Traumatised children’s view of their social world: The application of the Social Network Map for children who have experienced abuse and neglect

Take Two Research Team include:Associate Professor Margarita Frederico, La Trobe University

Annette Jackson, Knowledge Manager, Take Two

Carly Black, Senior Research Officer, Take Two

ACWAO8 Conference; strong, safe & sustainable

Sydney, Australia 20th August, 2008

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Take Two is a developmental therapeutic service for child protection clients in Victoria, Australia who have suffered trauma and disrupted attachment due to their experience of abuse and neglect.

Take Two provides a state-wide intensive therapeutic service to those children who have been severely abused or neglected and are at risk of developing or already demonstrate emotional and/or behavioural disturbance.

What is Take Two?

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Take Two is auspiced by Berry Street in partnership with the Austin Health Child and Adolescent Mental Health Service; La Trobe University, Mindful and the Victorian Aboriginal Child Care Agency.

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Purpose of this presentation

• To highlight the experiences of trauma, loss and disrupted relationships for children and young people who have experienced abuse and neglect.

• To provide some background information regarding the Take Two program.

• To provide early data on one qualitative outcome measure and approach to enabling children to portray their perspective of their important relationships.

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Key messages from the literature regarding trauma

• Trauma occurs when both internal and external resources are inadequate to cope with external threat” (van der Kolk, 1989)

• “Trauma arises when the child cannot give meaning to dangerous experiences in the presence of overwhelming arousal.” (Garbarino & Kostelny, 1996, 39)

• Children involved with the protection and care systems are some of the most traumatised populations (Harris, Putnam & Fairbanks, 2004)

• Trauma inflicted by those responsible for children’s safety, such as abuse is the most pernicious and can have the most devastating and lasting impact (Terr, 1990; Allen, 1995)

• Children can experience emotional, physical, neurobiological and other developmental consequences of such trauma, as well as specific mental health diagnoses (Perry, 1999)

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• We know that children in care are more likely to have experienced significantly more risk factors which predispose young people to develop mental health problems.” (Lindsey, in Richardson & Joughin, 2003, 7)

• Previous research highlighted that placing these children in out of home care was not enough to keep them safe or to enable them to work towards recovery.

• It is agreed that neither Child Protection, out of home care, nor therapeutic services were enough on their own to achieve the desired outcomes for these children.

• Morton, Clark & Pead, (1999) in their report “When Care is not Enough’ highlighted the experiences of children and young people in Child Protection and the lack of therapeutic services available to them.

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Take Two clients at time of second evaluation report (2004-2005)

• Mean age is 12.3 years (range 4 months to 17 years)

• 15% are Aboriginal (now 17%)

• 14% had a parent who was deceased.

• 90% more than one child protection notification. 50% more than 5 notifications.

• 55% had 5 or more previous placements

• Nearly all (96%) had experienced more than one type of abuse/neglect.

117

82

178 157

824 19

0

20

40

60

80

100

120

140

160

180

Num

ber

Living w ith oneor both parents

Kinship care Home-basedcare

Residential care Permanent care Other Missing Data

Placement

20%

14%

30%

27%

1%

4% 3%

Placement at time of Referral to Take Placement at time of Referral to Take Two - 2004 & 2005 (N=585)Two - 2004 & 2005 (N=585)

Type of Maltreatment by Severity Type of Maltreatment by Severity 2004 & 2005 (N=541) 2004 & 2005 (N=541)

273

143

37

214

217

20

110

67

57

256

249

22

96

179

71

0

100

200

300

400

500

600

Num

ber

Abandonment/noappropriate carer

Physical harm andinjury

Sexual abuse Emotional andpsychological harm

Developmental andmedical harm

Abuse

Concerning

Serious

Extreme

(NB: Missing data 44 cases)

84% 83%

43%

97%

64%

Number of previous placements at time of referral for all Number of previous placements at time of referral for all

Take Two clients (n=302) – 2004Take Two clients (n=302) – 2004

109 9

24

15

12

9

5 5

21

0

5

10

15

20

25

30

None 1 2 3 to 5 6 to 8 9 to 11 12 to 14 15 to 17 18 to 20 21 to 25 26 or more

Number of previous placements (does not include current placement)

Pe

rce

nt

of

Ta

ke

Tw

o c

lie

nts

Parents’ relationships of regional Take Two clients (at time of evaluation or case closure) – 2004

Parents’ relationships(n=233)

Number Percent of Cases

Both parents together 26 11.8

Mother single 75 34.1

Mother in relationship other than father 78 35.5

Mother in inconsistent relationships 25 11.4

Mother dead 13 5.9

Father single 52 35.4

Father in relationship other than mother 43 29.3

Father in inconsistent relationships 3 1

Father dead 20 13.6

Parents separated, no other information known 3 2.0

Missing data: Mother Father

1386

Note. The data relating to fathers is indicative only, due to the large amount of missing data.

Descriptors of trauma, other than intrafamilial abuse, experienced by regional Take Two clients according to Take Two clinicians – 2004

Other traumas/adverse events (n=204) Number Percent of Cases

Grief/loss/rejection as no/minimal contact with parents 36 17.6

Parents' separation/divorce 30 14.7

Parent /parent figure died 27 13.2

Sexual abuse – not by parent figure or not clear by whom 26 12.7

Death of significant other(s) excluding parent/parent figures 16 7.8

Hospitalisation/ medical interventions) 16 7.8

Abuse in care 15 7.4

Witnessing of death or other overwhelming incident 15 7.4

Exposed to general violence 14 6.9

Physical assault – not by parent figure or not clear by whom 12 5.9

Parent(s) incarcerated in gaol 12 5.9

Exposed to parent(s) violence/aggression towards others 11 5.4

Trauma related to access with parents 11 5.4

Missing data 29 cases

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Are social networks important?

• ‘Perception of support is more highly correlated with positive wellbeing than received support’ (Robinson & Garber, 1995).

• From a developmental psychopathology perspective (e.g. Robinson & Garber, 1995; Jackson & Warren, 2000); a resilience perspective (e.g. Gilligan, 1999; Gilligan, 2000) and a trauma perspective (e.g. McFarlane, 1987; van der Kolk, 1996; Garbarino & Kostelny, 1996)

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Social Network Maps• Social Network Map is not a standardised,

psychometric instrument, but a systematic, semi-structured approach to obtaining information about the person’s perception of their social network (Tracy & Whittaker, 1990).

• Developed by Tracy and Whittaker to use with high- risk families and has been used in various studies since.

• Take Two is using Social Network Maps to enable children to describe who is in their life and what they think of these relationships, such as level of closeness, type and amount of support, how often they see them and how long they have know them. It is about the child’s perception of these relationships.

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The social network circle (Part 1 of the Social Network

Map) (Tracy & Whittaker, 1990)

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Part 2 of the Social Network Map (the grid)Adapted from Social Network Grid of Tracy & Whittaker, 1990

The adapted social network grid (Part 2 of the Social Network Map)

Client’s NameDate Names of significant people

Area of Life 1.Household2.Other family3.Work/School4.Organisations5.Other friends6.Neighbours7.Professionals8.Other Age

Concrete Support 1.Hardly ever2.Some times3.Almost always

Emotional Support 1.Hardly ever2.Some times3.Almost always

Info / Advice 1.Hardly ever2.Some times3.Almost always

Critical 1.Hardly ever2.Some times3.Almost always

Direction of help 1.Goes both ways2.You to them3.Them to you

Cultural background 1.Same as me2.Different to me3.Don’t know

Closeness 1.Not very close2.Sort of close3.Very close

How often seen 0.Does not see1.Few times/yr2.Monthly3.Weekly4.Daily

How long known1.Less than 1 yr2.1-5 yrs3.More than 5 yrs

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Proportion of people listed as ‘the most important’ in each area in the child’s life (N = 31 baseline social network grids)

Friends13%

Family35%

Household22%

Neighbours1%

Clubs2%

School14%

Professionals13%

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Siblings

• Although siblings are most frequently listed, most children did not list all their siblings.

• Of the 28 children who listed one or more siblings, – 12 (43%) were not living with a sibling, – another nine (32%) only lived with some.

• 82% who listed one or more siblings described at least one as “very close”.

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Schools

• 71% mentioned someone from school, mostly teachers.

• Although most teachers were not described as ‘very close’, they were often acknowledged as providing support.

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FriendshipsPercentage of children’s descriptions of the types and level of

support they received from friends (N = 23 children; 77 friends)

52%

35%

65%

26%

52%

19%

26%32%

43%

12%

39%

51%

0

10

20

30

40

50

60

70

Almostalways

emotionallysupportive

Sometimesemotionallysupportive

Hardly everemotionallysupportive

Almostalways

practicallysupportive

Sometimespracticallysupportive

Hardly everpracticallysupportive

Levels of emotional and practical support

Perc

en

tag

e o

f ch

ild

ren

or

frie

nd

s

% of children

% of friends

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Change over time – closeness (N=10)

Mean percentage of people described in children’s Social Network Map as ‘very close’ over two time periods (N = 10)

17%

80%

47%

27%

60%56%

60%64%

92%

19%22%

87% 87%

15%

33%

87%

93%

73%

100%

44%

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10

Ten cases over two time periods

Mea

n pe

rcen

tage

of n

etw

ork

desc

ribed

as

'ver

y cl

ose'

Very close – Time 1

Very close – Time 2

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conclusions

• We know trauma impacts on all aspects of a child’s life.• Social network maps give the child an opportunity to

describe their world in their own words.• The inclusion of culture in the social network map adds to

the depth of the exploration and increases the relevance of the tool for indigenous children.

• They illustrate how a child is perceiving the level of support they have.

• They provide another measure of outcome for the child when repeated at stages during the intervention.

• Whilst to early to be definitive the use of social network maps with children is appearing as a useful tool for clinical use and in outcome measures.

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Key references

• Frederico, M., Jackson, A., & Black, C. (2006). Give sorrow words: a Language for healing, Take Two – Second Evaluation Report 2004-2005, Bundoora, School of Social Work and Social Policy, La Trobe University (www.berrystreet.org.au).

• Tracy, E. & Whittaker, J. (1990). The Social Network Map: Assessing social support in clinical practice. Families in Society: The Journal of Contemporary Human Services, 171 (8), pp. 461-470.

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