Trauma-informed approach helps vulnerable mothers in Oxfordshire

Action

Pause, a national charity that works with women who have had – or are at risk of having – more than one child removed from their care, offers emotional and practical support through its trauma-informed programmes.

Since it was launched as a pilot scheme in Hackney more than 10 years ago, the charity has developed a network of 24 Pause practices across 30 local authorities in England.

The practices operate under a model of care that recognises almost all the women supported by its programmes have experienced multiple traumas often both as children and into adulthood.

As such, the charity aims to address the impact of these traumatic experiences by creating supportive and trusting relationships between women and its team of practitioners over an 18-month period.

In Oxfordshire, where a Pause practice was set up in March 2021, an initial scoping exercise carried out by the charity identified there was a high level of need for its specialist support.

Oxfordshire County Council responded by offering Pause as an in-house service after recruiting a team of five permanent members of staff to deliver its programmes.

Jackie Atkins, who heads up the Oxfordshire practice, says her team of three practitioners have “amazing skills” in building relationships with women that need support from Pause.

“They come from a variety of backgrounds, one was a social worker, another was a probation officer for many years - it’s really helpful to have a range of skills in the team,” says Atkins.

“Our core technique is building a really positive attachment relationship with women which works both ways because it’s not us doing anything to someone, it’s working alongside them and being there at the most difficult time of their lives,” she explains.

Each practitioner works with up to eight women at any one time, having been assigned specifically to an individual for the duration of the 18-month programme.

However, an initial 16-week period of introduction to Pause and its benefits is the first hurdle for practitioners to overcome.

Atkins explains: “I always say to every woman when I first meet her that they can tell us to go away which raises a laugh but it’s clear they have a choice if they want to work with us or not.

“They can choose where to meet us whether that’s in a coffee shop, at their house or going for a walk in the park.

“But it could take six appointments that we’ve made before they actually turn up the sixth time.”

Common themes seen by the team among the women it supports are incidences of domestic abuse, bereavement, mental health issues, substance misuse as well as adverse childhood experiences.

Such high levels of trauma manifests itself in women presenting with a range of issues such as depression, insomnia, feeling completely emotionally overwhelmed to post-traumatic stress disorder and experiencing nightmares and flashbacks, says Atkins.

Despite these personal challenges, women are not difficult to engage once they start to be supported by the Pause programme, she adds.

“We take responsibility for that which means we know that women will find it really difficult to trust us, so we think a lot about the best way to make an initial approach,” says Atkins.

“We find out if the woman has any interests. If she’s got pets, we may send her a card with an animal picture on the front explaining inside who we are.”

The team also provides small care packages for women coming up to final care proceedings. These contain items such as a notepad and pen, hand cream, tissues and sweets that can be sucked to help soothe her.

“There will be a card attached that says we know how difficult attending court is, but we are here for you. It’s starting to care for someone because that’s what a lot of the women we work with have not experienced before,” says Atkins.

Practical help with issues such as housing and debt is also offered to women as well as frank discussions around sexual health and contraception.

Women who want to join Pause are asked after the 16-week engagement phase if they will commit to a pause in pregnancy.

If they agree, they will work with a local sexual health service so they can make informed choices about contraception to help avoid getting pregnant for 18 months.

Atkins says this is not a “difficult” conversation to have with many women at the start of their journey with Pause.

She says: “It is framed as a support need like any other but most of the women tell us that they cannot go through the trauma of losing a child again.

“So that becomes part of a longer conversation about what taking a pause in pregnancy would be like for them.”

Impact

With average annual running costs of around £300,000 for local authorities that choose to deliver Pause directly, Atkins says it is a “no brainer” in terms of financial benefits.

Impact reports published by the charity show savings of £4.50 per £1 spent on Pause over four years rising to £7.61 over 18 years.

Evidence of such cost savings can be seen in the average reduction of children entering care which is 14 per year for each local authority that has a Pause practice.

For Atkins, the team’s greatest achievement is not having one woman who has had a pregnancy and a child removed from their care after they have completed Pause in Oxfordshire.

She believes the impact of Pause’s work on children is “huge” as they get to see their parents in a “better, more stable place”.

“That parent is actually thinking about them in a different way - and that’s over a year and a half - which means helping them write letters, thinking about birthdays and Christmases and difficult times for their children. That’s more than any parenting course could do,” she adds.

• Read more in CYP Now's trauma-informed care special report