Working with trauma; finding new ports of entry

ABSTRACT

This paper describes how, in the wake of a spate of fatal knife crime in one London borough, the council, Clinical Commissioning Group (CCG) and Child and Adolescent Mental Health Service (CAMHS) got together to think about how to improve outcomes for their young people. Starting with schools and pupil referral units, the CAMHS and educational psychology service were commissioned to work with whole staff groups, from senior leadership to lunchtime monitors and playground staff, to embed trauma informed policy and practice. The aim was to spread understanding about complex developmental trauma; what it is, how it affects the behaviour and experience of children and families, and how to work with it. Given how widespread trauma is, the objective was also to think about what might need to change in the environment and ethos of the borough’s schools as a result. Following the project’s initial success, its scope and remit were expanded to support services on a policy level, while also working with their staff to think about the impact of trauma, and how best to support children and families who have been affected by it. As well as teaching about trauma, the project is primarily an experiential one. This paper explores the impact on staff who were involved in the project; what came out of it for them personally in terms of changes to their thinking and outlook, and what they saw as the changes for the children and families they worked with.

KEYWORDS:

• Complex developmental trauma
• trauma informed practice
• schools
• children’s centres
• community groups
• Attachment Regulation and Competency (ARC) framework

Acknowledgments

We would like to thank Alex de Rementeria for her thoughtful editing of this paper; our colleague Stephanie Campos for her brilliant leadership of the trauma informed practice community project; our amazing TIPs team; and the teaching staff and community workers we support whose skill in, and dedication to, this challenging area of work is inspiring. Most importantly we’d like to thank the trauma impacted children and families from whom we continue to learn so much about resilience and hope.

Disclosure statement

No potential conflict of interest was reported by the authors.

Confidentiality statement

The authors secured consent from their colleagues working in the TIPs projects and agreement from the Council and Trust running the projects to publish this paper. There are brief references to individual children in this paper and care has been taken to remove or change identifying details.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Notes

1. Stern’s concept of ports of entry is used loosely here to refer to different parts of the caregiving system around children that might be the appropriate target for intervention (Lieberman & Van Horn, 2011, p. 92).

Additional information

Notes on contributors

Lucy Alexander

¹Lucy Alexander trained as a psychoanalytic child and adolescent psychotherapist at the British Association of Psychotherapists (now IPCAPA at the British Psychotherapy Foundation) where she has since been involved in teaching and supervising. She has worked at Islington Community CAMHS for the last 12 years in the early years, schools and therapies teams; and in the last three years has managed the Tiny Tips team, facilitating trauma informed practice in nurseries and children’s centres. She has a particular interest in working with parents and their under 5s and in applying psychoanalytic ideas to non-clinical settings. Before becoming a child and adolescent psychotherapist, Lucy worked as a journalist.

Sian Barnett

Sian Barnett is a clinical psychologist and manager in Islington Community CAMHS. She completed her Doctorate in Clinical Psychology at University College London in 2003, following her undergraduate degree in Manchester and a Counselling and Psychotherapy course at Regent’s College London. She has worked in Islington CAMHS for 20 years, this year, and manages the Islington Schools Team and Islington Trauma Informed Practice in Schools Team (iTIPS). She also jointly manages the Early Years Team, with lead responsibility for Children’s Centres and Incredible Years Parenting Groups (IY). After many years of working clinically with children and families with significant trauma histories, in the CLA team, CAMHS therapies team, IY, schools teams and community settings, utilising CBT, DBT and systemic ideas, she has developed an interest in whole system approaches to children and families who have experienced trauma. As a manager and as an iTIPS Practitioner, she currently offers supervision, training, consultation, and reflective practice to staff, to help them support the children and families they work with.

Verity Wilkinson

Verity Wilkinson trained as a clinical psychologist at Royal Holloway University of London. She has worked at Islington Community CAMHS for the past 8 years within the early years team. For the past three years she has also worked as a specialist clinician within the Haringey Parent Infant Psychology Service. She has a special interest in promoting attachment-based care in therapeutic and community settings. In the last two years she has co-developed a project nurturing trauma informed practice in diverse community settings.