Children who have experienced trauma have complex needs and require highly-skilled psychological support, and these needs only become further intensified when children are in care environments. However, many of Scotland’s children’s service providers may not have the in-house expertise to care for the psychological needs of children who have experienced trauma.
With Child and Adolescent Mental Health Services (CAMHS) resources facing continuing pressure, one solution lies in having more clinical psychologists provide direct services to children’s care providers, particularly those who operate independently from the NHS.
Working outside NHS psychology services may involve relinquishing some of the professional security provided by the structures and systems of a traditional psychology department, but the positives often outweigh the compromises. For example, practising in a private service can offer more room to apply innovative thinking and adopt creative approaches, so long as management understands the unique skill set of clinical psychologists.
Clinical psychologists are trained to work with organisational systems as well as with individuals. They can play a critical role in developing an environment of emotional safety by contributing to policy and embedding psychological principles and approaches across the organisation. They can also develop psychologically-informed training for all staff, from senior management and care workers to catering and domestic support teams.
There are three innovative practices in particular that can be effectively applied:
The Owl, the Elephant, and the Meerkat
Firstly, clinical psychologists can teach all staff members the basic neuroscience that underpins emotional trauma. This needn’t be complex! For example, the ‘three animals that live in your brain’ approach is one that young children, teenagers and staff teams can all understand and most importantly remember.
The ‘Meerkat’ is the panic alarm system that drives us to escape or defend ourselves in response to threat. The ‘Elephant’ never forgets and stores our memories, while the wise ‘Owl’ acts as our emotional brakes, telling us to ‘stop and think!’ before acting impulsively. When the Meerkat panics the Owl flies away and leaves us temporarily without adequate impulse control and rational judgement.
The ‘three animals’ approach helps staff members remember that challenging behaviour has a biological basis and it is likely that the young person’s ability to exercise conscious control can be limited. It also forms the basis for developing a sense of self-compassion in young people who all-too-often have internalised feelings of shame and self-blame related to their behaviour.
Relaxation techniques for young people’s wellbeing
The second practice is to ensure that approaches such as relaxation, yoga and meditation are adapted and made available to all children within the service to manage anxiety and promote wellbeing. Young people can benefit enormously if these evidence-based approaches are made truly child-friendly with the same effort, thought, imagination and flair as we adopt to make Christmas or birthdays memorable.
A particularly useful and flexible system to apply within care environments is the ‘Relax Kids’ approach, which blends elements of play therapy, stress management and cognitive behavioural therapy to take young people from a highly-aroused state to a relaxed, calm state. It is a truly inspirational and adaptable approach based on sound evidence-based principles that can be interwoven into the culture of home and the fabric of classroom life.
Developing a bond with animals
Thirdly, clinical psychologists can encourage the service to offer interaction with animals. The humans in many looked-after young people’s lives have proven to be unsafe, and animals can be much more reliable in terms of forming attachment relationships. The simple company of companion animals provides psychological benefits, while formal animal-assisted psychotherapy offers more specialised treatment.
Horses in particular have proven to be successful partners in treatment overseas, but Equine Assisted Psychotherapy is only just beginning to gain recognition in the UK. The approach does not involve any riding and the focus is purely on relationship development and experiential learning. Seeing things from the perspective of another is an emerging skill and essential for the development of relationship skills, which can be significantly compromised by childhood trauma.
Animals can offer a truly safe emotional attachment experience, free of any power or control issues. For many looked-after children who have suffered trauma, this may be the first relationship of this nature that they have experienced.
In summary, clinical psychologists have a significant contribution to make in the provision of children’s services, and they should be encouraged to look beyond traditional career paths. The application of psychological practices within service providers can have a considerable impact on the wellbeing of looked-after children.
Dr Marie Holmes is a clinical psychologist with Spark of Genius, a member of the Scottish Children's Services Coalition. This article first appeared in The Scotsman on Wednesday 9th May 2018.