Assessing Psychosocial Protective Capacity

Psychosocial assessments are an integral part of my job. I frequently receive calls from both practitioners and students asking for assessment frameworks, particularly in relation to a family’s capacity to act protectively. Therefore, I offer my preferred model publicly for you to use.

Risk assessment: Capacity to protect is a risk assessment of a parent’s ability to keep their child safe. When assessing risk I use a four score system designed by my psychologist colleague, Nick Rayner. The system contains the elements of: Acknowledgement, Acceptance, Adjustment and Accommodation.

The risk will contain measures of low, medium and high-risk areas. Risk factors within each of the four “A” elements will be either static (fixed) or dynamic (change over time).

Acknowledgement includes the parties being able to objectively view their familial patterns from an external viewpoint. If an entity is unable to acknowledge a difficulty within a situational context then this suggests not only a closed system but also an inability to affect the following elements within the four score assessment.

Acceptance often hinges on personality constructs and whether an entity operates within an internal or external locus of control. A closed system with an external locus of control has minimal chance of acceptance.

Adjustment refers to whether the entity can adjust to news of difference and if there is a capacity to affect change. Without appropriate infrastructure, external supports and measures of check, adjustment can be difficult and take lengthy periods.

Accommodation is the practice and capacity in action to the point where it becomes accommodated into daily life and cognitive structuring. In closed systems, separate entities are often socialized to accommodate to the dominant authority only. When this authority is challenged, the structure may further close in upon itself and strengthen the internal accommodation to the dominant voice.

The “how-to” of applying the above elements to situational contexts cannot be offered in a blog. It is the subject of supervision, best practice and experience. Be aware that any assessment and report you prepare often requires defending in court. Never make an assessment without backing it up with evidence-based practice and a full understanding of the assessment framework you have used.

Article reprinted from Megan’s original blog where it first appeared in November 2006

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Life Story Scrapbook Work with foster or adopted children

Children in foster care (and often adopted children) have a HUGE need to know why they are living away from their biological families. When they leave foster care, they often have little factual or even anecdotal information to make sense of having been there. They struggle to explain their life history to new people that they meet and enter into relationships with, let alone  to themselves.

If you are caring for a child or young person in out of home care, help them to put together their experiences by providing them with a life story book that can be added to over the years.

I first heard about Life Story Work in 1997. I was working with children who had been sexually abused. Some of the seminal writers from England were talking about a process called “Life Story Books” for children who would never be returned to their abusive families. Whilst it sounded interesting, I had little time or energy to put into finding out about something that would not be beneficial to the children I worked with. Out child protection system did not adopt children out just because they may never go home to their natural parents. Our children in out of home care went to loving foster families who would meet all the child’s needs, including emotional and information needs. Why would our foster children need a Life Story Book? Our Child Protection system had all the factual information that was needed and most of the kids I worked with had regular contact with their families. No…all too hard. I didn’t need to know about it because I’d never use it. It was someone else’s job. A job for someone that had time and a creative flair for doing those arty crafty creative things.

Then I became a foster carer! How arrogant were my assumptions about it being a job for some other time deficit person! My foster children had no factual information nor were they able to integrate fact because they were too traumatised. Despite this, my foster children were desperate for stories about their biological families and stole some of my family stories to make their own.

Some years following my first arrogant and wrong assumption, I worked as a Child Protection Worker in the U.K. I saw the absolute change in a child knowing their full history (yes, even the bad bits) AND healing through the process of facing a lifetime of rejection, neglect and harm.

Life story work is not merely an elaborate photo album or a fun thing to do. It is a three part therapeutic process of integrating and healing past pains with a view toward moving to a positive future. It is a part of thereauputic or (re)intuitive parenting process of change with attachment disordered children or children who require knowledge around why they are in care.

How do I do life story work and it’s not really my job. Let’s leave that for the statutory workers. Rubbish. It is part of your job as a foster carer. You are in a perfect position to help collect and set out information and to assist your foster child to work through some of the issues that may be creating havoc in your home. The process of helping is:

1. Information collection,
2. Integration of the information by the child, and
3. the making of a book that can be added to (or even subtracted from) throughout the years.

It is the child’s book: the sum of their life, of who they are and where they came from. You are part of their life and therefore it is therapeutic and helpful to the child that you are part of the book making process.

It is a book that is a therapeutic tool, written by someone other than the child – the Life Story worker/s. It contains the good and the bad, the truth and the myths. It is everything that has impacted upon the child.

We are all part of the child’s story and we cannot afford to keep expecting that someone else will begin the child’s Life Story Work. Do we expect the child’s schoolteacher to engage in solution oriented therapy because that’s what we assess the child requires?

Whose job is it to do the Life Story Work? When I began doing Life Story Work I was worried that I may be breaching statutory laws. I saw the work as belonging solely to Child Safety Officers. My Australian experience with Child Safety workers told me that they were too busy and spent minimal time on their case loads and Life Story Work wasn’t being achieved. Also, their understanding of Life Story Work appeared to fit within a Freedom of Information framework – what they had was what they used. I handled it by not doing it. In the U.K., SACCS has nominated workers that only do Life Story Work – they are neither statutory workers, carers or the child’s counselor. Their sole task is to complete Life Story Work.

In the borough I worked in London we were able to do our own Life Story Work which meant I collected, collated, and worked therapeutically with the foster children on our case loads. I LOVED it. I now advocate that it is every persons responsibility to be an active participant in achieving Life Story Work for kids in out of home care.

Where do I get Life Story information from?Family Focus USA

  • Start with a genogram (a family map or tree)
  • Move to an eco map (who has or has had contact with the child)
  • Talk to significant people in the child’s life (statutory workers, schoolteachers, foster carers, birth parents). Find out first from the welfare agency who you are allowed to contact and how far you are allowed to go in making contacts. WORK IN PARTNERSHIP with the welfare agency.
  • Ask family members (old and new) to write letters to be included in the Life Story Book.
  • Take photos – even of the door in a house the child once lived.
  • Use children’s art work done in therapy or at home.
  • Research – find out addresses, old telephone numbers, family rituals, family secrets, family celebrations.
  • Do internet searches by putting in the child/family name. Include anything you find.
  • Contact past therapists and seek permission to include relevant information.

How to help the child integrate the information:

Foster Carer or adopted parent?- Always work with a therapist or statutory worker. Check the accuracy of information you are including with those people. Ask for at home strategies and interventions to help in the task of unpleasant information integration.

Counselor – draw upon a range of therapeutic interventions to assist the child to come to terms with the information. This is a healing process and you must use best practice principals and ethical considerations in everything you do. Remember too that your work will be open to scrutiny – stay accountable – know that this document could one day end up as evidence.

Show the child your work as you complete pages. Allow them to write notes to be included on the page. They may disagree with what you have written. This is their right and is part of the integration process.

How to put the book together:

  • The book needs to be something that can be added to. Many people use a ring binder. Pages can be easily added over the years.
  • Some people provide DVD’s or CD’s. It’s difficult to add to these though.
  • My love and preferred way to engage everyone in the process is for using a scrapbooking method of compilation (journaling is a central tenet of life story work) and scrapbook albums – the top fill pages allow for hiding things that the child may not want to talk about yet, the plastic covers offer protection and it is easy to buy refills. Scrapbook albums are also acid free and WILL NOT destroy photographs. PERFECT.
  • For children from a different culture it may be appropriate to use a different method of collation – a suitcase, a bag, a box, a postal cylinder. Use something that will have meaning to the child and their culture.

Where and when to start:

  1. Start today. The longer you put it off, the less likely you are to do it.
  2. Start with the day’s occurrences, at the beginning of life, at the time the child came into your care, or you can work backward. It doesn’t matter – just START. This will become a document that can be added to, pages changed around, and even passed to other carers to add to.
  3. If you’re a counselor, change your notes into scrapbook pages to begin the process. What happened today? How do you journal and decorate it? YOU JUST DO IT. Under whelm yourself, start with making a paper bag album of today’s session (above photo is of a training booklet for life story work – it is made from two decorated paper lunch bags).
  4. Write a therapeutic letter to the child. Explain in the letter why you’re in their life, what you know about them, what you see in them, what you hope for them. Make this letter the start of your child’s Life Story Book. If the child ends up hating you they can change the placement of the letter, hide it between pages, or even trash it if they choose to.

There is no right or wrong way to get the task of Life Story Work done, just remember that Life Story Work is about telling a healing story of a time of the child. The journaling (words of fact, hope, etc) supports the pictures, rather than pictures supporting a bit of writing.

Recommended discovering:

The Child’s Own Story: Life Story Work with Traumatized Children (HIGHLY recommended. Purchase new or used from Amazon)

Scrapbook Life Story Work with kids in foster care

Life Story Training

This is your life: Life Story Book (DoCHS newsletter)

Life Story Work: What it is and what it means

 A similar variant of this article by Megan Bayliss first appeared as a 2 part series at families.com

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Clean teeth a child safety risk

Photo by lusi at stock.xchngBeware the groovy flavored cheap toothpaste we buy to encourage good dental hygiene in our children. I hope that my youngest child never sees this news report (or that he never uses the dangerous toothpaste). Getting kids to clean their teeth is hard enough let alone having dubious Chinese companies filling toothpaste with toxic waste. It is struggling family terrorism at its best. Cheap toothpaste does not mean a license to kill. China, what are you doing to child protection?

Not only do we stop buying your unsafe toys made in slave labour sweat shops (I acknowledge that not all Chinese factories operate under such conditions), now we may well have to stop purchasing health and beauty products and our everyday affordable staples of hygiene products and Chinese food. Sorry China, my children’s health and safety is worth more than a measly saving on the weekly grocery bill. From this day on, your grocery store goods join my black list of unethical and child unsafe products. I will buy Australian thanks.

Three toothpaste brands banned in SA:  September 25, 2007 09:24am

THREE brands of toothpaste have been banned in South Australia amid fears they contain too much of a toxic chemical. Consumer Affairs Minister Jennifer Rankine said today the Mr Cool, Excel and Tri-Leaf Spearmint pastes would be subject to a recall, effective immediately.

She said the toothpaste contained more than 0.25 per cent of diethylene glycol (DEG), which could present a serious health risk if ingested, particularly to children and people with kidney or liver disease.

Although toothpaste is not meant to be swallowed, young children have been known to suck on tubes.

Adults also can unintentionally swallow small amounts of toothpaste when brushing their teeth.

“People should double check the list of ingredients on their toothpaste,” Ms Rankine said.

“If they find it contains DEG, check the label to ensure it has less than 0.25 per cent by weight.

“If it is more than this amount, do not buy it.”

Consumers with tubes of the three banned brands at home can return the toothpaste to the place of purchase for a full refund.

Article by Megan Bayliss

Further reading for in home child protection:

Diethylene glycol
China Investigates Contaminated Toothpaste

Article by Megan Bayliss

Photo of toothbrushes by lusi at stock.xchng.

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Family Talk – A Way to Prevent Child Abuse

A little girl, aged 11, asked me why her mother didn’t help her and stop the abuse. I explained that her mother had no idea that father and uncle were sexually abusing her. The abuse had gone on for years. The child was angry, her behaviour was telling everyone that something was wrong and she was sent to counseling to get sorted out.

During the therapeutic process, the child disclosed the abuse. She claimed that she had told her mother by saying things like, she hated her father and never wanted to see her uncle again. She was using a child’s simple language to explain something that her vocabulary and life understanding was unable to punctuate with words. The child’s mother didn’t understand what the child’s behaviour was saying. It wasn’t until I told the mother in plain adult English and gave her the choice to tell the authorities herself before I did, that mother understood what had been happening.
Identity Direct - Personalised Gifts For Children.

Devastated and wanting retribution, the mother turned her anger toward her husband and brother. She committed acts of violence and was charged with three counts of grievous bodily harm. The mother turned to alcohol to console herself and sought as much support as she could from other angry friends. While the anger danced around the household and the plotting thickened, the child and her enormous emotional and healing needs were forgotten. The child and her emotional needs simmered and the child developed a belief that her mother had (and was continuing to) failed to protect her.

The child saw family and friends that cared only about themselves and family that didn’t really believe the abuse because they acted like it was her fault that the family was now separated.Because of her young age, the little girl failed to recognise that her family were handling grief in their own way, that they did love and believe her but that were incapable in that moment of providing the support she so required.

The secrecy that surrounded the sexual abuse tore this family apart. It was not only the dysfunctional secrecy of the abusive acts, but the secrecy that then surrounded every-one’s coping mechanisms. Nobody talked through their primary emotions. Anger, a secondary emotion, quickly escalated to violent behaviour: behaviour that knew no words but that acted to further destroy the fragility of the family.

The 11 year old ran away from home at age 14. She lived with family of friends who would take her in and she drifted from bad situation to worse. Now 16, she has begun to visit her father again and never sees her mother. Where is the justice in this story? There is none. The perpetrator wins and the innocent remain wounded and cut off from each other. Why? Because they couldn’t talk about what had happened.

Talking to our children is important. If we can establish preventative cultures of talk then it makes it easier for our children to tell us if something happens to them. It is also easier on protective parents when and if they discover child sexual abuse. Talking about our pain, our betrayal, our shock is far healthier than acting it out and taking the law into our own hands.

Article by Megan Bayliss

Just as we invest in our children’s academic education, so too must we invest in our children’s development of emotional intelligence. Discussions about child safety, what to do if someone tries to touch you, and who to tell, are just as important as learning to read and spell.

The clock is ticking: it’s time for talking. I’d love to hear how and when you talk in your family. Every family’s situation is different but talk is something that we can all do – any time, any place, anywhere.

Article by Megan Bayliss first appeared at Megan’s earlier blog in Feb ’07.

Family Focus USAInterested in knowing more about how child abuse affects our children? Try these starters:

Children learn the cycle of violence from our parenting

Domestic Violence is child abuse: Story from a child

Helping children cope in the aftermath of trauma

The effect of trauma on secure attachment in children

BITSS of Protective Behaviours

Teens and post-traumatic stress disorder

The affects of childhood trauma

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Teens and post-traumatic stress disorder

Sunshine Girl On A Rainy Day

Sometimes a teenager’s home life can closely resemble a war zone.

Post Traumatic Stress Disorder is “a condition in which victims of overwhelming and uncontrollable experiences are subsequently psychologically affected by feelings of intense fear, loss of safety, loss of control, helplessness and extreme vulnerability. In young people, the disorder involves disorganized and agitated behavior.”

According to a Harvard/Casey study, former foster children suffer PTSD at a rate twice that of Vietnam war veterans. Twenty-five percent of foster care alumni participating in the study experienced PTSD, as compared to only 12 – 13% of Iraq war veterans and 15% of Vietnam war veterans suffering from the disorder.

Immediate symptoms of PTSD can include:
- Tense muscles, body poised for fight or flight
- Desire to escape; feeling bored suddenly or anxious to leave
- Change in breathing; might hyperventilate or stop breathing
- Flash of irritation; defensiveness; heat rushes through body, might lead to angry outburst
- Distraction,  disorientation; blanking out at certain words or sentences, hearing seems distorted
- Frozen; feeling coldness in body’s extremities, such as hands or feet
- Headache when certain subject matter is being discussed
- Speechless terror, knot in throat, difficulty forming sentences
- Sudden thirst; dry mouth, sweaty palms, dizziness
- Stomach ache, nausea

Teens and Hypervigilance
The world seems threatening after a traumatizing experience. After experiencing and/or witnessing a life-threatening even, teenagers often believe that if they are vigilant enough, they will be able recognize the warning signs and avoid future traumas.

Teens can develop an exaggerated “startle response.” Their body and emotions are on “high alert” in order to ward off against future dangers. There is also a tendency to focus and fixate on things that are worrisome or frightening.

Fight, Flight or Freeze!
When fear from the past raises its ugly head and causes the body to react with fight-or-flight or freeze responses, the cycling back between these three responses can become a self-sustaining feedback circuit. The cycle takes on a life of its own. This pattern becomes imprinted in the neural networks as a self-perpetuating system. If left unchecked, symptoms become increasingly entrenched, and often worsen.

Nightmares and Flashbacks
Flashbacks can be elicited from even vaguely related cues of the initial threat — such as a loud noise, a reminiscent smell, a movement from the corner of the eye, a familiar building or the shadow of a person approaching from behind.

This is because traumatic memories are processed and stored differently than memories of ordinary events. “Normal” memories are encoded verbally, and thereby can be verbally communicated to others afterwards. But traumatic memories are experienced as emotions, sensations and physical states.

The trauma survivor faces an odd contradiction. The memories are so vivid, rich with emotional and sensory details. Yet it’s difficult to put words to these experiences, to make cognitive sense out of them. The phrase “speechless terror” is not a hyperbole; people literally cannot talk when affected in this way. PET scans demonstrate the physiological basis of this phenomenon: during flashbacks, oxygen levels and the verbal centers of the brain are affected.

Impact on High School Performance
It is difficult for teens who are traumatized to learn new things. The aftershock of trauma can include recurring intrusive thoughts, memory lapses and difficulty with focus, concentration and sustained attention. There is a sense of being scattered, distracted and unable to focus on work or daily activities. Making even simple decisions can seem overwhelming, because this requires sorting out relevant matters from the daily bombardment of information.

COPING MECHANISMS
1.) Knowledge: Empower teenagers to know what their triggers are, and to recognized when they are experiencing PTSD.  It’s important for teens to be aware of how they feel, both physically and emotionally, rather than disconnecting from those sensations.

2.) In the moment, they will need to know what is going on, and try to remind themselves that they are no longer trapped in the past. Hopefully they have established (or are establishing) more tools and resources than when the original trauma took place.

3.) During fight-or-flight response, teenagers might forget to breathe or start to hyperventilate. The first step to getting breathing back to normal is to force a yawn. Then, breathe in and out as slowly as possible.

4.) Support their development of personal boundaries: In the moment, a teen might need time to calm down. Or, the teen might want the comfort of another person, who is trustworthy, stable and secure.

5.) Consider leaving the situation: If a teenager is alone, he or she can whisper encouragement to themselves, as a reminder that they are not powerless.  Teens can also stomp their feet to remind themselves that they can run away or kick if the situation became dangerous.

Sources:
Breno, A. and Galupo, M. Sexual abuse histories of young women in the U.S. child welfare system: A focus on trauma-related beliefs and resilience, Towson University.
Darling Villena-Mata, Ph.D. Flashback Intervention Tool
McGraw, P. (2004).It’s not your fault: How healing relationships change your brain and can help you overcome a painful past. IL: Bahaii Publishing.
Pecora P., Kessler R., Williams J., et al. (2005). Improving family foster care: Findings from the Northwest Foster Care Alumni Study. Seattle, WA: Casey Family Programs.
Whitfield, C, M.D.. (2006). Boundaries and Relationships: Knowing, Protecting and Enjoying the Self.

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