Adoption support – the tanker is turning

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 ┬ácommitment 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.

7 thoughts on “Adoption support – the tanker is turning

  1. Helen Oakwater

    Superb piece. Yes tankers take a while to turn. Individual voices are now forming a choir which will inspire others to harmonise and be heard more widely. Thanks Sally. Always an honest realistic pragmatic voice focused on the future.

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  2. Marie Kershaw

    Well said Sally. In my opinion, the ASF is both a blessing & a curse. No doubt it has enabled many families to access support they would otherwise never have received & has contributed to debate re: need for better support. However my worry is this. The ASF was set up to address the shortfall in mainstream services, but in reality it has done nothing to address this shortfall. If anything, it has given CAMHS services an excuse to close the door even more firmly in the face of families. You might say, “fine, we don’t need them anyway”, but we do.

    Adopted children are not the only ones with attach/dev trauma issues, but their parents have a powerful voice & are intelligent & articulate folks. Parents of other kids with attach/trauma often are not for a whole heap of reasons. When we take these issues off the health radar by sidelining them into an independant marketplace, they stop being visible & evident to health commissioners. The unintended consequence is tge risk that even fewer trauma informed mainstream services are likely to be commissioned. The Radio4 programme & others have called for comprehensive MDT assessment of kids needs. I agree, but this is super expensive. The fund cap can’t cover it & LAs have no money to match fund. LA shouldn’t be subsidising what should be mainstream, free to access NHS assessments (psychology, OT, Paediatrics, Speech & Lang etc). We are robbing Peter to pay Paul & this isn’t a good use of public money.

    On top of this, there is good practise & bad practise all across the board. In my LA we have worked hard to advocate for a robust high quality assured commissioning framework of providers. A clinician oversees referrals & matches children’s/ families needs with appropriate, qualified & skilled therapists. But in most services we are expecting Social Workers with no mh training to inform these decisions &/or parents in high crisis/stress to ‘know’ what they need. I mean this as no disrespect to adoptive parents. Many are well informed, but many are not. Some think they know what they want, but this is not always the same as a joint clinician/parent assessment & formulation of what they need. There are many benefits of the ASF, but I have also seen in increase in fragmentation of services, ethical dilemmas (stopping therapy half way cos the funding ran out!), and some very dubious practice. I’m not convinced it is the most cost effective way to maintain support services in the long term. The ASF may have started turning the tanker, but I’m not conviced it is the best way to run a tight, safe & efficient ship.

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    1. Anne

      Marie, thank you for your comments about the way the asf has left camhs underdeveloped rather than helping to fix the problems in the service. It has made me think.
      I have always believed in, advocated and used public swimming pools, sport centres, schools, libraries, hospitals etc for the reason that I believe these provisions should be available for everyone and kept to a good standard. We had around 5 years involvement with camhs from when the children first came to us nearly 10 years ago. This involves long waiting periods between appointments, changes of therapists with short notice, little or no progress with one worker who refused to accept suggestions from me after 18 months of weekly sessions with one child.
      Eventually we saw no options but to pay privately for therapy whilst waiting for the LA to support us, shortly before the asf was introduced.
      It never once occurred to me to fight the camhs system, I wouldn’t know how, I just wanted what was best for my family and our survival. We are currently in receipt of asf for all three children who are on a three weekly rota of DDP therapy. This takes place in our home and is led by the same excellent therapist who we all get on with and like. Ours is the best support plan we could ask for and the system works for us as much as possible under the circumstances.
      However I am concerned that for many more people out there the system is still one that lets them down. Regularly. Children and parents alike.
      The CAMHS system should be a good quality organisation that is consistently able to help those who have experienced neglect and trauma and the affect that had on mental health. Future reviews of ASF should take that into account. It owes it to everyone.

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  3. Amanda McCaig

    Well said Sally. I am one of those ‘rogue traders’, who having completed a great deal of training in assessing attachment and working therapeutically with children, funded by myself, the ASF enabled me to do the direct work I wanted to do and support some families along the way. Sadly I come across a number of LA managers who still believe (or it suits them to believe) that love fixes trauma, and also recently an Assistant Director who said children removed at birth (due to parental alcohol/drug misuse) should have no attachment issues…..the ASF is not perfect but it is a start and offers some support to families who get it from nowhere else and who did not sign up to parent traumatised children, but to be a family. I have yet to come across a CAMHS team who will touch trauma and it is exasperating that they are still viewed as the beacon, when the lack of funding, training and knowledge around adoption issues is astounding. In my area all any adopted child would get is a diagnosis of ADHD or ASD and sent on their way. It also frustrates me that because my background is social work, I am a sole worker and don’t have the glossy PR machine to wow LA managers into awarding large contracts I am called a ‘rogue trader’. Workers like me charge a fraction of the cost of the bigger organisations so the cap goes much further, don’t expect families to travel to us, can be responsive and think outside the box for what are very complex family situations and in my experience have undertaken much more in depth training in order to do what we do. I hope the ASF doesn’t get binned because it has opened Pandora’s box, let’s hope It doesn’t become a victim of its own revolution because where will that leave families?

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    1. Sue Randell

      This is such an interesting discussion! I am a Health Visitor and a L A Foster Carer (LA because i think private agencies charge immoral rates!).
      I have just been approached to do somepost adoption support and am really keen to join theranks of “rogue trader”. I agree regards Camhs I have never had a referral accepted by them and having lived and worked with traumatised children it infuriates me the lack of support available to families. This is why I am keen to undertake this piece of work and make a positive impact. I would love to know any pointers on what has helped and what hasn’t helped if anyone is happy to advise me?

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  4. Megan

    Terms like ‘lone’ or ‘rogue’ providers are somewhat loaded but we believe that it is a problem that there there is no proper regulation of small scale providers for whom Ofsted is prohibitively expensive. Nevertheless this was no reason to suggest these providers are causing harm.

    Without rigorous policy evaluation to examine the impact of the ASF, on all types of adoptive family, in every region, it is not possible to know whether the fund is reaching all those it needs to reach, and the support provided is sufficient. It seems to be of critical importance to get beyond the political rhetoric and to properly understand where the fund is working, and where it is failing.

    There is a great deal of denial about the impact of childhood trauma (as described by the film Resilience, which is about the Adverse Childhood Experiences), and for such a long time there has been denial about the difficulties faced by adoptive families. It is so positive that the File on 4 programme, and others aired on 26.9.17, brought our problems into the open.

    We remain concerned that the commitment of adopters who are ‘parenting from a distance’ when their children cannot live together with them and re enter care, is much undermined by the use of the term ‘disruption’, ‘adoption breakdown’ or ‘failed adoption’, all of which convey a finality that may be misleading and deter efforts being made to maintain positive relationships between parent and child, and to keep reunification on the table, as was recommended by Selwyn (2014)..

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  5. Joy Hasler

    Hi Sally
    Thank you for this. Yes we need to turn the tanker and change the climate of Adoption Support.
    An adopter sent me a quote from you with a list of things you think needs to happen. One of them was a suggestion of an app. At Catchpoint we worked with Portsmouth University and IBM (an adoptive parent who works at IBM headed this up) to create such an app for adopters. It won an award from The Jnternational team of IBM while it was being developed. They could see it as being of value world wide. The students, over three years, talked to Adopters and our team to decide what was needed. Unfortunately at the end of the project it just got dropped and we are now negotiating with Portsmouth to hand over the project so we can get someone to create it. We have been very busy (lots of families in crisis) so have not given it the attention it needs but if we work with someone else this could be easily set up. Are you interested? It would be good to meet sometime.
    Kind Regards
    Joy Hasler. (Just retired from being director of Catchpoint)

    Reply

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