The media coverage this week, sparked by the File on 4/Adoption UK survey into adoption support has been saddening, a bit maddening and in a strange way uplifting. Uplifting because it’s the first time I can recall the knotty reality of parenting traumatised children being extensively explored and aired on mainstream media.
We adopted our children thirteen years ago when the prevailing belief was that love and boundaries would fix whatever was broken. There were few to no services within either local authorities or the health service. There wasn’t even a language with which to describe and make sense of the complex and totally unfamiliar set of behaviours that we and many others like us were faced with, some of which were reported this week. After years of bafflement and mistake-making it slowly became clear to me that what helped to make sense of the great magnificent mess of it all was an understanding of physical and psychological trauma. That realisation was like the illumination of a giant lightbulb and it has lit my thinking, my parenting and my work every since. But until relatively recently, to talk of trauma and even attachment (hardly a new kid on the block) was to risk much professional eyebrow raising and worse, being blamed.
For some years now I’ve been involved, as have many others, in the push to improve services around adoptive families, including improving the understanding of early life trauma and the provision of family-friendly, trauma-informed therapeutic services. In 2013, the then Minister for Children and Families, Edward Timpson, who crucially has personal experience in the context of adoption and fostering, secured an amount of money to trial the delivery of therapeutic services to adoptive families. It was to involve as little bureaucracy as possible, as much choice for families as would allow and would, it was hoped, invigorate a starved and conservative (with a small ‘c’) public, voluntary and private sector offering. It was an ambition of many that if proven to work, the project might widen to transform services around all care-experienced children. I was asked to join a committee to steer the design and implementation of the fund, which I did.
The Adoption Support Fund didn’t get a good rap on the File on 4 programme. I can see why the ‘this ASF is funding a load of hokey’ story stuck as surely it must make sense that therapeutic services should be delivered under the watchful eyes of CAMHS, but it’s a long way from the whole story.
The ASF funds a bunch of therapies that, crudely speaking, adoptive families like and find helpful and mental health academics and others write off as a pile of hokey being delivered by charlatans, the majority who work alone, like rogue traders. Damage could be being done, they say, funded by tax payers money. What kinds of idiots and cowboys must these adoptive parents, social workers and civil servants be to allow such awful practice to carry on, one might ask.
The ASF was born (again crudely speaking) because CAMHS appeared to be mostly absent, because it rolled it’s eyes when ‘trauma’, ‘attachment’ and ‘early adversity’ were mentioned, because it was able to declare ‘these are not mental health issues’ and ‘we do not treat adopted or fostered children’ (yes really) and because of its propensity to ‘medicalise’ and medicate symptoms and send parents on inappropriate parenting courses. It was and is also chronically lacking in funding. All this left an enormous, howling void of distress. Voids get filled, with all sorts of good and bad stuff. What happened with this void was that it got filled with the efforts and dogged commitment of adoptive families and many of those supporting them to make sense of the behaviours, finding what improved the lives and outcomes of their children. Adopters aren’t stupid hysterics who will fall for any old horse-wash, not in my experience anyway.
What was found were the sorts of therapeutic approaches allowable under the Adoption Support Fund, many originating in the US and not evidenced to the satisfaction of UK bodies. These are approaches such as DDP and Theraplay. Many adopters who could afford to, funded these therapies themselves, some even remortgaged their homes. Word spread, conferences were attended, experiences were shared and many local authorities, recognising the value of these approaches, came on board too. Some professionals working within the NHS, such as clinical psychologists began to come across these approaches and finding them useful absorbed them into their own practice. (I know I’m explaining this mini-revolution crudely and possibly inaccurately, but bear with me.) These are some of the rogue traders that were described in File on 4 – individuals or collectives who left the NHS, for a multitude of reasons.
That’s not to say that all those practitioners being funded by the ASF are good, or that their practice is positively impactful, because lots more research is needed. It is said by some that we also need more research into some of the interventions employed under CAMHS – what’s good for the goose is good for the gander.
The ASF is the start of what promises to be a long, difficult process of assessing and embedding best practice, of encouraging more flexible, family-friendly approaches that respond to the complexity of individual need, of responding to latest findings, of ensuring that services around children are trauma-informed and of measuring long-term outcomes. I say it’s the start, but if the ASF gets written off as funding horse-wash then it risks being binned and we’ll be back where we started shouting into the howling void being pelted with CBT, Ritalin prescriptions and blame.
Changing complex human systems that sweep up the very best and worst of human experience, that involve budgets, politics and power balances is devilishly difficult. It takes bloody ages and for long stretches it can seem as though nothing is happening and all you hear are criticisms. But this kind of long, difficult work is like trying to turn a giant tanker, using a few little tugs, being fired upon by gunships. You have to stick at it.
The tanker is starting to turn. Discussions around the long term impacts of early adversity, childhood trauma and attachment difficulties are coming into the mainstream and tremendous work is being carried out around the country to support and heal adoptive children and their families. Things are unrecognisably better than when we first found ourselves grasping into the dark, being told that trauma wasn’t a thing. There is tonnes more to do for all children who have experienced early adversity for sure, but the foundations are there. Now is the time to build on those foundations, not to tear them up.