Breaking the Silence on Violent Challenging Behaviour: a conference review

Last week I brought you the reflections of Dr Girish Vaidya, who had attended the Violent Challenging Behaviour conference, organised by Yvonne Newbold. The post has attracted some interesting discussion. This week Yvonne has kindly allowed me to repost her own reflections and review of the conference.

Yvonne begins by recounting the hopes of those attending, and ends with her own dream that this, by breaking the silence, will be just the start. “Part of achieving this level of widespread acceptance must include training for all frontline professionals about the issue, and why it happens and how they can help. Ideally, I’d like to see a future where professionals and parents work together in a spirit collaborative respect to find individual support and solutions that work for each child.” There are some salutary lessons for professionals in her post. Please do read it and understand that this is the real experience of many parents, while we always acknowledge that there are also informed, compassionate practitioners already out there who do truly “get it”.

What did parents want? Continue reading

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Child on Parent Violence: Beginning of a paradigm shift?

I am grateful to Dr Girish Vaidya, Clinical Director at Sheffield Children’s NHS Foundation Trust, for allowing me to repost this recent blog on his experience of discussing CPV with colleagues.

Originally published on April 8, 2017

Al Coates and Dr Wendy Thorley’s 3 reports (the last of which is linked here) into an online research project provided fascinating reading and prompted me to present the subject in a CPD seminar for fellow psychiatrists in Sheffield’s Child and Adolescent Mental Health Service (CAMHS). I was particularly keen to share the findings of the reports, my fellow professionals’ experience of this issue and how they managed to address it.

It was heartening to hear that all my colleagues were aware of the issue. When I invited them to think about the impact on the families experiencing, their guesswork was entirely in line with the findings from Al Coates and Dr Thorley’s investigation. What this meant was that once seized of the behaviour as a problem, professionals were able to consider its consequences to the children, families and wider society.

There were also some examples that colleagues offered. One Learning Disability CAMHS Consultant recalled how she was horrified when confronted with a suggestion from social services that a child – who had earlier required 5 people to restrain him – had been advised to be returned home to his frail mother. Quite a few chipped with their experience of Sheffield Children’s Social Services and expressed their pleasant surprise at the speed of response and collaborative nature of working. It was also acknowledged, much in line with what Mary Aspinall – Miles said at a recent conference, that “parents should consider carefully before calling the police”.

So, what should parents (and professionals) do when dealing with a difficult subject like Child on Parent Violence?

My fellow psychiatrists were keen that professionals and parents work out a ‘pre-emptive emergency plan’ so that parents are not left in a dilemma about what they should do. A couple of colleagues were passionate about treating CPV on the same level of child abuse. They were also aware of the Sheffield Domestic Abuse Coordination Team’s MARAC (Multi Agency Risk Assessment Conference). Some suggested that parents should be asked about their ability to cope vs. their ability to manage their life.

Reassuringly, there was a near universal desire to have a ‘rating scale’ on the lines of various risk rating scales that professionals use, to have a common language about CPV. (I am not aware if there is any such scale and if there is, would be keen to know about it). If there isn’t a scale, my colleagues are keen to work with anyone to help develop one.

Writing this, I am reminded of an incident many years ago when one family’s holiday came in for professional scrutiny. The child had been inflicting severe violence on his parents which had destroyed many a family holiday for the rest of the family. Parents decided that they wanted to do something which didn’t wreck their other children’s holiday. They planned to take separate holidays – father with the other children and mother with the lad. They would swap the following year. It was deemed to be a demonstration of family pathology that they didn’t manage to have a family holiday without a fight. I felt that was being a bit too harsh since the family were trying to find a way out of a very challenging situation not fully appreciated by professionals. What do you think? Would you agree with Hannah Meadows’ assertion that self-care is an intelligent response to dealing with long term stress? Or would you rather that the family learn to live with the CPV on holiday?

What next?

Feedback from the CPD seminar suggested that this is just the beginning of our journey. Professionals want to know more, need to know more so that they can support more. Everyone agreed that it was a less discussed issue in clinical discussions and many emphasised that they would be on the lookout for CPV in their clinical practice in the future.

Let us continue the conversation…………………………..

If you are keen to collaborate on scientifically researching this challenge, we – as an organisation and I as a Clinical Director – would be keen to work with you.

 You will find the original here.

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Child to parent violence: Realities, Enigmas and Ambiguities

A number of new papers – academic and discussion – have been published recently, and I have gathered them all up here together for ease. Continue reading

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Child on Parent Violence – DfE Expert Advisory Group

With permission, I am reblogging this post by Al Coates, from his site: Misadventures of an Adoptive Dad. (Wednesday March 29th 2017). Al is a member of the DfE Advisory Group on fostering and adoption, and has been instrumental in bringing the issue of child to parent violence to the attention of the Department. 

It was the quarterly Department for Education’s Expert Advisory Group on Adoption Support. Today was the usual updates on this and that and a few larger issues addressed such as the working out of the role of the Virtual School Heads. We focused  to how the Adoption Support Fund was progressing, of course there are challenges but to date nearly 18,000 children had been helped and that the fair access limit remained above the average cost of the vast majority of applications. No help if you’re over with match funding and a difficult issue for some but 80 families have been match funded, which is more than I’d envisaged.
We had a discussion around the incoming legislation of the Virtual School Heads with NAVSH represented in the room they gave a good account of how they envisaged it playing on the ground. It is was a good discussion and there’s room for encouragement and optimism. Of course there are uncertainties as we move into new responsibilities and grey areas but without doubt we are heading in the right direction, it would have been nice to have heard Gareth Marr’s thoughts as we discussed the role.
The final item on the agenda was Child on Parent Violence, I’d asked for it to be there.

Drawing tougher all the findings from the Survey that I’d undertaken and the subsequent findings that Dr Wendy Thorley had made sense of in the first and second CPV reports that laid it all out. It’s too much go through verbatim and a text version of a 45 minute presentation is too much to bear so here we go in eight words.

Taboo (fear of response, isolation, criminalisation, ignorance, stigma, victim blaming)
Paradigms (different professionals view it very differently
Definitions (the trouble with them)
Causes (complicated)
Prevalence (lots, 30% ish)
Impacts (massive)
Responses (shocking)
Actions

It was well received, they’re a polite bunch, but I do think the collective minds and organisations in the room took the message to heart.

Child on Parent Violence is a ‘thing.*

This is a thing that we need to act on, a complicated, ugly, painful and prickly thing that needs to be grasped. As one member noted, not a can of worms but a bucket of worms.

Actions is the interesting bit, so what do we do next?

That’s the question, what do we do with this ‘thing’, first we call it a thing and we start to raise awareness and we start to consider if this as big as we suspect and believe that we make it a part of Social Workers Continual Professional Development.
We consider how we prepare adopters to let them know it’s a ‘thing’ and it’s ok to say it’s happening.
We liaise with safeguarding and tell them about this ‘thing’.
We develop out knowledge of interventions and what works in a real world situation.
The DfE are going to talk to the Chief Social Worker about their views and knowledge.

Today felt like a start line not and maybe a consideration of what may be the first steps in removing the taboo and developing the culture that makes it ok to ask for help and ok to say you’re not ok.

I apologise that this is all a bit vague, it’s late and having thought hard about this for a long long time and lived to varying degrees with it and in it. I feel very sleepy all of a sudden.

On another note I’m thinking of getting the presentation, with other stuff,  out to a wider audience and there’s even talk of putting on a free event for whoever’s interested and recording it, podcasting and you tubing it. I’m pondering that thought so if that’s of interest let me know.

All in all a good day.

*Speaking to a group of Social Workers last week  a senior practitioner said “We knew that this happened but we didn’t realise it was a ‘thing’.”

 

If you have found this of interest then please do check out other posts on Al’s site. 

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CPV: So what does it look like, Part 1.

This is a post I have had in mind for a while, and which has been changing shape faster than I can write. As a result, this is going to be part 1, and I will continue the discussion over the next weeks and months. It really develops two themes and questions: what are we actually talking about when we present training or speak about child to parent violence (CPV); and where are the edges of the definition – what’s included, who’s included, and what and who’s not? It is something we need to address. I am often asked for examples to illustrate a discussion or seminar. It is lazy to simply assume that people understand the concept just because we have become familiar with it. “The outside world find it hard to imagine. As a mother you don’t broadcast it to the outside world because its not something you’re particularly proud of.” (Rosie Noble) But as more and more people start to speak out and to use the phrase “child to parent violence” it inevitably stretches a bit at the edges.

Many years ago now – by CPV standards – Eddie Gallagher gave a handy list of the types of family situation that might be affected (in his experience) by child to parent violence. Since then the list has grown, and it inevitably includes examples that make us a bit squeamish in including them under an official definition: severely disabled children for instance, or those acting in self defence. I have sometimes pondered how parents themselves feel about including themselves in a CPV definition. Indeed, I have asked parents of children with ASD whether they feel it is appropriate to their situation. Is that how they experience the situation? Do they feel they need to protect their child by rejecting the definition? Are the types of help currently available completely inappropriate to their situation and so it does not seem to include them? I  meet parents of children with a learning disability who describe persistent and escalating levels of violence and abuse, that in many ways matches the experience of families with adopted children, or families who have experienced domestic violence, or with mental ill health. And of course in each situation there may be layer upon layer to consider. There is rarely one clear cause or trigger, and for each family it will look and feel slightly different.

Is it taboo to admit your child with disabilities hits or bites you? On Woman’s Hour, on February 21st, Jane Garvey introduced a segment about caring for a child with disabilities. You can hear the programme here, and the discussion lasts from the start to 25 minutes in. There are interviews with Nikita, parent of a five year old child, Nayan, with microcephaly, who shows tremendous resilience in the face of regular tantrums and lashing out which comes from frustration; with Rosie Noble, Family Support Manager at Contact a Family, who offers reassurance that things can get better; and with Yvonne Newbold, mother of Toby, who has written extensively about caring for a child with disability. Yvonne has since blogged about the experience of appearing on the programme, and about her decision to speak out. I highly recommend her blog both for the honesty of the encounter, and for information about Yvonne’s wider campaigning to improve support for families experiencing long term, significant levels of violence from their learning disabled children. I’m not going to repeat the details here. If you are interested in knowing more about Yvonne’s experience then please do check out her website. She has organised a groundbreaking conference for the coming weekend, following her Woman’s Hour appearance, and I hope to post more information about her campaigning in the coming weeks.

For what it’s worth, I don’t think Nikita’s situation would be included by many people within a CPV definition. That is not to diminish the level of violence she and her husband face – and sadly may continue to experience, but to question the level of control or intent involved in the hitting and lashing out. But how will we feel as Nayan becomes older, bigger and stronger? What about Yvonne and Toby – how is their situation different? Is it different? The issue of intent is one I will return to in later posts, as it seems to be a central part of the conversation, and yet raises more questions than it answers.

If that’s not enough questions, I want to conclude by drawing some thoughts together and throwing a final one out there for discussion.

When we discuss child to parent violence we are not talking about the odd push or shove, about stroppy teenagers, or about an argument we once had that got out of hand. The phrase is used to describe a pattern of persistent and often escalating violence and abuse over perhaps years, from a child or young person towards their parent or carer. The routes to CPV are many and varied, and frequently overlapping. Each family situation is unique, and yet there are many commonalities, not least in the actual day to day experience and damage – physical and emotional that is done. Nikita describes the pain and hope of living with a disabled child. Yvonne has years of experience and has taken a decision to break the silence, to encourage others to speak out, and to campaign for better support. These are just two examples of what CPV might look and feel like.

So my question(s): Does that help your understanding or does it complicate it? And if you have a disabled child yourself, how do you feel about being included within the definition of child to parent violence? As always, please do join in the conversation!

May 3rd 2017: I’m adding on a bit here rather than starting a new post, because I think it furthers these particular thoughts. 

Yvonne Newbold has continued to add to her own website over the last weeks, and this includes a page about dealing with violent and challenging behaviour from children and young people with neuro-disabilities. I think it is significant that Yvonne chooses to use this phrase – VCB rather than CPV – in this situation.

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The use of restorative work in CPV: where it diverges with IPV

The recent publication of the paper, Under the Radar: The Widespread use of ‘Out of Court Resolutions’ in Policing Domestic Violence and Abuse in the United Kingdom, by Westmarland, Johnson and McGlynn,  once again draws attention to the differences between adult perpetrated DVA and child to parent violence. Continue reading

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Safeguarding Adolescents in London: survey for professionals

I am very happy to support the dissemination of this survey from the London Safeguarding Adolescents Steering Group, developed to inform improvements to the safeguarding of young people aged 10 – 17. If you are engaged in work with young people in London, please do read this letter and complete the survey.

Please note that this survey is now closed, but I have kept the links here for the interest of those involved in work in this field. Continue reading

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