Sefton’s trauma-informed approach helps families to recover from ACEs
Joanne Parkes
Tuesday, September 29, 2020
Sefton Council rolls out its adverse childhood experiences (ACE) recovery scheme after a successful pilot.
- Practitioners use a toolkit to help parents and children understand how childhood trauma affects behaviour
- Coping strategies are designed to boost confidence and improve young people’s engagement in education
ACTION
A major driver of poor life outcomes for some children and young people is the relationship with their parents and the trauma they experience in the family.
“It has become apparent that to break the intergenerational cycle, we as a society need to become more trauma informed and ACE aware,” says Sefton ACE practitioner Alison Lovelady, a youth worker who says her practice has been “transformed” through trauma training.
Lovelady is one of three practitioners from Sefton Council’s early help service trained in a toolkit to deliver a recovery programme for vulnerable children, young people and families affected by childhood trauma.
Leeann Doolin, a youth worker and ACE co-ordinator at the council, describes the programme as having led to a transformation” for families.
Rock Pool, an organisation providing training in this area, developed the ACE recovery toolkit which is now formally part of Sefton’s early help offer for children, young people and parents.
The approach – piloted in 2018 with parents and in 2019 with children and young people – is used to educate both parties on how ACE has affected them and how it can be passed down through generations. Doolin says these can have “long-lasting effects on their health and wellbeing”.
The recovery programme attempts to unpick this and create positive change, explains Doolin, with an emphasis on strategies that “increase confidence, social skills and self-esteem”.
Practitioners selected 10 suitable parents to participate in last year’s pilot, as well as to support 10 young people with a range of ACEs (see box) through an eight-week programme, which ran from July 2019.
During a one-hour home visit, practitioners spoke to young people to determine suitability, with reference to the “ACE vulnerability checklist for young people” which covers risk of sexual and criminal exploitation; mental health issues; parental separation or bereavement; risk of exclusion from mainstream education or low attendance; risk of offending behaviour; and having been missing from home.
Many of the candidates emerged as having multiple co-occurring risk factors for trauma and poor outcomes – both socially and with their health.
The idea of pinning a young person’s life chances to a checklist of traumatic experiences has triggered national debate, with some commentators flagging concerns over the approach.
Doolin is keen to emphasise that their recruitment phase is more multifaceted than a series of ticks in boxes, arguing that it is geared to build understanding and engagement from the outset.
“The aim was to ensure the process did not re-traumatise,” she says, adding that the practitioners instil a sense of hope and opportunity through “motivational interviewing” techniques, similar to those used in counselling.
During the programme, delivered in a group format, practitioners focus on giving the children and young people their full attention, offering “caring awareness”, explains Doolin.
They ensure they make “changes to delivery based on the needs of the group”.
The team, guided by the “4R model”, starts with “realisation” of the role of trauma in families, groups, organisations and communities, as well as individuals.
They then “recognise” the signs of trauma, “respond” with changes in their language, behaviour and the environment to meet need, and finally “resist” re-traumatising participants as well as promoting resilience.
The steps of the programme teach young people about toxic stress and its impact on behaviour; emotional regulation and mindfulness as a positive response; techniques borrowed from cognitive behavioural therapy, which encourage reframing situations with a more objective and less emotional eye; problem solving for every day challenges; and self-care and self-esteem strategies, which are a foundation throughout.
Young people felt positive about having their feelings acknowledged and being engaged in reports written about them. Less positive remarks arose from having to repeatedly describe painful experiences, and if practitioners had not done their homework on their case.
John Moores University researchers, who are measuring Sefton’s outcomes over two years to test their sustainability, say: “We got some great feedback from the young people about how much they are enjoying the programme and the benefits they are seeing, including using coping strategies and examples of using these at home, improved confidence and self-esteem and making friends in the group.”
IMPACT
Early indications suggest positive outcomes for those who took part and more participants have been recruited for four courses – one for young people and three for parents – due to begin in October 2020.
From the pilot group, the six young people at risk of exclusion have all sustained improved educational attainment and attendance in school.
All 10 young people engaged with community-based support run by the voluntary sector, and all have taken part in follow-up events to ensure learning, reflections and their voice is embedded into future service transformation.
None have reoffended or entered the criminal justice system.
All noted their self-esteem and resilience had increased as a result of the programme, as measured using the Rosenberg Self-Esteem Screening Tool.
Parents of seven of the young people have accepted a place on the next parents’ course.
Following intervention, a 14-year-old with a history of offending was stepped down from children’s social care to early help, and has had no further engagement with the youth offending team.
He was referred while living with his aunt following a relationship breakdown with his mother. There had been previous social care involvement due to the conditions in the family home and domestic abuse.
He has moved back home, has significantly improved school attendance, and not had any missing episodes.
“He has been able to apply the strategies he learned from the programme to control his anger,” says Doolin, adding that as a result of his experiences, he wants to help practitioners improve their work with young people with mental health needs.
ACE prevalence among 10 pilot participants
- Low level mental health problems – 9
- Involved with child and adolescent mental health services (CAMHS) – 9
- Parents have separated – 9
- At risk of exclusion from mainstream education – 6
- At risk of exploitation – 5
- Parents are unemployed – 5
- Repeated missing episodes from home – 4
- A risk or involved with the youth offending team – 3
- Exposed to domestic abuse – 3
- Parent in prison – 1
- A perpetrator of domestic abuse – 1
CHALLENGES OF COVID RESPONSE
The closure of schools, early years settings and family wellbeing centres, together with social distancing measures, have restricted face-to-face contact Sefton’s early help team has with children and young people.
This has made it “much more challenging to spot the early signs of potential ACE issues”, says Doolin, and there is a risk some will go without help at the earliest, most beneficial, time.
“However, as a service we have adapted to work virtually and where safe, implemented social distancing visits and provided targeted programmes to ensure we remain connected to the families during the pandemic,” she adds.
Both young people and adults offered the courses in March 2020, along with those families engaged with early help services, have received weekly contact from the early help team to support their emotional health and wellbeing, and reduce the risks of escalation into poor outcomes.
