truth Project is the first support I’ve felt I have had in my whole life where I can actually tell a story,” one participant stated.

In order to meet our objectives, it was vital that these individuals had the trust and confidence to come forward and actively participate.

Building trust through a trauma-informed approach

For victims and survivors who may have been failed in the past by some of the same institutions we were working alongside, ensuring individuals would not be re-traumatised following involvement with the Inquiry was key. Adopting a trauma-informed approach to safeguarding enabled us to minimise this risk, and was something that underpinned IICSA’s engagement with victims and survivors across the board.

We achieved this by seeking to foster trust from the outset and being reliable, consistent and transparent. We ensured we were always clear in our language and communications, whilst always maintaining empathy and understanding. Trauma is an individual experience with varying responses, so we made sure to give consideration to culture, past experiences and gender, working in collaboration with individuals to ensure they felt empowered to make their own choices and that they had control. In doing so, we aimed to create a feeling of safety throughout their journey with us.

Eighty eight per cent of Truth Project participants reported that their experience of CSA had affected their mental health; through our contact with victims and survivors, this is something we witnessed daily.

Equipping staff to safeguard survivors

Individuals described to us how they were dealing with extreme feelings of shame and guilt, depression, as well as suicidal ideation. As such, our safeguarding approach needed to provide for the significant number of staff members at the Inquiry who had not previously worked in CSA or with high-risk, vulnerable individuals. We provided safeguarding training for all staff and contractors, regardless of their role within IICSA, and access to a member of our team to provide timely advice and guidance on any decision where safeguarding was concerned.

Given the lack of familiarity with safeguarding for some staff, there were occasions when non-social work professionals exhibited anxiety at being presented with risk-related behaviours, such as receiving highly emotive correspondence from individuals. It was for management of this anxiety that we needed to provide our specialist support and training, so that staff were able to effectively deal with such incidents, whilst also managing their own emotional responses.

Social workers often have to work in high-pressure environments, adopting crisis intervention methodology to manage people’s anxieties, assess risk and make decisions. Our team of social workers, alongside psychologists, psychotherapists and counsellors, provided a calming and reassuring presence to other teams within the Inquiry.

Following the publication of the final report, we are now thinking about next steps and which areas of good practice we will take forward into our new roles and organisations.

Safeguarding within the context of a public inquiry brought both challenges to social work practice and opportunities to think and practice in a different way. Developing a safeguarding framework that held the tenet of ‘do no harm’ at its core, whilst meeting the current safeguarding needs of both vulnerable adults and children naturally required some creative thinking.

By applying key social work skills – such as empathy, communication, critical thinking, active listening, cultural competence, patience and advocacy – we have been able to support the most unlikely of organisations in achieving its objectives, and ultimately help to ensure that children are better protected in future.

Cassy Harrison is safeguarding lead, and was previously deputy safeguarding lead, on the Independent Inquiry into Child Sexual Abuse, and Jacqui Smith is an independent social work consultant who also worked on the Inquiry.