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The Life Journey of Trauma

The Police and Crime Commissioner hosted the Life Journey of Trauma Conference which included a livestream, now available to watch. If you asked a question and we didn’t have time to answer it at the conference, the OPCC will endeavour to respond to all questions and publish them on this page, week commencing Monday 7 March. Please bookmark this page for updates. 

Agenda and conference livestream

Agenda

09.00 Opening the Conference – Police and Crime Commissioner Donna Jones

09.10 Latest Research on ACEs Professor Mark Bellis

09.40 Time to Reflect

09.50 Brain development in early years, and the opportunity to shape our world view – George Hosking OBE CEO WAVE Trust

10.20 The Health Visiting Role in the First Years of life – Charlotte Gatehouse Specialist Health Visitor

10.35 Time to Reflect

10.45 Break

11.00 The importance of creating a contained environment in which a young person can feel safe and secure and how that can be achieved, including the need to first contain ourselves emotionally before we can successfully contain those in our care – Marie Gentles OBE (from BBC2 Two Part Documentary Don’t Exclude Me)

11.30 Time to Reflect

11.40 Premiere of the film showcasing the value of Trauma Informed Practice (not available to livestream viewers)

12.00 Chief Supt David Powell – Introduction to the pilot of Trauma Informed Practitioners (TIPs) supporting three Response and Patrol Policing teams to support Trauma Informed Policing

12.10 Sgt Jamie Sharp – The impact of Trauma Informed Practitioners (TIPs) from the police perspective

12.20 The experience of supporting police as Trauma Informed Practitioner (TIPs)

12.30 Lessons learnt from the pilot Sue Penna – Joint CEO Rock Pool

12.40 Time to Reflect

12.50 Update on the Integrated Care System – Representative from the ICS Team

13.00 Lunch

13.45 Safeguarding Minister Rachel Maclean to address delegates

13.55 Presentation of the signed Trauma Informed Concordat – Karen Dawes Office of the Police and Crime Commissioner

14.05 Break-out rooms to help shape What Next? (not available to livestream viewers)

14.45 Break

15.00 Creating Self-Healing Communities in Washington State, and the striking results achieved by them. Also, the cost benefit appraisal of their impact – Laura Porter

15.40 Time to Reflect

16.00 Based on his best seller ‘The Body Keeps the Score’ – Bessel van der Kolk

16.40 Time to Reflect

16.50 Closing the Conference – OPCC chief executive Jase Kenny

Questions and answers

Our Early Years response from Charlotte Gatehouse Health Visitor

Have we considered the impact of screen time on attunement? The disruption that parents scrolling on their phones can have on their engagement with the newborn. The economic impact of having a baby means parents need to work, but struggle to afford high quality childcare. How are we supporting childminders, nurseries and other care givers to ensure they’re aware of (& are supporting) attunement? If parents are not engaging in the 5 mandated contacts what is our response? Where is the public health campaign to engage families in hearing and implementing these messages, services can only do so much.

Yes we do consider how things such as screen time can impact on attunement and responsiveness. Within my role I would explore this sensitively with the mother, including the impact, but also consider the reasons for use such as her own emotional wellbeing and any support needs.

In reference to your question regarding childcare. Locally we use a model called ‘Five to Thrive’ which uses simple language to support families to understand babies healthy brain development bridging the gap between your professional understanding of neuroscience and everyday family experience. In Solent we are integrating this into our public health communications, such as our digital platform called Family Assist as well as Personal Child Health Records (red books) and direct contacts with families. The ambition is that ALL professionals working with children and families would have knowledge of ‘Five to Thrive’ which will include both the training to increase knowledge of neuroscience and resources to support families. This would include education and childcare settings, as I agree these are a really important and consistent resource for both children and their parents. There should be further training for relevant professionals later on in the year and we hope to disseminate this widely across sectors. Please do let me know if you would like further information as I receive it.

In reference to your question regarding the 5 mandated contacts and non-engagement. As stated in the presentation, we are a voluntary service and not statutory and therefore parents can choose to engage with the service or not. Each area will have its own ‘non-engagement policy’ which will stipulated how many attempts for contact are made and how, and our response if parents do not engage. This would include a holistic assessment of concerns, risks, actual or potential impact on the child and any protective factors known. This would then inform the plan and who would be appropriate to share information with. Last year Wessex Voices undertook a project called ‘Opening Doors’ within 4 local areas with high index of deprivation. The project sought to specifically understand barriers for women in accessing perinatal mental health care and what might make a positive difference, however the findings have relevance to engagement with services such as health visiting who are often the ‘gatekeepers’ for assessment and referral. A particular point that stood out to us here in Portsmouth, was that what was reported to be helpful was professionals noticing and inviting rather than asking them to seek help and support (such as choose and book) and we are therefore adopting this approach more for example with the 1 and 2 year health reviews.

Charlotte Gatehouse (Specialist Health Visitor PIMH)

 

Just a note, it was nice to see a Health Visitor present at the conference, however, the services described are not equitable across Hampshire, and some families are only being seen virtually which does not lend itself to robust holistic risk assessments. The HV service cannot be called upon to provide insight or support to all families; which is what is needed to recognise trauma.

Thank you for your comments. The presentation was written with representation from health visiting teams across Hampshire, Southampton and Portsmouth to try and reflect the local commissioning and delivery across all areas. It represented the national guidance for health visiting and what we strive to deliver locally. There will be some variation as each area is commissioned by a different local authority. We know across all areas the health visiting services had to adapt in response to COVID, including some virtual contacts, the effectiveness of which is unknown and untested. However, as we continue in a period of ‘reset and recovery’ we have returned to offer more and more face to face contacts in the home, family hubs and clinic settings. I agree that face to face contact is important in both outcomes and experience for families, in identifying trauma and being trauma informed in our delivery. As reflected in the presentation, we know national health visiting numbers have reduced by 1/3, and investment is needed to ensure we can provide robust assessment and support to all families. Thank you. Charlotte Gatehouse (Specialist Health Visitor PIMH)

 

Our Early Years response from George Hosking OBE WAVE Trust

Have we considered the impact of screen time on attunement? The disruption that parents scrolling on their phones can have on their engagement with the newborn. The economic impact of having a baby means parents need to work, but struggle to afford high quality childcare. How are we supporting childminders, nurseries and other care givers to ensure they’re aware of (& are supporting) attunement? If parents are not engaging in the 5 mandated contacts what is our response? Where is the public health campaign to engage families in hearing and implementing these messages, services can only do so much.

Yes, I worry a lot about both screen time, and tiny children being given mobile phones to play with. They are both marvellous for taking pressure off parents and terrible for the development of the brains of very young children. I am particularly frustrated when I see mothers pushing babies in push chairs, facing away from the mother’s face, while the mother is engrossed in her mobile phone. Firstly, the babies should face the mother in the push chair for the first 12 months, as during that period the attunement with the mother is much more important than seeing the world; secondly the baby needs that interactive, responsive attention as much as possible. That does not happen when the mother is glued to her phone and not engaging with the baby’s need for warm, two-way interaction.

Sad that so many children’s centres have been closed.

Yes indeed. Family Hubs will be created under government plans, but I am not sure they will be the same, being spread over all ages.

How much does the PCPS intervention cost, and what is the minimum scale of delivery for this.

The cost is very dependent on how the programme is resourced. Local authorities and NHS generally have all the human resources they need to deliver PCPS – health visitors, nurses or health support workers, psychologists, speech and language therapists – but they are usually spending the vast bulk of their time on remedial rather than preventive work. There is also a need for physical resources, such as a Health Centre, a Children’s Centre or a Family Hub, which can turn 5 rooms over to the use of PCPS. Some local authorities still have these; some have shut them all down. At one point I calculated the cost in Camden as £200 per baby, but at that point they had resourced the service almost entirely by redeploying staff, and repurposing existing buildings.
Absolutely with you in getting children in the government radar. Will be interested in finding out more about PCPS

Do email ghosking@wavetrust.org

Need to reflect on the impact of the pandemic within the community on people leaving prison system trying to resettle in unsettled times. We need to make more effort at this across the system.

We allow far too high a percentage of our young children to be traumatised and damaged while they are young; then we exclude from school the most damaged, helping them to choose a pathway to crime; then we lock them up in prison, where they are re-traumatised; then we throw them out on the streets with totally inadequate support. The pandemic has made it worse, but it was bad enough beforehand.
Just a note, it was nice to see a Health Visitor present at the conference, however, the services described are not equitable across Hampshire, and some families are only being seen virtually which does not lend itself to robust holistic risk assessments. The HV service cannot be called upon to provide insight or support to all families; which is what is needed to recognise trauma.

In Scotland, the Universal Health Visiting Pathway mandates a minimum of 11 home visits to families – 8 within the first year of life, and three Child Health Reviews between 13 months and 4-5 years. They “get” the early years. PCPS has a mother (and father if he will) visit a clinic with their baby 6 times between 3 and 18 months, with 60-90 minutes attention per visit.

 

Education response from Marie Gentles

How we can persuade schools to invest in time for school staff to learn about containment strategies. To move away from punitive zero tolerance behaviour strategies towards trauma informed, restorative approaches.

Unfortunately this is one of the hardest hurdles to overcome. By making connections and speaking with other schools who have received training is powerful. However moving forward, connections and conversations with the Department.

How can we support our workforce to contain themselves?

Via CPD initially, so that they understand the benefits and the ripple effect in regards to overall support for the entire school community.

Is it possible to apply the seven containment approaches to adults who are stuck in ‘fight or flight’ state of mind to help them regulate their emotions?

Yes! Ironically these strategies work best when we understand what I call the ‘mirror effect’ of adult – child behaviour.

I would’ve liked to have heard more about the impact of what you were doing in the PRU on outcomes for vulnerable children, especially those with additional learning needs?

Quality first teaching (only qualified teachers teaching the curriculum) and by creating a contained environment for all children and young people, meant that regardless of need every single individual made progress academically, socially and emotionally. Ensuring that all staff were trauma informed and received regular CPD.

Also I’m curious as to the difference between standard cognitive-behavioural therapy (CBT) approaches (thoughts-feelings-behaviour) and your thought-feeling-action slide? If there is no discernible difference, that’s ok but you can’t then claim this is your own thinking/model and it needs to be referenced to the original authors.

The phrase thought, feeling, action I’ve coined, same as no blame, no shame, not the model. Good point and I’ll ensure that’s clearer as no one’s ever commented on that before so thank you, much appreciated!

How can we work closer with families in a more cohesive way? Seeing the family/individual not the ‘incident’?

Via more professional collaboration. If professional bodies joined up their working, I believe it is a more productive and cost effective way of working.

 

Self-Healing Communities – Response from Laura Porter

How can public agencies best foster an environment conducive to expanding leadership at a grass roots level?

Some general guidance from Laura Porter including the attached document
Support a four-phase process that generates reinforcing feedback and drives sustainable transformative positive change. (As does the Self-Healing Communities process).

Take a learning systems approach: create contractual agreements that control for learning – and model learning as a central goal in the partnership between government and the people.

Develop an education framework that unites people across professional disciplines, class lines, sectors, etc. For example: create capacity to teach everyone about NEAR Science (Neuroscience, Epigenetics, Adverse childhood experiences, Resilient communities – the science that explains how experience shapes development and life course health). Teaching should be structured with local trained trainers, who can both teach the science with fidelity and can serve as cultural translators. Iterative exposure to the science replaces a mandate – because people who are learning the science will naturally gravitate toward a focus on preventing adversity. Tell everyone… and ask them what they would like to do with NEAR science.

Form long-term partnership commitment with community leaders. Create a structure that can be used as a central point of contact that can “represent the local community”, as opposed to only representing a local organization within the community – and fund idea generating and reflection processes that engage community residents in the processes of generating improvements in BIG goals that are relevant to the community. Create a structure at the government that local people can send observations, ideas, reports to – and reach multiple disciplines within the government. That way, there is a structure for community-government partnership.

Structure staff for both short and long term needs (see section in the attachment: How we structured staff).

Take actions that demonstrate a fundamental respect for the wisdom of every person – their culture, experience, capabilities, and aspirations. For example: use processes for pre-procurement – gathering ideas from residents and professionals about what actions, if we took them, would generate safety and family support. In the U.S. governments typically use Request for Proposals (responding to these requires considerable expertise). We used Request for Ideas, and then connected people and organizations with similar ideas and facilitated a process for these to be bundled and turned into proposals that could be funded. That way, local ideas become a vehicle for increasing efficacy.

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