Alex Soteriades, Teacher and Trainee Art Therapist, reflects on how art therapy can help developmentally traumatised children
Children are naturally creative, as are adults, and sometimes it’s easier to explore a feeling by ‘making’ rather than by ‘talking’. Art therapy is a vessel for communication. Its nonverbal and non-threatening approach allows children to tackle difficult and sometimes traumatic issues they are experiencing.
When a child makes art, the therapist along with the child can attempt to interpret and make sense of it. This is sometimes called the triangular relationship. This approach is pivotal in getting to the heart of the problem or at the very least starting the process.
Adopted children can do to the artwork what they can’t do to people and this is so profound and empowering for many children that come to Family Futures.
In this way, art can be loved or unloved, survived or destroyed, but ultimately, it can preserve imprints of oneself and provide an opportunity to express metaphor. In fact, one of the benefits of art therapy is the ability to embolden and enrich storytelling and narratives through the use of metaphor.
When a child experiences something tragic, this gets buried in their unconscious. Imaginative storytelling through painting, drawing, sculpting can help bring these suppressed emotions to the surface.
With the support and guidance of the therapist, these narratives serve as a way to slowly and safely release disturbing or terrorizing experiences and can focus on helping the child heal.
Family Futures will be closed from 5pm on Monday 23rd December 2019 to 9am on Thursday 2nd January 2020.
If you are a family in treatment with Family Futures and have a serious emergency or crisis during this time and you think that the crisis requires the emergency services, we suggest you call them first. You can then ring into Family Futures on the main number 0207 354 4161. On the days when the office is closed a Duty Manager is available between 10am and 5pm. On working days you can contact a Duty Manager between 5–9pm. If when you ring in, you then press 3 as instructed on the answerphone message, it will divert your call to the Duty manager’s mobile.
Please leave a message with your name, number and why you are calling and the Duty Manager will call you back as soon as possible. We hope however that you have an enjoyable Christmas and New Year.
Julia Press, Senior Social Work practitioner, reflects on Adoption Assessments at Family Futures
Joining the i-Adopt team at Family Futures really enlightened me as to how assessments of prospective adopters can, and should be done. That is, effectively, therapeutically and meaningfully, while always holding the ‘developmentally traumatised child’ in mind – the child who will, if all goes well, be placed for adoption with the families who are being assessed.
While following the standardised two stage assessment process, Family Futures ventures away from the traditional style of assessing, which may typically involve a social worker travelling to the home of a prospective adopter and asking questions which enable the professional to get to know them and assess their ability to adopt.
An assessment at Family Futures is approached quite differently – it is an education programme, for both the prospective adopter/s and the professional team – a two-way process where each party is learning, and equal to the other.
Stage one of the assessment entails completing a Taster Day at Family Futures which helps the team and applicants to understand their attachment histories and styles. This includes their ability to confide and the active use of their family and friends network. Prospective Adopters also gain insight into the therapeutic tools used with families who are engaging in post-adoption therapeutic support at Family Futures. These tools are experiential and incorporate creative arts and drama techniques. For example, we utilise paint, clay, sand and movement to explore a variety of issues which help prospective adopters to emotionally engage with the material.
Those who struggle to relay information verbally also have the opportunity to convey information in an alternative format. The tools are powerful in terms of their ability to unlock what’s beneath the surface (the unconscious) and they allow the Assessor to observe the capacity of prospective adopters to engage with difficult material, their openness to a variety of therapeutic approaches and their capacity to be creative and playful – crucial information for us when we are considering placing complex needs children within these families.
Using the approach and tools described above, Stage two of the assessment process builds on Prospective Adopters’ understanding of themselves; their histories, relationships, strengths, vulnerabilities, stress responses and triggers. This stage also addresses each applicant’s journey to adoption, paying meaningful attention to experiences of loss and possible unresolved feelings associated with infertility or miscarriages. Crucially one module of learning is devoted to the experiences of children who are removed from birth families and the impact of this, with particular focus on Adverse Childhood Experiences and Significant Harm.
In my experience an in-depth understanding of trauma, plus a commitment to apply, and the ability to deliver, therapeutic parenting, aids the success of a placement.
Crucially, an assessment and education program at Family Futures also involves a multidisciplinary team, including a Social Worker, Therapist, Occupational Therapist and Education specialist, who are there to guide and support, offering varied experience and insights from diverse perspectives. Family Futures also pledges to continually nurture a family’s support network, to strengthen the placement by assisting their understanding of the reality of adoption today and what it entails. Our team also identify what support people can offer the family to avoid isolation often felt by adopters post placement.
While I fully endorse the Family Futures approach to assessing prospective adopters and think that this acts as a strong foundation to healthy family life, I am sure this is not enough for children who have suffered trauma and abuse. Matching children for adoption is not the happy ending of a nightmare. Wounds do not disappear. They may reopen, become infected and hurt. They need thoughtful and ongoing aftercare, to help the healing process. Scars are a reminder that we need to care for families’ long term needs. Families require ongoing therapeutic support to ensure that they can continue to heal, grow together and thrive – this is something that urgently needs to be secured for adoptive families now and in the future.
After 21 years at the helm of Family Futures, our co-founder Alan Burnell, retired in September 2019. You can read a Q&A with Alan which featured in Adoption Today magazine (October 2019) here, about the highlights of his career and his hopes for the future of adoption services.
Adoption Today is a magazine for Adoption UK members. If you are interested in more information about the magazine visit: https://www.adoptionuk.org/adoption-today.
New research by Family Futures, to be published in the Journal of Child Abuse & Neglect, November 2019, provides supporting evidence that a therapeutic intervention which is neuro-developmental and holistic in approach improved outcomes for children who had experienced developmental trauma and who had later been placed for adoption.
There is substantial evidence regarding the life-long impact of early maltreatment and adverse childhood experiences (ACEs) on health and social prospects, mental health, violence, criminality and poor engagement in education. Children who have been maltreated and subsequently fostered or adopted are more likely than others to have been subject to ACEs prior to their removal into care.
There is limited published research, however, that indicates what is effective in treating older adopted children who have experienced maltreatment and sustained trauma in their birth families. This study is the first to compare outcomes for adopted young people who received an integrated multidisciplinary treatment intervention with those who were recommended the approach at assessment but were unable to receive it (mostly due to funding restrictions).
Family Futures’ neuro-sequential and multidisciplinary treatment model, NPP (Neuro-Physiological Psychotherapy), is informed by neuroscientific research on the impact of maltreatment on the developing child and by therapeutic models such as Ayres Sensory Integration, Theraplay and Dyadic Developmental Psychotherapy (DDP). Alongside regular NPP family therapy sessions the model supports applications of its principles at home, school and in the wider family network. In doing this NPP provides wrap-around therapeutic support for adoptive families and children in alternative care settings.
Dr Elaine McCullough, author of the research said:
“This is currently the strongest evidence for a therapeutic intervention for adopted children who have experienced developmental trauma. The results indicate the potential far-reaching improvements the NPP model can have for adoptive families. However, the findings have also highlighted the detrimental consequences for some families of not receiving appropriate support.
Therapeutic interventions need to influence all aspects of the child’s system to improve outcomes and long-term impact. It is important that health, education and social care provide consistent and joined-up support for children and their adoptive families. This support should be informed by neuroscientific research on maltreated children and acknowledge the impact of developmental trauma on the underlying neurological and physiological aspects of their emotional, cognitive and behavioural presentation.”
These research findings are consistent with the recent Adoption Support Fund study (Gieve, Hahne and King, 2019) which concluded that although moderate improvements were found from interventions offered through the ASF, there is a need for wider support than traditional individual therapy, to support children with complex underlying difficulties. It is hoped that this research can inform policy and practice in effective support for children who have experienced maltreatment, abuse, neglect, and/or Adverse Childhood Experiences.
The full research article was published in Child Abuse & Neglect, 97, 104128: McCullough, E., & Mathura, A. (2019). A comparison between a Neuro-Physiological Psychotherapy (NPP) treatment group and a control group for children adopted from care: Support for a neurodevelopmentally informed approach to therapeutic intervention with maltreated children Child Abuse & Neglect, 97, 104128.
Thank you to the many families and professionals who have sent messages to Alan on his retirement. You can read a few of the tributes below.
“We feel a sense of pride, gratitude and hope as a Family Futures family. You’ve kept us on the right side of chaos. A big heartfelt thank you for the inspiration, innovation and hard work you’ve brought to us and others here.”
“Alan is remembered by adoptive families in difficulty for believing those difficulties they were facing (in many cases he was the first professional to do so), and for how hard he worked to get assessments for children who so desperately needed support, despite the lack of funding on offer for treatment. Years later those assessment reports continued to offer families validation and education for the child’s network.”
“The ripples have gone out throughout the UK and beyond, through the courage to bring in new people like Dan Hughes, to exploring different ways of being and ways of working with children who are deeply traumatised, including working with the whole body.”
“One of the most original thinkers in the field of adoption today. Alan has helped to shape the thinking to bring adoption practice and adoption support right into the 21st century. You have challenged the complacency and the status quo in the system.”
“We have learnt so much that is embedded in Family Futures. At the heart of all Alan has done is the belief that adoption is a lived experience in a most profound way. There’s not an end to the story. Our sense of gratitude for all you have contributed over the years cannot be underestimated.”
“Alan’s work has blazed a trail in the area of adoption. He and his colleagues at Family Futures have changed, for the better, the lives of many children and families.”
“That Family Futures is held in such high regard by families and practitioners across the UK – and beyond – is testament to your dedication to understanding and improving the lives of countless children.”
“The people who have been on the two-year adoption and attachment course set up by Alan have gone out and made transformative changes around the country. They’ve done that because of Alan’s pioneering and courageous approach.”
The recommendation to develop a multidisciplinary approach needs to encompass the whole adoption process, not just adoption support
We were delighted to read the APPG for Adoption and Permanence’s recent Investing in Families report as it had both a positive and constructive view of the Adoption Support Fund (ASF) based on the evidence collated. We can only endorse from our experience the recommendations of the report. The ASF (as it has been for the past four years) has to be seen as a first step in funding focused therapeutic support for the contemporary adoptive family. Like any first step a lot can be learned from it and we think the APPG report spells out those lessons very clearly and carefully.
The APPG’s recommendation 4 calling for an increase in clinical input is something that Family Futures have been advocating for some time now. The report recognises that for a significant number of families (56% if using Adoption UK’s Adoption Barometer as a guide) are still needing a longer and more significant specialist and therapeutic service. We know from our own clinical experience that at least half of the children placed for adoption today have high levels of complex needs that require therapeutic input and support, at varying intensities, throughout their childhood. Because of the complexity of these needs and the early ‘significant harm’ this group of children have experienced, the allocation of longer term therapeutic packages needs to be one that is assessed and evaluated by a panel of clinicians.
Currently it is difficult to obtain matched funding for the more complex cases and the annual re-evaluation can lead to unhelpful breaks in therapy while administrators resolve the funding issues. As a consequence the children with the highest level of need have been least well served by the ASF. This seems like ‘unfair access’.
One of the difficulties the ASF and adoption services in general are currently experiencing is the lack of a coherent and consistent theoretical approach to providing post adoption support. We don’t believe it can just be left to whatever the market delivers or to whatever parents think they need. There is now copious evidence on the impact of neglect and abuse upon child development. It is this body of knowledge that should form the basis for post placement support.
This body of knowledge combined with our experience of working with adoptive families has led us to provide an integrated multidisciplinary post placement service for adopted and fostered children. Family Futures’ approach has now been peer reviewed, evaluated and published and provides evidence of positive outcomes so we very much support the APPG’s recommendation for developing a multidisciplinary approach, not just to post adoption support, but to the whole adoption process. In this way children in foster care would be assessed more comprehensively, better matches made and post placement support programmes put in place using the expertise of a range of professionals.
How can we improve the experience of adoptive families today?
Of all the descriptors of adoption today, we believe the Adoption Barometer published by Adoption UK is the most meaningful because a large number of adoptive parents describe their lived experience of adoption. The fact that ‘56% of established families faced significant or extreme challenges’ is a compelling finding. It tells two stories: presumably 44% of adoptive families are enjoying their adoption experience and finding it relatively unproblematic which is good news. However, for the 56% who aren’t, there still remains a significant need for more comprehensive, therapeutic, trauma-informed services to help families in difficulty.
The other most significant finding is that ‘54% of newly-placed adoptive families experienced stress, anxiety or symptoms of post adoption depression during the early weeks’. In our view, this common experience for many adopters should be addressed by more sympathetic and informed support offered during difficult times, particularly post placement. Sadly, this is not always available.
We very much hope that the Department of Education listens to the collective voice of parents and is not just predicating policy on academic research which is often inconclusive. Well done Adoption UK.
Tips from our team of Ocupational Therapists/ Sensory Integration Practitioners at Family Futures
Have a look at our Sensory Summer Activities guide here with tips for parents and carers on keeping structure going through the summer, sun screen recommendations plus activity ideas for at home, the pool, the beach and outdoor play.
Therapist, Adam Goren, reflects on how to best meet the needs of families in stress or distress
Coming to Family Futures from a small local authority post adoption support team felt like moving to the gold standard service. Years back I saw a BBC documentary called ‘A Home for Maisie’ and admired the work of the therapists with the featured adopted girl and her family. And I remember thinking that in another life I might work in a place like that.
It was only a few weeks into my job at Family Futures that I realised that this was the same place! What attracted me was a completely different model of working from that of classical child psychotherapy.
Working with traumatised children I realised that talking therapy wasn’t in and of itself enough. Children had sensory and physical difficulties and suffered from huge anxiety.
I was looking for something else to help my work to be more effective. Family Futures offered a much broader more inclusive range of tools for helping children and families. When I arrived I was somewhat awed with a bit of survivor guilt. There are not the same resource pressures as in the local authority and the emphasis is definitely on quality long term support. I also felt really tested to think outside the box of my professional training, even though this was what I was searching for. I had to get used to different creative ways of working and to working alongside staff from a wide range of professional backgrounds in sessions.
I was struck by how much time was carved out for planning and calibrating the support to suit each family’s specific needs. We are always asking how can we improve what we are offering and what more can we do? But I think that what I was most struck by was how totally passionately committed Family Futures is to helping families. Kindness and commitment maybe somewhat under-rated qualities, but they strike me as some of the most powerful tools we have in helping families in stress or distress.