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Age 2 to 18: Systems to protect children from severe disadvantage

Author: Ita Walsh

I embarked on the groundwork for this report following WAVE’s 2014/15 global research project, funded by the LankellyChase Foundation, to identify (a) whole life course transitions and transits likely to increase the risk of severe and multiple disadvantage (SMD) and (b) systemic approaches to reduce such blights on lives. In this context, SMD is defined as the co-occurrence of two or more of: serious mental health problems; substance dependency; chronic unemployment; homelessness; anti-social behaviour; criminality.

Our initial ‘broad brush’ trawl for information spanned birth to ‘older old age’ and covered (inter alia) ethnic minorities, addiction/alcoholism, the mentally ill, asylum seekers, sex workers, street-dwelling former members of armed forces (likely to be suffering post-traumatic stress disorder (PTSD)), homelessness, and bereavement, especially suffered when elderly. Early research also included a formal Delphi Process (described below) and interviews with 40 adults already living in conditions of SMD. Any one of these groups and topics could warrant deeper research to underpin a specific report recommending improvements (or alternatives) to current UK systems.

Overwhelmingly, the evidence from our first two rounds of research pointed to SMD being rooted in adverse experiences in childhood. The Delphi Process identified two prime ‘Adverse Childhood Experiences’ (ACEs) as (i) maltreatment and (ii) family breakdown. We therefore agreed with LankellyChase that the most useful report would be one focusing on systems to protect children from the threat SMD, and identifying systems to equip them to fulfil their inherent promise. Although the grant had been exhausted in a combination of the initial global research and over a year of new, age 2 to 18 focused research, in mid-2016 I undertook to continue the research to enable me to write a childhood/systems-focused report. I did not expect it to take me until spring 2018 – or that so many exciting research findings and practice developments would occur over the ensuing 18+ months.

While c.60% of children cope well within the current education system, another 40% (and especially the most disadvantaged 15-20%) do not. This report is aimed at impacting policies for that significant 15-20% minority. Focused research into the 2-18 age group made it clear the key threats to human ability to thrive are unmitigated adverse experiences in childhood; happily, in March 2017, evidence was published to demonstrate that mental wellbeing from the impact of these experiences can be mitigated to the extent of reducing damage by more than 50%5 (Key Message IV).

Of identified mitigating factors, the one that best fosters successful development, despite even the worst circumstances, is resilience – the ability to bounce back from reversals, to find ‘silver linings’ in the darkest clouds of adversity, and successfully navigate the ups and downs of life. Resilience is an outcome built at the individual level in a trusting one-to-one relationship between a child and an available, accepting adult. This is also a key component of ‘Trauma-informed Care’ (TiC). It became clear that understanding ACEs, however enlightening, is of little more than academic value without the healing counter-balance of Trauma-informed Care (Key Message V). If we take note of this plus the opportunities inherent in Trauma-informed care, we might be able to reduce our current social problems (and costs) by as much as half.

New research also showed that the risk of poor outcomes for children lies less in the negative effects of being in any minority group than in being deprived of acceptance and support for their individuality. The American Journal of Community Psychology reports that the key difference in outcomes for sound mental health (including sound levels of both self-acceptance and self-esteem) lies not in the circumstance of being ‘privileged’, ‘normal’ or ‘average’ but in the level of support and unconditional acceptance received from family (and friends, in the case of gender issues)6. When we receive nurturing love, support and acceptance as children, our opportunities to thrive happily and succeed are boundless. The obvious inference is that significant focus on educating and supporting parents plays a major role in improving outcomes for children (see especially Key Messages I, IV and V).

Our calculations show that the incidence of FASD (Foetal Alcohol Spectrum Disorder) endured by an estimated 3+% of the UK population has been an under-reported, insidious threat to normal development and, consequently, to social inclusion. Yet neither perinatal professionals nor Education and Health professionals are trained to detect this either at birth or in the most challenged/challenging 3 to 12-year-olds (the age range when it is most obvious and diagnosable).