APPENDIX 76
Memorandum submitted by the Association
for Family Therapy and Systemic Practice in the UK
SUMMARY
— AFT is the UK's leading professional
body for people working with families in public and Third Sector
services. It supports, registers and accredits trainings in systemic
practice and Family and Systemic Psychotherapy. It works to develop
professional and wider understandings of strength and resilience
in families and supportive communities, and the importance of
these to individual and social well-being (AFT, 2008).
— The impact of domestic violence
is felt for generations.
— A large proportion of children,
adolescents, adults and older adults who experience serious mental
health difficulties have experienced domestic violence.
— Families can be supported
in recovery from its aftermath.
— Despite greater awareness
of "domestic" violence and its consequences, and the
excellent support provided within many refuges for individual
women and children experiencing the immediate practical and psychological
consequences of abuse, there remains:
— a shortage of professionals
trained to identify risk and support family members who have experienced
domestic violence. Too often, a diagnostic label is applied to
adult or child distress while the background violence remains
unrecognised;
— a shortage of services to
help children and their families recover from the long term effects
of violence; and
— an urgent need to develop
staff training and supervision structures supported by professionals
skilled in domestic violence and family work.
— As a society, we need to address
urgently the impact of identified, hidden and masked trauma due
to violence on all family members and across generations. We need
to support family and other potentially supportive relationships
if we are to protect and serve the best interests of vulnerable
children, young people and adults (Cooper and Vetere, 2005; Vetere
and Cooper, 2005).
1. Supporting children
1.1 Working with families
can help identify children and adults living with domestic violence
and/or its aftermath, and help children and adults recover and
build healthier, safer relationships.
1.2 Recent research highlights
the risks for children living with domestic violence (Cunningham
& Baker 2004, Geffner et al 2000). A review of research suggests
that 40% of children from families with domestic violence exhibit
clinically significant behavioural problems in their families
and/or schools (Harold & Howarth 2004). Children exposed to
domestic violence present a variety of emotional and behavioural
problems, including increased internalizing symptoms (Adamson
& Thompson 1998), externalizing problems, decreased cognitive
functioning and an increased risk of post-traumatic stress disorder
(Rivett et al 2006). The more severe and chronic the violence,
the more at risk children are; alongside the effects of witnessing
violence, children often experience abuse themselves, physical,
emotional and sometimes sexual (Cunningham & Baker 2004).
Children who have witnessed domestic violence are vulnerable to
developing relationships in which there is violence when they
become adults (Hotaling & Sugarman 1986, Newton 2001). An
estimated 50% of women adult mental health service users have
experienced violence and abuse as children (DoH, 2008).
1.3 Nearly one million children
in the UK may be living within violent domestic contexts (Unicef
2006). Three quarters of children on the Child Protection Register
in London have experienced domestic violence (London Child Protection
Committee, 2006).
1.4 While a child's distress
is often recognised by referring frontline professionals, this
can mask problems linked to violence within the family or other
significant relationships. Many children referred to child and
adolescent mental health services (CAMHS) have experienced violence
in their family, yet as CAMHS are currently organised around helping
children with specific psychiatric diagnostic labels (such as
conduct disorder) these children's experiences of violence and
its effects (including parental mental illness) are often overlooked
(Rivett et al, 2006).
1.5 Children may need the
help of highly trained practitioners to talk about their experiences,
fears and feelings, especially if they are confused, concerned
and/or fearful of expressing disloyalty to one parent. A child
who does not go to school, for example, may not have the words,
security or understanding to explain that he fears his Dad will
hit his Mum if he is not there to protect her. Viewing and responding
to children or their distress as "the problem" can place
large obstacles in the path of effective support for them and
the people and communities that help sustain them.
1.6 While the "bigger",
relational picture remains largely unexplored in routine assessment,
child support professionals risk failing to explore whether children
live in contexts of violence or fear. Neglect of these issues
can leave children vulnerable to the inappropriate application
of psychiatric labels and all family members without appropriate
and effective support.
1.7 In supporting children,
we need also to support the relationships that sustain them (with
parents, grandparents and other close and extended family members,
with foster and adoptive parents and wider supportive networks)
and to provide services to perpetrators (female and male).
2. Supporting women and children together
2.1 Violence against women
has serious consequences for their mental and physical health
and for mother-child relationships.
2.2 Abused women are more
likely to suffer from depression, anxiety, psychosomatic symptoms,
eating problems and sexual dysfunction (Fischbach & Herbert
1997, World Health Organisation, 2000). Around 50% of women adult
mental health service users have experienced violence and abuse
as children (DoH, 2008).
2.3 Violent men often hold
female partners responsible for violence, while minimising its
extent (Jenkins 1990, Rivett & Rees 2004). This has profound
effects on women's self-esteem (Goldner et al 1990). Alongside
physical violence women often experience criticism of themselves
as partners and parents in front of their children, which can
undermine their parental authority.
2.4 If the perpetrator has
disciplined through fear, mothers often find it a challenge to
provide discipline of a different nature (Safer Families Project,
1994). When a perpetrator of violence leaves the family, another
family member may become violent, often boys with their mothers.
Mothers often struggle to reclaim a sense of their own agency
and authority. Mothers may try to protect children by not talking
to them about violence in the family (Burck 2005, Cooper &
Vetere 2005).
2.5 Interventions offered
to families who have experienced violence have tended to consist
of separate groups for mothers, children and perpetrators (Baker
& Cunningham 2005, Jenkins 1990, Paré et al 2006, Rivett
et al. 2006). Yet recent evidence highlights the importance of
working with mothers and children together, in a flexible combination
of individual and joint sessions.
2.6 Helping children talk
with their mothers and receive support from them through their
acknowledging of the child's experience can be key in the important
task of rebuilding relationships and supporting recovery (Burck
2005, Rabenstein & Lehmann 2000, Vetere & Cooper 2005).
2.7 As children's coping strategies
often go unnoticed during the experience of violence, helping
children and parents to identify and validate these can support
and develop resilience (Burck 2005, Walsh 1998, Weingarten 2003).
Adults and children can be supported by skilled professionals
in re-examining family and cultural beliefs and their impact,
such as the gendered messages conveyed through violent interactions
that can cascade through generations (Burck & Daniel 1996,
Jenkins 1990, Rivett & Rees 2004).
2.8 Safe work is sometimes
possible with couples and families who have experienced domestic
violence in the past, supported by rigorous assessment and management
of risk (Cooper and Vetere, 2005; Vetere and Cooper, 2005).
3. Perpetrator programmes
3.1 Focused perpetrator programmes
for men and women often suffer from short term funding streams,
yet have long term consequences for the future health of the nation,
including a reduction in violent relationships and in addictive
behaviours, depression and anxiety in the child/adolescent/adult
populations.
3.2 Accessible, securely funded
perpetrator services can support family members and those working
with families to acknowledge violence and its impact, and work
towards safer, healthier futures.
4. Culturally sensitive family work
4.1 Awareness of and ability
to work with families from minority cultures is essential if services
are to develop ways to engage and work with minority ethnic communities
and to extend support to all vulnerable children and adults. At
present minority ethnic communities are significantly under-represented
in mainstream services.
4.2 Centres developing culturally
sensitive trainings and therapeutic services for minority ethnic
children, adolescents, adults, couples and families within their
communities include The Centre for Cross-Cultural Studies, based
at the Institute for Family Therapy, London, and The Marlborough
Cultural Therapy Centre (MCTC).
5. Thinking Family sooner
5.1 Too many children and
families reach crisis point before accessing the skilled and effective
support they need, if they do at all. AFT agrees with the findings
of the recent Commission for Social Care Inspection (CSCI) report
on the state of social care in England, that, "Increasing
financial pressures are resulting in high eligibility criteria
and thresholds for access to services. Children and families are
not always getting the help they need, at the time they need it".
5.2 AFT warmly welcomes plans
set out in the Social Exclusion Task Force "Think Family"
reports, to encourage a whole family approach and joined up working
between adult and children's services. It hopes "Thinking
Family" will now be extended beyond provision for "families
at risk" to services for families and family members generally,
to equip staff with skills in family work, helping them identify
difficulties earlier and providing effective support at whatever
point families access relevant services.
5.3 Frontline workers need
training and specialist consultation and supervision in family-sensitive
working if they are to intervene effectively and to recognise
when individuals and families may need more specialist support.
Access to specialist services and practitioners skilled at working
with families with more complex and serious difficulties is necessary
for families and for the workforce. Without it, staff may find
themselves in roles they are neither trained nor qualified to
perform.
6. Workforce training and supervision
6.1 We know that many professionals
find it difficult to talk to families about violence (often because
they do not know what to do should family members disclose ongoing
violence) and that children/parents often find it shameful to
discuss.
6.2 Without robust and supportive
structures of staff supervision and consultation with more highly
trained professionals skilled in family work, initiatives to train
workers to "talk" with services users about violence
risk becoming tokenistic or even "silencing". Many staff
will have experienced violence themselves and need support to
work constructively in this area. Without trainings and support,
many may not have the skills or confidence to talk with children
and adults about violence in ways that invite rather than close
down possibilities and conversation.
6.3 AFT values the important
contribution of many Third Sector services in providing relationship
support, such as couple counselling. It recognises the importance
of these "self-referral" services in identifying and
supporting vulnerable adults and children. It hopes these services
will be encouraged to develop staff understandings of domestic
violence and its impact, to develop staff skills, services and
supervisory structures that "think family", and be mindful
and inclusive of children and other family members.
7. Extending family-sensitive work
in Adult Mental Health services
7.1 Most AMH workers are not
trained to recognise the impact of parental mental health problems
on children, or the background family violence that may fuel them.
7.2 Even if children's distress
is acknowledged, few if any services are available for them until
their distress has escalated ie because of high eligibility thresholds
to CAMHS and other services, children have to become symptomatic
in their own right before accessing support. There is clear and
urgent need for "whole family" provision and trainings
within the AMH system, inclusive of and sensitive to the needs
of family members of all ages.
8. Multi-agency working
8.1 Families living with violence
and its aftermath need the support of effective, specialist multi
agency links. This requires more than "information sharing"
across service boundaries. Each service will have statutory duties,
professional anxieties, and beliefs about constructive ways forward
that may conflict with other agencies also working with the same
family. Multi-agency meetings, facilitated by supervisors
skilled in working systemically with the "family of professionals,"
are key if those competing agendas, anxieties and beliefs are
to be identified and resolved so constructive and co-ordinated
cross-agency working can function.
April 2008
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