Triumph over trauma

Charlotte and her husband knew that the children they were about to adopt would need lots of support. Social workers told them that the two boys aged three and five, and their seven-year-old sister, had suffered neglect. But they were not prepared for the shocking reality of extreme sexualised behaviour, aggression and self-harm.

“The children exhibited disturbing sexualised behaviour between themselves, and also to any male that came to the house in the case of the girl. It was graphic and very difficult to see and stop,” explains Charlotte. “The five-year-old boy also exhibited really extreme bad behaviour. His way of getting himself to sleep was to hit his head against the wall. It was horrendous, blood all over the walls.”

Charlotte was convinced the children had suffered from more than neglect, but says social workers refused to countenance the idea that abuse had taken place. Then the family came across Family Futures, an agency that offers therapeutic help to children who have experienced trauma living in birth families, foster homes or with adoptive families.

“We were able to tell them everything, and it was the best thing ever to finally be believed,” says Charlotte. The family received intensive therapy and support. Visiting every few weeks for “a good couple of years” helped resolve many of the boys’ issues. They had to make the distressing decision that they did not have the specialist skills needed to parent the boys’ sister, but, says Charlotte, without Family Futures’ support they would not have been able to hold onto any of the children.

The government’s adoption tsar Martin Narey recently referred to Family Futures as “one of the most impressive organisations I have been to”. It has also been awarded the government’s C4EO centre of excellence award for its work. The breakdown rate of adoption placements among children the organisation has worked with is four per cent, compared with a national average of around 20 per cent. This is especially impressive given that Family Futures tends to work with the most damaged children.

The agency supports around 50 to 60 children every year, and was set up by Jay Vaughan, therapy services manager, and manager Alan Burnell, in 1998. “We came to realise the days of baby adoption were past,” explains Burnell. 

“Adoptive parents were asking for help with older children and sibling groups, and the problems they were presenting were far more challenging and difficult to resolve.”

The concept of “developmental trauma” is at the core of Family Futures’ work. It holds that the failure of a child’s primary attachment figure to protect, nurture and model secure attachment behaviour will distort not only the child’s attachment relationships but also their neurological, cognitive and physiological development.  “We have arrived at a point where we think that complex needs require complex solutions,” says Burnell.

Initial assessments of children often reveal undiagnosed issues such as dyslexia, dyspraxia and serious physical conditions. Research on a sample of 47 children seen by the organisation found 43 per cent had undiagnosed conditions.

Vaughan says that by the time families come through the doors of the organisation’s light and airy Islington base, they are generally in a bad way. Many have gone through a gruelling journey, both literally – families travel from as far away as Northumberland, Cornwall and Wales – and emotionally. “So many parents who come here are exhausted, overwhelmed and on antidepressants,” she says.

“The children we generally see have had terrible abusive experiences. They are living in a state of terror.  They may not settle to eat, they may not sleep well, they may explode at the smallest thing, or soil and smear their faeces and urinate in corners of the room.”

“Many, if not most, children who experience early trauma have spent their first couple of years petrified. Their brain is obviously wired up for fear, so a lot of their reactions to normal, everyday situations in nice adoptive homes is the fear response,” explains Burnell. “This distorts the way they perceive the world, so you have to go back to go forward, not just metaphorically but neurologically, helping children to be calm and regulated.”

This can involve using the arts – drawings, puppet shows – or physical activities such as yoga. Children and parents are helped to understand how bodies react to stress. Occupational therapy takes place in an on-site gym as well as in the therapy rooms. “Sensory work is important,” adds Burnell.  “The children we see are often either sensorily avoidant or sensorily highly stimulated and rather hyperactive,” he explains. “They might have poor co-ordination, muscle tone, a poor sense of balance; their eye and visual development may have been impacted.”

An environment to cope with

The occupational therapist works alongside the education consultant to help teachers and parents create an environment that a child can cope with at home and at school. This might involve special cushions to help a child sit still or a top for a pencil to allow a child to chew it.

Parents are also encouraged to treat a child as if they were a lot younger, perhaps by spoon feeding. Charlotte describes the effect this had on her son: “I remember feeling uncomfortable at the thought of wrapping a five-year-old wild thing in a blanket and giving them a bottle of milk. He is now a gorgeous 16-year-old at college, but back then it was like having a scary alien in the house. I could now see his scary face transformed into almost a baby.”

Family Futures’ approach is reflected in its offices and therapy rooms. “It is a quiet environment,” explains Vaughan. “It is important the rooms are clean and friendly, the toys are not broken.”

Once a child has reached a point where they feel safe, therapy starts to look at attachment relationships and finding ways for a family to enjoy being together, and follows this with life-story work. Rooms such as the theatrical “Star”, cosy “Snug”, calming “Sky” and sandy “Oasis” are themed around their names, with cushions and soft toys for making dens as well as art materials and sand trays. Children are encouraged to choose toy figures to represent important figures in their lives. Therapists ensure each room is appropriately furnished before each session – certain toys, such as baby dolls, can trigger re-enactments of past experiences which can be damaging.

“It is about doing little bits of their history in a way that doesn’t overwhelm them,” says Vaughan. “The idea is to move someone in the therapy to the point where they can make some links between their past experiences and their present responses, and I think that empowers them to make different choices.”

Paul and Jane’s son Jack had already gone through the trauma of an adoption breakdown by the time he came to them aged four. Having previously fostered Jack from the age of 11 months to two and a half, the couple knew they would need specialist support if the placement was to succeed.

Jack’s problems forming attachments led to behaviour that made his parents feel unsafe in their own home. “The CAMHS [child and adolescent mental health service] with a traditional one-size-fits-all approach, only made things worse,” recalls Paul.  “Family Futures looks for people who are cutting edge and brings in up-to-date research and thinking in how to help people.”

“In the first residential they got Jack to do a timeline, working with him on what happened before his birth, in his first 11 months, being fostered, adopted – getting Jack to use colours that showed what he might have felt like.”

“At the same time they were helping us connect through attachment-based therapy while he was fighting us off,” explains Jane. 

“What we were trying to offer him, he wasn’t able to accept – he didn’t believe he wasn’t going to be moving on.”
Dr Elaine McCullough, the team’s clinical psychologist, says Family Futures is in the process of drilling further down into its outcomes, including educational achievement, employment, the quality of relationships, use of mental health services and experience in the youth justice system. The research will be completed by next summer.

Ongoing support

The current focus on boosting adoption numbers triggers a corresponding need for post-adoption support. Burnell says referrals from local authorities have increased as opposed to self-referrals.

But, as ever, funding is an issue. “Even when local authorities acknowledge this is what a family needs, they will increasingly say they are not able to provide it,” Burnell says. “Local authorities say ‘our post-adoption budget is £20,000, £50,000’ – but their fostering budget is how many million? They don’t seem to join up the dots that adoptions that break down end up back in foster care, or residential.”
Charlotte, who had to threaten a local authority with legal action to get funding for the support she received from Family Futures, is still benefiting from its long-term approach. “Every now and then if I need advice I can phone and say ‘this is going on, can I bring the boys down for the day?’”

Jane says: “Jack is now 17 and without Family Futures I don’t think we would still be living together. There is a myth in some local authorities that this kind of service is a luxury but for some children it is absolutely essential.” Paul agrees: “Love is important. But for these traumatised children, love is not enough.”

Some names have been changed


FAMILY FUTURES: HOW IT WORKS

Family Futures’ multi-disciplinary team includes social workers; dance, drama and arts therapists; an occupational therapist; psychotherapists; clinical psychologists; an education consultant, and a paediatric nurse.

This blend of talent enables the organisation to look at each child and family’s needs and create a package of support tailored specifically for them, looking at areas such as physical and mental health, sleep issues, diet and education as well as therapeutic support.
In general, all the children in a family have a therapist each, and the parents have one or two, depending on their needs.

A family of five might be involved with four or five therapists, as well as other specialists such as the educational consultant.
Families receive support in intensive “chunks” of one day, two days or more, taking place perhaps every fortnight or month at the agency’s premises. There are separate sessions for children and parents, and the family then comes together. Families also benefit from home visits and can contact Family Futures at any time by telephone. 

“Our standard formula is ideally a three-year treatment programme for younger children, aged three to eight, as a starting block, with the opportunity to recontact those families at specific developmental stages,” says manager Alan Burnell.