Submission from NCAT, the Nelson Child and Adolescent Therapists
Introduction
This submission is made on behalf of NATA (Nelson Child and Adolescent Therapists), a Nelson based network of play therapists, counsellors, and psychotherapists working in non-governmental agencies and/or in private practice with parents, children and adolescents. We all have training specific to working with children and adolescents, an average of over 15 years experience each working therapeutically with children, and are supervised by child and adolescent therapists.
Many of the clients we see are vulnerable children, often with high and complex needs, who have experienced physical, emotional and/or sexual abuse, moderate to severe neglect, and/or have witnessed violence in their homes. Most often these children’s parents have experienced similar childhoods and are struggling to provide good-enough parenting.
e.g. Andrew and Paul, now aged 8 and 10, were emotionally, physically and sexually abused by their alcoholic father throughout their young lives until he murdered their mother. When a relative inquired in the small rural community she learned that the townspeople were aware the boys were being beaten and raped – their father frequently boasted of it. No-one acted to protect them or their battered mother. The boys show psychological and behavioural disturbance, have attachment disorders, and post-traumatic stress disorder symptoms. Their caregiver struggles to parent them.
Because of our extensive experience with such children we appreciate the opportunity to contribute to the discussion concerning vulnerable children.
As child and adolescent therapists we bring the following expertise to the debate on the needs of vulnerable children
we have specialist knowledge of child development, especially children's emotional development
we are skilled in interpreting children's symbolic representation of their experience when they are too young or too traumatised to put their experience into language
we understand the neuroscience of trauma, how it impacts on children's cognitive development, and how the consequences of trauma may prevent a child being able to respond to cognitive or behavioural treatments
we have an understanding of the centrality of secure attachment for the capacity of a child to understand and regulate their emotions - "The emotions, their understanding and regulation are seen as central to sound psychological development, and the communication, recognition and naming of emotions underpin much of therapy" (David Howe, 2005, Child Abuse and Neglect, Attachment, Development and Intervention, Palgrave McMillan, Basingstoke). Until a child can develop a therapeutic alliance with an attuned caregiver or therapist they cannot begin to achieve control over their emotions - without control over their emotions they cannot learn, they cannot develop a stable sense of self, they are unable to manage interpersonal relationships and intimacy; in other words they cannot develop cognitively, emotionally, or socially.
we have the skill and experience to understand and work with extreme emotional states which enables us to 'hang in there' with challenging children and parent/s, whereas less informed counsellors might find such children too emotionally challenging, and give up - exacerbating these children's experience of rejection and abandonment.
We are skilled and experienced in monitoring our emotional reactions to challenging children. This understanding enables us to remain observant and not to act out, not to retaliate or abandon children emotionally, but to remain available to help our clients to develop their own mind-mindfulness.
We are skilled and experienced in family systems and working with parents who abuse or neglect.
Response to Specific questions, in brief:
Parents, caregivers and communities:
We have among us and as colleagues child and adolescent therapists who have lived and worked overseas, in Europe and the United States. They generally experience New Zealand society as hostile or blind to the interests of children, by comparison to their own. For example, they reflect that the level of violence demonstrated and accepted in NZ society as a whole, and to its children in particular, would be intolerable in their own communities. This is of course borne out in OECD figures on levels of child abuse. Mandatory reporting of abuse in the U.S. and longstanding Action Plans for vulnerable children in the U.K. have contributed to greater provision of services and greater community involvement in looking out for children in need.
We believe greater emphasis must be given to promoting community awareness about the needs of children and of the social obligation to look out for them, including how to get help for vulnerable children.
Government spending:
We have all struggled to find funding for our clients’ needs. The CYF website records that of those children who came into their care as the result of the Gateway Pilot Project 65% had mental health or behavioural problems, 40% of those needed specialist services, and only 7% were receiving these services. The situation is even more parlous for those deprived, neglected and/or abused children who are not under CYF care. Our local CAMHS service will not accept children with ‘acting out’ behavioural difficulties but will accept those who ‘act in’ and demonstrate depression, self-harm or suicidal ideation. Unless the parent/s are beneficiaries and so their children eligible for Disability Allowances (or they have been sexually abused) there is no alternative funding to meet the needs of the ‘acting out’ child and their family, and yet they can create distress for everyone around them.
For parents or caregivers on low to medium incomes, bringing their child to therapy can be too costly because of transport costs, paying for other children to be babysat while they bring their child to therapy, or (especially for rural parents or shift workers) because they can’t afford to take the time off work needed to get their children to appointments. Having these services provided in schools is not always the answer, as social workers in schools are not trained at an adequate level to provide the therapy very vulnerable children need, and the parent/s or caregiver’s presence is often very desirable, or imperative.
e.g. there are two N.Z. initiatives with international standing which provide a psychotherapeutic treatment for distressed children and their parents / caregivers. For younger children is the Wait, Watch and Wonder programme, and for older children Parent and Child Therapy (PACT), including Parallel Parent Child Narrative therapy. Play therapy, Narrative therapy and child psychotherapy all offer attachment based intensive treatment for traumatised vulnerable children.
We believe that there should be no reduction in the provision of funding for child and adolescent clients overall, indeed more is needed. Instead, extra provision should be made over and above that generally available for children in need of mental health services, for the specific needs of New Zealand’s 163,000 deprived, abused and/or neglected children, and their parent/s or caregivers, to fund the longer-term treatments appropriate to their needs. Not to provide the appropriate treatment is as neglectful as to provide no treatment at all.
Watching out for vulnerable children:
We have already mentioned our concern about the lack of social responsiveness to children in NZ. We welcome the TV campaigns there have been to raise awareness about child abuse and neglect. We would like to see initiatives which place all children at the heart of communities, which ensure for example that all children are monitored by having free health checks (including mental health checks).
We believe that where a child is identified as vulnerable because of deprivation, abuse or neglect their need for care and protection should override the Privacy Act, to the extent necessary for involved professionals to make informed and accurate decisions regarding their care. Only directly involved professionals who are governed by an appropriate Code of Ethics should have this right, and only to the extent required by the child’s and family’s / whanau circumstances.
We do not have a firm view on mandatory reporting, but suggest it would be useful to have a specific public debate on the issue, perhaps at Parliamentary Select Committee level.
Improving the workforce for children:
We have all experienced frustration with the lack of provision of adequately funded, appropriately skilled government services for vulnerable children. Foremost for us as skilled professionals with a commitment to promoting quality child and adolescent therapy is the failure to include child therapists in decision-making or consultative processes, for example in the High and Complex Needs or Gateway Assessment processes, and the low level of understanding of some government agencies of the emotional needs of children. It is this lack of understanding that underlies hopelessly short-term thinking in regard to the recovery time of traumatised children, only providing funds for ‘evidence–based’ brief, cognitive behavioural treatments for children sometimes too terrified or too deprived to be able to think.
e.g. when we met several years ago with our local Child Youth and Family management we were told by a Manager that she did not believe in counselling for children and that child counsellors were meeting their own needs and not those of their child clients. Social workers who have attempted to get us to work with children with Attachment Disorders in only 6 sessions had little knowledge about attachment per se, and the difficulties such children have in making therapeutic relationships.
We believe that training for social workers must include specific modules on child development, the impact of trauma (including neglect) on that development, attachment theory, and children’s emotional needs.
Skilled and experienced Child and Adolescent Therapists should be involved in multidisciplinary teams planning and delivering services to vulnerable children, in government agencies such as the Family Court, in the Justice system, CYF and CAMHS, as contributors to Gateway Assessments where we are involved with a child and family/whanau or can contribute our expertise in the assessment of children’s emotional wellbeing, in non-governmental agencies, and in the community.
We believe too that we have expertise not currently available in the education system, particularly at primary and pre-school levels. The Special Education Service is driven by a behavioural model which is inadequate for many vulnerable children (because of such children’s inability to regulate their emotions arising from insecure/disorganised attachment), and RTLBs are not trained to provide therapy which is needed to help these children to develop.
Conclusion:
We believe we have an important contribution to make to the debate on the needs of vulnerable children and how we as a society can improve the way we value children and young people. We look forward to being involved further as debate continues.
Signed on behalf of NCAT by
Christine Gillespie,
Registered Psychotherapist, MNZAC, MNZAP Advanced Clinical Practice
c.gillespie@xtra.co.nz 03 540 2432 027 22 888 47
45 Trafalgar Road, R.D. 1, Upper Moutere, Nelson 7173