One size doesn’t fit all

Some time ago I had a conversation with a parent of a child with an ASD diagnosis about the use of public care for both respite and therapeutic purposes, particularly when there has been violent and abusive behaviour towards parents present. Since then we have corresponded from time to time as media interest or legislative procedures have bobbed up and down.

The issue which initially brought us together was with regard to the need for specific understanding of the different and differing needs of neurologically atypical children and young people. We were concerned about a “One size fits all” approach in many aspects of support for families, and a shortage of specific training in neurological conditions for many engaging with families regularly in their work. We acknowledged that some conditions (such as PDA) had only recently been identified, but that other diagnoses were well known and well documented, so that there seemed little excuse for ignorance about the effects on mood and mental health, learning and employment opportunities, behaviour and offending. This parent had undertaken significant research into the diagnosis, communication with family, documentation and support for children and young people with ASD, and found that many went undiagnosed or their specific needs unrecognised, despite their over-representation within care and the juvenile justice system.

I have worked with families who have chosen not to obtain a diagnosis. For them it was important that their child was not labeled and treated differently. But for many (most?) a diagnosis is crucial in accessing advice, support and therapy. Different conditions may require very different responses and the wrong approach may serve to worsen a situation.

ASD / ADHD / FASD diagnosis is a frequent factor when we look at the broader picture of child to parent violence. But it is important to remember that not all children with such diagnoses will become violent and abusive. This is a correlation, not a cause. I am interested however that, around the world, I have recently heard of different groups simultaneously looking at this issue and the need to develop specific programmes of support for families where this is an additional factor. It seems to be there are a number of specific questions to be addressed, among them:

  • Is the family able to access help for the diagnosed condition as well as the CPV?
  • What particular techniques might be more, or less, appropriate to use?
  • Are there considerations about the delivery of the programme to the young person in terms of the dynamics of group work, the presentation of materials, or the timing and structure of sessions?

The parent wishes to remain anonymous, for the protection of her child’s interests, but has given me permission to publicise some material which she has gathered, and which deserves a wider audience. If you are interested in work on the Children and Social Work bill you can see this here. If you would like to add comments of your own you can do so via this Survey Monkey link.

The Challenging Behaviour National Strategy Group Charter can be viewed here.

As always, I welcome your comments to further this discussion.

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Oh! Can I have a quick word?

It started off almost as a throw away comment, made its way into a conference presentation, and now seems to have become a thing. So its definitely going in my book under “things not to say to parents”!

What we hear depends so much on where we are at that moment (emotionally and geographically), why we’re there, past experience, how distracted we are – before we even start on tone of voice, inflection or status of the person speaking. I thought I’d ask friends and family what they assumed if they heard that request. A quick straw poll came up wth the following responses and variations on the themes:

  • Something must be very wrong
  • Oh God, what I have I done now?
  • It’s almost certainly not going to be quick!
  • This is going to be bad news
  • No, I absolutely don’t have time

I have every confidence that the person making the statement originally had the very best intentions, perhaps wanted to appear casual, to put someone at their ease even. That might work for some people (or there again, judging by the responses above, it might not).

If you are used to being called in to school for a child’s behaviour, if the police are regular visitors at  your home, or if you are hiding something that is happening in your family because you are too ashamed to talk about it – child to parent violence for instance, then its not going to go so well. If we want to really work in partnership with parents, to help people feel valued and not ashamed, to encourage people to be open with us, then we need to choose our words extraordinarily carefully. Not just with comments like this one of course, but everything we say. We won’t always get it right. But if we start to think about it then that must be a good thing, yes?

(Bizarrely this article appeared in the Guardian this week, and seems to demonstrate clearly every possible way of alienating parents and preventing working in partnership!)

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Soaring number of children being taken into care for abusing and beating up parents

This was a headline in the Sun newspaper last weekend, in an article by Michael Hamilton. Freedom of Information requests to 149 councils in England resulted in a figure of 62 children, ranging in age from 10 upwards, removed from their homes in 2015 by just 16 authorities. Some authorities refused to answer, citing data protection laws. The article lists the authorities which did respond and the relevant number in each case. The corresponding number for 2014 was 49. There are no other details, other than comments from an NSPCC spokesperson, recognising the impact of trauma on children’s behaviour and highlighting the need for help and support for families. Please assume my usual comments about the reliability of statistics such as these!

Having a child taken in to care is a generally a last resort for families experiencing child to parent violence. Firstly a family will typically experience abuse over a long period before it reaches a stage when this might be considered. Once the difficulties are acknowledged as abuse rather than “normal” behaviour, other help will have been sought; but sadly may not be available for too many families. We hear of families being repeatedly turned away by Children’s Services because their problems do not match the services available or reach the threshold for care. And of course, most families do not want a child removed until there is no other option available and the levels of threat have become unbearable and unsustainable.

There is no information given as to the route into care, nor how long children remain in care. Some children will be placed under section 20 in Britain, but others are likely to be on care orders. Some will expect to return home after a period of respite or therapy, others are removed permanently. Sadly once in care, the type of support available does not always meet the specific needs of children and young people, and some families have reported that their child’s behaviour worsened as a result; and I know that many adoptive families would be concerned that a return to care would further traumatise an already fragile individual.

Having said that, I also hear of the tremendous relief that having a child removed from the home can bring to a family in crisis, where not only the parents but also siblings and pets are being terrorised on a daily basis. Each family will make the hard decision for themselves. What it means for that family, and how things then change, is as individual as the factors behind the abuse, and the journey to that point.

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Learning about feelings, building resilience with Cyril Squirrel

Cyril Squirrel Finds Out About Love, by Jane Evans (2016) Jessica Kingsley Publishers.

I was very pleased to be asked to review this book, having first met Jane around the time she was starting to write the first of her books for young children. Jane is a trauma parenting specialist with many years experience in the field of domestic violence, fostering and, most recently, work on the brain responses to trauma. We met at the Oxford APV conference, and of course the experience of early trauma does seem to be a factor for many families where there is child to parent violence. If we can get things right early on with resources such as these books, then we can hopefully help parents create a healthier and more resilient environment for their children.

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Cyril Squirrel Finds Out About Love is Jane’s fourth book exploring feelings and emotions; with bright, engaging illustrations by Izzy Bean. Aimed primarily at 2 to 6 year olds (but anecdotally appreciated by older children as well) – and all those caring or working for them, this book helps in understanding love, friendship and kindness, and works on many levels.

The basic story follows Cyril’s quest to discover the nature of love and where it might be found, but along the way there are things to spot on the page and questions to ask, and – as we have learned to expect from Jane – lots of naming of other emotions and feelings, and reminders about personal safety. With additional activities at the end for both adults and children, this is packed full of useful material and very successfully bridges quite a wide age range. It is a wonderful book to read to any child, but will be particularly useful for those engaging with young children whose early lives have been disrupted, and who may struggle to see love around them.

Jane’s earlier books follow a similar structure, helping children to identify and talk about feelings, and to understand the complexities of an unpredictable life. The third book, exploring anxiety, offers an endearing and accessible manual for children and adults on the working of the brain.

How Are You Feeling Today Baby Bear (illustrated by Laurence Jackson) 2014

Kit Kitten And The Topsy-Turvy Feelings (illustrated by Izzy Bean) 2015

Little Meerkat’s Big Panic (illustrated by Izzy Bean) 2016

Cyril Squirrel Finds Out About Love (illustrated by Izzy Bean) 2016

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CPV: working across other communities

In one of those serendipitous ways this topic has cropped up in a lot of separate conversations recently so I thought I’d gather a few thoughts together.

I am indebted to Carole Williams, Parenting Officer in Ipswich and with many years experience as a Who’s in Charge? trainer, for her help in putting this piece together; and also to Cathy Press, Who’s in Charge? trainer, therapist and DA consultant with Awareness Matters, for her input. Although these comments come particularly from experience of working in group situations, many are relevant to one-to-one work also.

Within the UK there is a long history of settlement in major cities, where incoming communities may be well established, though not necessarily fluent in English. More recently there has been larger scale migration to rural market towns, and not only a seasonal basis, so that many more professionals are having to address what it means to work with mixed populations, with all that brings in terms of different languages, different patterns and expectations of parenting, and even different relationships with figures of authority.

Indeed, language difficulties may well be the first issue that comes to mind when working with people from other countries and cultures – and I’ll come back to this in a moment, but there are other significant considerations to address. At a very practical level, finding the most convenient time to meet may cause problems, when parents may be working long hours or unsocial shifts in the jobs that have drawn them to this country.

Differences in experiences of parenting and being parented are serious issues that must be considered. For instance, indigenous communities particularly around the world will have different expressions of family, of community, and of responsibility for care for children and dispute resolution; but the issue is not confined to such groups.

When the RCPV research team began speaking with their Bulgarian partner in the project they quickly learnt how different the situation behind the experience of child to parent violence was in that country. Having lived under communist rule for so long, many individuals had developed a deep distrust and antagonism towards state officials, and so were reluctant to approach the expected agencies for help. Within what remained a patriarchal society, family space was considered very private and families were expected to resolve problems without outside help. In addition, the RCPV research found that those experiencing abuse within their families were often grandparents – the parents having been forced to leave the village and seek work elsewhere because of the economic crisis.

A recent conversation with Who’s in Charge? trainers highlighted a similar example within Britain. A parent from Eastern Europe who had freely participated in a group for several weeks suddenly became resistant and reluctant to engage after a family member perceived the charitable organisation working with them to be closely linked to the authorities. They began answering questions as if undertaking a police interview. It transpired that a family member had suggested she did not disclose anything about the situation at home to “an authority figure”. Of course, resistance to difficult questions is not confined to any particular group or community.

Further examples were given of very high (relative to British norms) expectations of young people’s behaviour and participation within the home from some communities and cultures. Far from the usual suggestions to involve teens more in taking responsibility for themselves within the home, here there was an instinctive urge to pull back. What would the effect of this level of responsibility have been within the home country? Is it problematic in itself, or simply because of the more relaxed local environment? Transitioning from one country to another immediately exposes young people to very different experiences of being parented, with perhaps stricter or, more likely, more relaxed rules. How can families be helped to make the adjustments while maintaining a sense of integrity and continuity?As a British social worker these questions bring to mind the findings of the Laming Report following the tragic death of Victoria Climbie in 2000, specifically the need to be aware of our assumptions and beliefs about other cultures and the way this impacts our beliefs about acceptable or normal behaviour; as well as being clear about the way in which we feel competent to challenge parenting practice within a context of a fear of being accused of racism.

How do we work with families where there are high expectations of men being in charge, or the acceptance and normalisation of levels of violence towards women and children? Issues around “normal” parenting practice and styles of parenting are very much thrown into the foreground in work with child to parent violence, where the very relationships within the family have been upended, and “normal” no longer applies. Nevertheless, the risks of presenting as patronising or culturally superior should not be overlooked.

Reiterating clearly the purpose, and authority, of the group or intervention on an ongoing basis is obviously a necessity. Adaptation of materials and style of presentation – including exercises – also needs to be considered. Programmes and manuals created with one community or solution in mind do not necessarily travel easily.

It is worth noting that much of the early understanding and many of the materials in use around the world for work within the area of child to parent violence have been imported from the USA or Australia. The Step-Up programme, originating in Seattle is one such programme, much in use in adapted form in both Britain and Australia; and its influence is seen wider still in home grown programmes. Step-Up was designed with a very specific group of young people in mind, mandated from within the juvenile court system onto this diversionary programme. The Who’s in Charge? programme of parents’ groups has its genesis in Australia, and is more strictly controlled in its dissemination, but is now widely in use within England. Britain and the US are sometimes described as two nations divided by a common language. We cannot simply expect to lift programmes from one prosperous western nation to another. Legislative framework, cultural context, or underlying assumptions and understanding about meaning, all impact on content as well as the way instructions and exercises are designed and given. Is it reasonable to continue to adapt and readapt programmes to fit a different national context, often at great expense, or should more time be given to local homegrown responses? The issues around child to parent violence have many similarities around the world, but the way they play out and the local or national responses do not always accord.

Not just the content of the programme and style of presentation, but the measurements in use before and after also need addressing in work with groups of people for whom a programme was not originally created. An article which caught my attention recently concerned the use of equine therapy with teens in Guatemala as a way of addressing violent and aggressive behaviour. One of the issues that had to be addressed right at the start was with regard to self-report measures that were completed before and after participation in the programme.

The measures, all originally developed in English, were translated to Spanish by the third author bilingual in Spanish and English. Another native Spanish speaker, also fluent in English, verified the translations and minor discrepancies were reconciled via discussion. Because youth participants may not have had much exposure to Likert-style scales, slight modifications were made by including illustrations with scale points to indicate the magnitude of agreement/disagreement.

Returning then to the issues of language and translation. We are used to ensuring we are not using children as interpreters within health and social care settings. Particularly when a conversation may be with regard to their behaviour, or that of their siblings, there is no guarantee that the message you need to get across will be the one that is translated, and information may be filtered or missed. The same may apply where a husband speaks English and his wife does not.

But what is also clear is that straightforward translation by a professional interpreter is not sufficient either. Even with interpreters present, some parents may be working in a second or third language if there are participants from a range of nations. Some words and terms simply do not exist in other languages or cultures. Who’s in Charge? facilitators in groups in East Anglia found that fundamental concepts such as “abuse” had to be broken down to make them understandable. Constant checking that parents understood the discussion was hindered, and it was impossible to access other significant factors in a family’s situation through tuning in to what a parent said: for example did the child have additional needs, did the parent have additional needs or what was their level of literacy within their own language? A full understanding of the issues of child to parent violence and the programme materials was clearly needed and so bi-lingual facilitators have now been trained and lead groups within this area in order to assess how to make child to parent violence and abuse programmes better available to other communities.

Finally, some thoughts that have been suggested as a good entry point for work with parents from other communities are worth thinking about for all of us. The need for professionals to communicate effectively with parents shouldn’t need repeating but sadly does. Meeting broader needs of families – through ESOL classes, craft or homework groups, and not only the immediate issue may help to draw families in and help them feel comfortable, but also strengthens family interaction and integration. At the end of the day, if we cannot help families to feel comfortable engaging with us, they will get up and leave – or simply never attend.

 

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A parent campaigns for child to parent violence to be recognised in law.

A parent campaigning for recognition of child to parent violence and abuse within the legal system in the state of Florida, recently posted this video on youtube.

 

I am told that the animation was made with the full knowledge of the young person concerned, and that her mother, Heather, is keen that as many people view it and hear her story as possible. She would also like to hear from people who recognise her position and would like to join with her in lobbying the state legislature.

No matter how often I hear stories such as this one, I continue to be taken aback by the detail of the abuse, the overwhelming difficulties in obtaining help, and yet the continuing ongoing deep love that a parent expresses towards their child in this situation.

Wherever you live in the world, I imagine you will be able to identify with some of the issues that are raised: the “invisibility” of the issue of child to parent violence, the difficulties around budget cuts and thresholds, and the focus on the protection of the child FROM abuse. Some of the problems faced by this family are also particular to an insurance-based health care system, and so more confusing to those of us in Britain for instance. Likewise the insistence that a parent accepts a child return home to live with those they are abusing – or face neglect and abandonment charges.

But wherever a family lives, what is needed is an understanding of children’s violence to parents as a distinct issue, that needs addressing as well as and alongside mental health or juvenile justice issues. Perhaps incarceration is not the answer, but then there is a need for alternative provision that recognises the risks to health and welfare – and even life – for families; that responds to the up-ending of authority within families, and offers a way back to healthy, respectful relationships.

If you would like to respond directly to Heather, you can contact her via her twitter account.

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France responds to “tyrannical children”

I was approached recently by a journalist covering the issue of child to parent violence and abuse in France – where the term “tyrannical child” is being used to describe the issue, for the International Business Times. You can read the article here.

It is always encouraging to hear about new work starting around the world. In France the specialist help that is being developed is located within health services. At the moment the only service is in Montpellier but after an initial trial, using a combination of CBT and NVR techniques and a support group for parents,  this to be rolled out across the rest of the country soon.

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