Category Archives: Discussion

Do you know about the Forensic CAMHS service?

I must confess I hadn’t heard of Community Forensic CAMHS services, so it was interesting to sit down (virtually) with Dr. Andrew Newman from Oxford Health NHS Foundation Trust to hear all about the work they do. The service is quite new, established nationally around 3 years ago, although already operating in some areas prior to that. Currently it covers all of England, divided into 13 regions. As a highly specialist service, the regions are large and Andy works within the South West (North) Community CAMHS service, covering Bristol, South Gloucestershire, Gloucestershire, North Somerset, Wiltshire, Swindon, Bath and North East Somerset.

Working at the interface between mental health and risk of harm to other people, the service has many functions primarily focused on supporting professionals who work with complex cases and to intervene (ideally at an early stage) to prevent custody or secure hospital. It works supporting children and young people up to the age of 18 (though the majority seen are older – around 14 and 15), and these are high harm situations, presenting a risk to others, where there is are concerns about the young person’s mental health – but this can include trauma and neuro-developmental conditions. Many of the young people the service provide input to may have never been seen by mainstream CAMHS because of rigid referral criteria, limited capacity and long waits, and recognised issues with engagement. 

All the work involves risk of harm to others. Some children and young people are referred because of the risk specifically to a parent or carer, or similarly to a teacher. In addition to risk to adults there may be a risk to other children/adolescents. Although most referrals are concerned with violence, they also receive referrals for harmful sexual behaviour and / or fire setting. Andy reported that the majority of those he sees where there is a concern regarding child to parent abuse have a neuro-developmental conditions, generally autism, though this alters by region according to local service provision. While the family may be seen on occasions, this is predominantly a consultation service, offering advice to the professional network on how to support the family and manage the risk.

Referrals are accepted from any agencies (not from families), but statutory involvement is also required from a lead agency and this should continue throughout the contact. A team might typically include a psychologist, assistant psychologist, consultant psychiatrist, social worker and nurse, often working part time in FCAMHS and part time in another service. They would help develop safety plans and offer advice on (for instance) management, achieving sensory assessments, obtaining a diagnosis or understanding the history. Success in these situations can depend on in-depth support, and it is important to ensure that programmes such as Non-Violent Resistance (NVR) or Positive Behaviour Support (PBS) are properly understood and being applied in a consistent and meaningful manner. 

Andy suggested thinking about the involvement of Community Forensic CAMHS as like clinical supervision… complete honesty is needed for the work to be effective, and this can sometimes feel challenging. Consent to – or at least awareness of – the team’s involvement by the family and young person is required, though this may on occasions be over-ridden if there is significant risk. 

For those working to support families where there is significant high-harm child to parent violence and abuse, this is certainly a service to bear in mind! 

Dr Andrew Newman is a Consultant Clinical Psychologist working in the South West (north) Community Forensic Child and Adolescent Mental Health Service. In this role he works with professional networks offering consultation & assessment where a young person (under 18) is considered a risk to others and presents with mental health difficulties, to include neurodiversity and learning disability. All of his practice as a psychologist has been in forensic settings and he regularly works with professional networks where there is concern within the family about child to parent abuse.

Dr Newman is also the clinical lead for the Bristol Probation Mentalisation Based Therapy (MBT) Service. He also regularly offers training to external agencies and presents at conferences. He offers expert witness assessment for the family court, crown court, magistrates and parole board and has published a number of papers within the field of psychology. 

He is currently the child and adolescent committee member representative of the British Psychological Society (BPS), Division of Clinical Psychology ((DCP), Faculty of Clinical Forensic Psychology.

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Familial IDVAs

IDVAs (Independent domestic violence advisors) are front line practitioners with specialist training in delivering practical and emotional support to victims of domestic abuse, and their children. While the vast majority of clients will have experienced violence and abuse from a partner or ex-partner, a small percentage of the work involves what is termed “familial violence”, and I was pleased to be able to speak with 2 Familial IDVAs recently to hear more about what they are able to offer.

Patience and Susie are based in the Stronger Communities Directorate for Southampton. Theirs is an ‘adult service’ and so they support a range of individuals where there has been what they term COPA (child on parent abuse), POCA (parent on child abuse), sibling abuse, or abuse to grandparents, as well as honour-based abuse; all where the perpetrator is over 16 years of age. Those using harmful behaviour are mostly male, and a mix of adolescents and men in their 30s and 40s, with the vast majority of the work involving abuse from men to their mothers. There is often a link with intimate partner violence, in that the perpetrators ‘ping-pong’ between the homes of their partner and their parent. They work with an average of 75 – 100 high risk cases a year referred through the MASH (multi-agency safeguarding hub), using tools from their IDVA training, and from specialist adolescent to parent violence (APV) training, in their case provided by AVA.

While some of the skills are transferable, there are very different dynamics with APV and so it is important to have this broader understanding and perspective. 

Familial IDVA work is short term – around 4 months though sometimes longer – and involves the offer of emotional support, risk assessment and safety planning, and then referral on to a more appropriate service. It is notable that issues of love and guilt are frequent themes which come up in the emotional support work, and the victim will often be concerned to find help for their child and to enable them to remain safe together. The work is solely with the adult victim, but ideally they would work in conjunction with others offering a service to the perpetrator, and there is frustration that this is not always possible or available. If the adult victim is not identified as vulnerable in their own right, or the young person is similarly not considered vulnerable, then it can be difficult to access support from Children’s or Adults’ Social Care for instance.

Despite these frustrations however, both Patience and Susie reported tangible benefits which are experienced by those they support. For many, them “just being there” no matter what, being non-judgemental, and listening helps victims to keep going, to remain safe, and to develop greater self-confidence. They recognise the privilege of being allowed into people’s lives and are keen to emphasise the importance of viewing the victims as the experts in their situation – rather than rushing in with ideas and suggestions. So they seek to help their clients find their own solutions, reflecting on what has already been tried, rather than suggesting lots of new things themselves. 

Is this a role that could be rolled out more widely?

It is often said that our understanding of children’s violence towards their parents lags a long way behind that of intimate partner abuse, and yet we have seen a tremendous increase in interest and awareness over the last 10 – 15 years. Many things work together to discourage those experiencing CPV from coming forward for help – the stigma, lack of awareness, poor resource provision, but the situation is improving and we will undoubtedly see a rise in the demand for help. In an ideal world we would see a range of services to meet the needs of many different family configurations and situations, with expertise spread evenly around the country and throughout different sectors. In the meantime, it is encouraging to see a growing and widening appreciation of the pain and harm caused through CPV, and an increasing group of practitioners trained to provide a service within their field of work.    

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School based support for #CPV

I feel very strongly that school-based family workers are ideally placed to offer parents support, where there is child to parent violence (CPV). Let me tell you why.

Parents can feel comfortable talking to staff based in schools about a whole range of issues. For many – admittedly not all – there is familiarity with the environment and at primary level particularly there may be known faces in the playground to gravitate to. As well as regular parent evenings and conversations with teachers, parents may have met with other support staff in the past.

For many families this is the first place they would choose to seek advice about parenting issues. See this graph for instance, from the 2011 Family Lives report, When Family Life Hurts (p12), showing the sorts of places that families had initially sought help for the difficulties they were facing.

Similarly, an older survey from 2001, The Home Office Citizenship Survey: people, families and communities, found that 55% of parents were aware of schools as a source of information on bringing up children, second after healthcare, and that of parents who received help from educational establishments, 84% reported finding it helpful.

School may be the first place that difficulties are recognised or named. While some children will confine the harmful behaviours to home, others will be acting out their anger and distress within the classroom, leading to opportunities to work together with parents to try to understand what is happening and how to help everyone involved. Or a child may be refusing to get out of bed and come to school, alerting the authorities that all is not well. I spent many years from 1993 working in schools in different guises, for some of the time with the organisation School Home Support. It was not unusual to hear from parents asking for help with a child who was “out of control” or who refused to get out of bed in the morning, or where teachers asked for help to prevent a child’s exclusion; and where the more obvious suggestions had already been tried to no avail. As a consequence, it did not come as a surprise to learn that one of the first support programmes for families experiencing CPV in Britain, PEACE, had arisen in schools in the Wirral.

As an almost universal service, schools can potentially reach the most families in need of help. Increasingly practitioners of many disciplines are based there to support a family’s wellbeing as well as a child’s learning and it is possible to work with a family earlier on to help prevent problems becoming entrenched. This might mean running support groups for parents experiencing child to parent violence on site, or one to one sessions, or an awareness raising session and signposting to services. There is space to work with young people on their relationships generally, and to offer individual counselling where there are concerns. It was great to read the recent blog from PEGS. Michelle was invited to take part in a school’s virtual SEND conference for parents, at which she spoke about CPV and the types of help available, including from PEGS.

Practitioners based in schools cannot do this on their own of course, but they hold a key piece of the jigsaw and have significant knowledge of families which may stretch back generations. Working together with other professionals they can help to bring hope and safety to families affected.

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CPA by any other name…

I have always welcomed guest posts on this blog, and so it was good to be able to invite Michelle John of PEGS to contribute to our mutual learning and understanding of the issues. Michelle is the Founding Director of PEGS, and has the rare combination of a background in domestic abuse advocacy, lived experience, and the willingness and ability to speak up for her fellow parents. Michelle and her team support hundreds of parents impacted by CPA, alongside delivering impactful training for organisations such as police forces and local authorities, campaigning nationally for policy change, undertaking speaking engagements and raising awareness of the issue.

When it comes to describing abuse directed towards a parent, carer or guardian, there are so many phrases in circulation. While to some extent, what we call the abuse is secondary to the action we are taking to reduce it and support those impacted by the issue, it is important that we use words which don’t lead to misconceptions.

When I set up PEGS, myself and my team made the decision to refer to CPA or Child to Parent Abuse. At the time, this was at odds with the definition of ‘Adolescent to Parent Violence or Abuse (APVA)’ used in Home Office guidance and other professional literature. But the crux of our decision was the potential of shunning the majority of parents if we promoted that our services were for those experiencing APVA. An adolescent is a person aged 13 to 18. By contrast, you are always your parents’ child – whether you are 1 or 51. Finding organisations set up to support them, and then taking the leap of actually asking for the help they need, is incredibly difficult for all parents impacted by CPA; with that in mind, we wanted to make sure our language was as inclusive as possible so we didn’t put off anyone whose child had either not yet entered their teen years or had already reached adulthood.

The results of our first parental survey – undertaken in November 2020 – back up the general consensus that many cases of CPA start well before the teen years. More than half of our families had started experiencing abusive or violent behaviour when their child was aged 12 or below – and a significant number had children who were just 5 when the CPA began. We’re currently mid-way through our second survey so the results haven’t yet been collated, but looking at the data from the responses we have so far supports the fact that CPA really is happening within all types of families.

We know that CPA is under-reported (and historically under-researched) so it’s really important for all of us involved in campaigning, supporting and/or researching collectively eradicate this perception that the problem is limited to a handful of teenage boys being physically abusive. Both research and anecdotal evidence are beginning to build up a picture of every single type of family being impacted by CPA.

Even if their child is not tall enough or strong enough to physically overpower them, CPA takes many forms and coercion, threats, stealing and many other types of abuse are not restricted by the size or force of the person displaying the behaviours (or the person on the receiving end). 

That’s why at PEGS, we’ll continue to use the term Child to Parent Abuse and encourage others to do so, too.

Many thanks Michelle, for your insights and your support for families. We look forward to further posts from her in the future.
If you would like to contribute anything, whether from your work or experience, learning or practice, please do get in touch!

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The need for “safe houses” as part of the provision in #CPV

Government of Catalonia sets up state flat for Spanish teenagers who beat up their parents

I was really interested to see this piece in The Times this morning reporting on the provision in Spain of accommodation for young people using violence within the home.

Despite the framing of the story in the headline, and indeed in the main body of the article, those offered a place will have been convicted within the juvenile justice system, and the 9 – 15 month placement will be “offered” as an alternative to remaining at home under supervision. Such accommodation is intended to provide respite for both parents and teenagers, while they undergo counselling to address their mental health and behaviour. This response to the issue of adolescent to parent violence is typical of the Spanish approach which differs somewhat to that in other countries such as Britain.

Having said that, the question of whether safe accommodation should be made available to young people using violent and abusive behaviour towards their parents in this country is one which has come up in conversation a number of times recently. Removal from the home tends to be viewed as a last resort – frequently meaning that families must reach breaking point before such help can be accessed – and might be through local authority care, hospitalisation or a residential educational placement, or within the youth justice estate if diversion is not applicable. Yet families regularly ask for respite, as a way of meeting the needs of other children, of recharging their own batteries, or indeed as a safety measure because the situation is feeling too dangerous. Who might provide this, how it would be accessed and how it fits into other avenues of help are all interesting questions that must be considered.

The recent research from Condry and Miles into the impact of Covid-19 on the issue of adolescent to parent violence and abuse specifically recommends the establishment of such provision:

4. Provide safe spaces for families at crisis point and respite care for young people

Local authorities need to consider the provision of safe spaces for families in crisis. We were told of an example in Brighton where the police are working with the youth offending service to offer a safe space for young people to go during lockdown. Previously they were taking young into custody as there were no safe spaces for them to go for a ‘cooling off’ period so they have collaborated with the youth offending service and a family support service to offer a safe space for young people to stay while their parents are given support. This kind of innovation is important
at all times, a police cell is not the appropriate place for a child or young person in crisis, but during lockdown when other routes of escape are closed this becomes even more important. As one policy lead said: ‘There is a requirement for safe spaces for families in circumstances when the situation begins to escalate beyond parental control. The risk of criminalisation of children due to these circumstances is increased and should be avoided if possible’.

In an ideal situation there would be help provided before the situation feels unmanageable and dangerous, saving further harm to relationships, to health, to future prospects and wellbeing – and indeed to the public purse. As there is greater recognition of the issue of child / adolescent to parent violence and abuse, and as we see moves for a more strategic and joined up response, we must hope that such provision becomes part of the accepted norm in a suite of responses, designed to meet the very specific needs of individual families.

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“An escalation of distressed behaviour”

I was interested to read this paper from the Chief Social Workers for England, when it was published at the end of February. A spectrum of opportunity: an exploratory study of social work with autistic young people and their families looks at three things:

  • how responsive social workers were to the needs of young adults and their families
  • what barriers there were to enable more effective interventions
  • how things could be done differently to improve outcomes

I won’t go in to detail about the main body of the report – it is straightforward and easy to read, so I recommend it to you. It talks about what works well and what needs to be done better. Unsurprisingly, it points to the importance of the development of specialist knowledge in social workers, joined up work across agencies, and earlier intervention and proactive support to provide help before things go wrong; with the centrality of long-term trusting relationships between families and workers. Sadly, there is mention once again of parents’ fears of being labelled as ‘bad’ or ‘failing parents’.

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Taking #CPV Services online, Part 4 (or possibly part 5)

With a hope that we may be starting to see the beginnings of the end of lockdown, we are reminded that we won’t be seeing a wholesale return to ‘life as we once knew it’; and there are plenty of discussions about what the new normal will look like. So it’s not too late to bring you another in the series of learning from lockdown and taking services online! Hopefully there might be something here that is interesting to you, or can help inform the wider changes …

The team working at Family Based Solutions (FBS) have been delivering support to families experiencing child to parent violence and abuse since they were established (as PAARS) in 2013. As a specialist organisation, they have developed real expertise in this field, but part of their success is that they are able to offer a holistic, wrap around response to families, addressing any and all issues they face and which may be contributing to the break in relationships. Taking advantage of training opportunities, they have now adopted a Solution Focussed approach, which they have found enables families themselves to recognise the way through and to re-establish parental authority and respect. 

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What do we actually know about #CPV?

An odd question for me to be asking perhaps after all this time! I was very struck by the recent paper from Amanda Holt and Sam Lewis talking about the ways that child to parent violence is variously constructed by government and by practitioners, and the implications of this for practice. The starting positions we take, the assumptions we make may well be unconscious, but if it has taught us nothing else, CPV has surely taught us that we need to examine every assumption, challenge every preconception and get ready to believe the apparently impossible! That said, the debate as to where CPV “sits” (not quite domestic abuse, not quite juvenile delinquency, not quite safeguarding) does continue to grind on – albeit very slowly. Continue reading

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Co-producing a new #C/APV programme in Kent

Having spent the last few months thinking about the issues of delivering work to families online, interviewing practitioners (here and here) and a parent, and reading commentary and reports, I have formed in my head a series of questions, the responses to which seem fundamental to safe and respectful delivery of this particular type of work:

  1. Power. Who is defining the problem, the need, and the appropriate response? What demands are made in terms of compliance and availability? How are solutions negotiated and achieved?
  2. Technology. Access to devices, to broadband, to knowledge and skills.
  3. Space / Time. The possibility of being able to think clearly and speak safely. The possibility of making use of suggestions made within current family life. The possibility of escape.
  4. Monitoring of risk and safety. Awareness of coercive and controlling behaviours and their impact on the ability to monitor this remotely.
  5. Knowledge and skill sets. Including confidence in the issues and in technology, curiosity, creativity.

All of the work I have looked at so far has been designed originally for face-to-face delivery, and then adapted for online work. In contrast, The Kent Adolescent to Parent Violence programme for families with children aged 10-18 experiencing Child and Adolescent to Parent Violence (C/APV), currently being developed and piloted in Kent, has been written almost entirely with online delivery in mind. It was interesting then to see how these questions had been considered and answered. Elaine Simcock, Practice Development Officer within the CYP Directorate talked me through it. Continue reading

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Taking #CPV services online, Part 3

Welcome to 2021 as we in Britain face the prospect this week of further restrictions, even as the COVID vaccine becomes available! This time last year many of us would have been very sceptical about delivering services online, or even working from home, yet here we are – struggling with some aspects admittedly, but wondering whether some things work better in fact, and vowing to keep them on in future; and so I bring you the third part in a series looking at issues around taking services for families experiencing CPVA online. The last few months have seen the publication of numerous reports into life and service effectiveness under the pandemic, and I am particularly conscious of recent research highlighting the problem of parent participation in work with children’s services around child protection. While different circumstances pertain to work with families experiencing violence from their own children, this has also highlighted issues of power in the relationship with those who use our services, which we do well to remember and attend to in all our plans and delivery.

Back in July and August I spoke with a team delivering the Who’s in Charge? Programme online, and with a parent, and remained keen to examine the impact of the changes for those working directly with young people causing harm in the home. This was reinforced for me by the recent HMIP report, highlighting the need for changes in the delivery of support to families experiencing child and adolescent to parent violence, so it was good to be able to speak to a practitioner using the Respect Young People’s Programme (RYPP) for IDAS in Yorkshire. Continue reading

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