Evaluating a new model of tackling child sexual exploitation across England

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Setting CSE in the context of trauma: reflections from a therapeutic CSE service.

Posted: Thu Apr, 2017

Author: Lucie Shuker

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Dina Holder is the Child and Young Person's Service Manager at CLEAR in Cornwall. In this post, she shares some thoughts about integrating a therapeutic approach into their work on CSE.

Hi Dina, can you tell us a bit about you and your service?

“I joined the CLEAR team as a manager in 2016, having worked in domestic violence, rape and sexual assault and in probation, family court welfare and youth offending services before that. I have an MA in Social Work and a Domestic Abuse Manager’s qualification. However, all my working life I have attempted to work to provide better services for children and young people and moving to work for CLEAR has allowed me to specialise in this area. CLEAR is a therapeutic service that has been working for nine years with children and young people who have experienced or witnessed abusive relationships, but CSE is a relatively new area of work for us.”


There is more and more awareness amongst services of the need for CSE work to be ‘trauma-informed’. Is that something you advocate in CLEAR?

“Yes, CLEAR is a therapeutic service, but this is something we’ve been thinking about in more depth around CSE in the last six to nine months. I’ve been reflecting on some of the insights that have come from recognising the significant impact of childhood trauma on all sorts of outcomes. I saw a fantastic TED talk by Nadine Burke Harris, a paediatrician who describes how exposure to childhood trauma affects long-term outcomes at much more extreme rates than other things that damage children’s health. Adverse childhood experiences (ACEs) are those stressful events children can be exposed to, including physical, sexual or emotional abuse; family breakdown; exposure to domestic violence; or living in a household affected by substance misuse, mental illness or where someone is incarcerated.

We now understand better than we ever have before how exposure to early adversity affects the developing brains and bodies of children. There are real neurological reasons why children and young people exposed to high doses of adversity are more likely to engage in high-risk behaviour, and that's important to be aware of in relation to CSE. So we know sexual exploitation is hugely damaging, but it is also complex and therefore our response can’t be simple or linear. No one agency can deliver a safe model of support. It will take many different perspectives to help children, including working with trauma within a therapeutic model."


Is this something you’ve worked with in your previous roles?

“Yes, in different ways. In the field of domestic violence there is understanding of Stockholm syndrome and trauma bonding - of how power and control work. It’s common for people to ask familiar questions of domestic abuse victims; ‘Why do they stay? Why do they put up with it?’ What has been helpful in this role is gaining a greater understanding of the role of attachment styles, and a child’s ‘window of tolerance’. We are trying to integrate that understanding into our assessment processes and to recognise that for our high risk/high vulnerability young people, there is a greater likelihood of a disorganised attachment and/or for them to experience traumatic bonding with someone abusing them. If you understand disorganised attachment, how that leaves a young person’s feeling, and how perpetrators take advantage of that - then you see a perfect storm.” 


What does that look like – integrating understanding of attachment and a child’s response to trauma into your work?

“Well we already have a psychologically informed service, but we are trying to develop it further. I have a referral coordinator – a psychologist -  who works with me looking at referrals. I also have a psychologist who has been providing supervision to our CSE workers, and I can see the value of having a psychotherapist in that role in the future - someone who can really help my staff make sense of the cases they are working with.

So many young people get blamed for their behaviours, or at least their behaviour is not understood, and they don’t then get the right support to help them move forward. If they’ve experienced lots of trauma and problems with attachment, their window of tolerance is going to be fairly small and they may regularly experience hyperarousal (the fight/flight mechanism) or hypo-arousal (freeze/flop). 

Trauma training has helped me understand that there is a limit to how useful safety planning is if you haven't done the work of understanding these defence mechanisms. A child’s experience of abuse may mean that their ‘safe place’ is actually back with the perpetrator, either because they are searching for that love and affection or because it feels safer and predictable to be with the person who might harm you. So, we have to understand this idea of the window of tolerance, and work with it. Not every child feels safe enough emotionally to reflect on their situation, as we might want them to."


Yes, not all children at risk of, or being sexually exploited are ready for therapy. How do you manage that?

"We attempt to provide the right response at the right time. I work with our Referrals Coordinator to establish what kind of support we think a child needs first and whether they will be able to handle therapeutic support, because, as you, say not everyone is ready. But it’s important to remember that the CSE practitioners are not therapists. Their work to build consistent, meaningful relationships with the children and young people is supported by a therapeutic understanding, but very much built on youth work/outreach practice.  Lots of the young people we are working with are saying ‘What's the problem? It's you lot that are the problem’. 

We are working with a child now who doesn't recognise any problems with her life at all and is struggling to set any goals with her worker. So, we are taking a youth work approach and doing music with her. She's loving that and slowly starting to talk about her life. But of course, as she starts to talk she begins to feel unsafe. It's going to be a long time before we go anywhere near therapy, which is why I want our workers to have a good understanding of trauma, attachment and the window tolerance. I think we can expand someone's window of tolerance even if they do not want to engage in therapy, by very gently helping them understand some of the issues."


Do you have any thoughts about the wider field of CSE work and how well services are able to work in this way?

"I know that a lot of CSE services don’t have the resources to be able to work in this way, but I’m increasingly convinced we need to offer youth work approaches, safety planning and therapeutic support. Even if you don't offer therapy as such, I feel it’s really important for CSE workers to be trained and supported to understand the psychological impact of abuse, and how that will affect their attempts to keep the child safe. I’m very aware of the risk of pathologising (victim blaming) young people in the process of talking about trauma within CSE, but I still think it’s a crucial aspect of our service response. Of course, this approach has to be set within some key principles, including a sound understanding of CSE, so all of my team has, as a minimum, attended the NWG Foundation level CSE training which ensures that CSE is contextualised. We see as central to our work the clear understanding that the child or young person cannot be held responsible for their abuse and exploitation. It’s also important that our staff receive high quality clinical supervision as well as line management supervision, because this is a stressful role for practitioners.

We know that relationships can transform lives so we strive to create respectful, active relationships where young people are empowered. We also utilise advocacy skills to ensure that children and young people are supported to get access to the services to which they are entitled, and we work with, include and support parents/carers to be a strong protective factor. So being trauma-informed is one piece of a much bigger jigsaw, and at the centre of our practice has to be the young person whom we respect, listen to and involve in decisions about their lives."     


Finally, are there any good resources or links you want to share, for those who want to understand this better?

  • "I very much value the work of Norma Howes, and a really helpful article “Using the trauma model to understand the impact of sexual exploitation on children”. In it she writes: “Three key elements of a trauma model are particularly useful in assessing and working with young people who are sexually exploited – attachment to the perpetrator; trauma bonds and a belief that the behaviour is not the problem but the answer to the problem. It is important to remember not to focus on what is being done to a child or what that is doing to a child but rather to identify the child’s needs that are not being met. It is these needs – that are being met through a child’s involvement in sexual exploitation – that will help to provide appropriate interventions and resources”.  
  • We also use the learning from various training presentations from Zoe Lodrick who is a psychotherapist. You can visit her website here.  
  • A pioneer in working and training in Attachment Theory is Daniel Hughes, and his book Principles of Attachment-Focused Parenting: Effective Strategies to Care for Children is helpful alongside the Pace model of working with parents.
  • The ‘social model of consent’, developed by Professor Jenny Pearce can help professionals recognise the context of abuse, and that a child’s capacity to consent might be abused in four ways (coerced consent, survival consent, normalised consent and condoned consent). I suggest that people watch this short film to understand the model"


For more information about CLEAR, please visit their website.

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