Starting early and staying connected My name is Gemma Burns and I am a Clinical Psychologist who leads a small psychology service working into Adoption Services in South East Wales adoption Service. My clinical background is working with children who have experienced early trauma and abuse, who are in the looked after system. I have also worked into local CAMHS services and adolescent forensic services. We have been providing a service into adoption for the past four years and today I wanted to share with you some of my insights into what we have learnt in this time and our resulting psychological modal. We have learnt a great deal from the adoptive families and professionals who have worked closely with us over the past three years and for these relationships we are for ever grateful. Starting early and staying connected A Psychological Model of support throughout the journey of adoption Dr Gemma Burns

So what is our story….. Four years ago ABUHB local health board in partnership with the Gwent local authorities decided that they would dedicate 5 days of clinical psychology time into adoption services in south east wales, what this has meant in practice was three clinical psychologists who had extensive experience working with families and children within health services provide this support.

What shall we do? With this brilliant opportunity facing us our first question…..so what shall we do? which was followed swiftly by the question what is the task facing us. We had a lot of knowledge about child development and the family life cycle and what children should be doing at different ages and stages, we also knew a lot about the impact of developmental trauma and attachment theory Our first job was to build relationships with people who could help us learn what the task was. We spoke with adoptive parents, social workers, the national adoption service, third sector partners. We began to understand that there were many ways in which we might work, in our experience and through lots of conversations, we felt that our efforts should be focused on supporting the development of adoptive families.

Becoming a parent Parenthood is learning how to be the safe hands for a child to explore the world from and return back to. There is significant psychological adjustment for any person becoming a new parent There are a number of additional factors which makes this adjustment greater for adoptive families. Attachment theory tells us that the job of the parent is to be the safe hands from which a child can feel safe enough to explore from and return to when they need comfort and emotional regulation. So in these terms becoming a parent is about becoming this safe pair of hands. The psychological challenge of becoming a parent is enormous. Questions such as What do they need?, how much do the need, when do I stay close/when do allow them to explore? What type of parent do I want to be? All of these questions require us to learn about our child, what they need, what settles them, what excites them. The task of ‘learning your child’ can be both wonderous and overwhelming at times. Now add to this the following complexities: As a parent you have experienced a long, arduous and publicly assessed journey to arrive at parenthood. You have undergone a rigorous process of assessment to get your ‘stamp of approval’. You have hopes, dreams and wishes about your child and your future relationship just like any other parent, you have thought long and hard about the ‘type’ of parent you will be. Add to this the fact that all adoptive children will already have experienced a caregiving relationships and from this they will have developed some expectations around relationships with caregivers. For some these might be - adults are unreliable, I must work really hard to always keep them close, adults cannot be trusted, I must make sure that I am in control and do not let them close to me in case they let me down, or I must always be delightful in order to be loveable. Many adoptive children find it difficult to know how to allow a parent to be their safe hands as this has not been their expectation of relationships. People who care for me can be terrfiying, I need you to care for me and I am terrified of you, this can be very confusing for children. Families told us that difficulties can begin to arise in understanding what a child might bring to this new relationship, making the task of ‘learning’ their child more complex. Our experience has taught us that if parents are not given adequate support at the beginning of these relationships then they can be left feeling that they are doing a poor job of understanding and meeting their child’s needs. This can be devastating when you have waited so long to become a parent and can make it really It can also make the task of creating an intimate, loving, safe relationship where a child can both seek comfort and explore so much more challenging. With all of these factors in play it is tremendously hard to feel that you can be the safe pair of hands that your child needs.

The psychological model In essence our psychological modal is based upon the idea of being a families safe pair of hands. So just like a child needs a parent to be their safe pair of hands in order to learn and develop, we believe that for many adoptive parents they too need this safe pair of hands in order that they can feel safe to access support and develop. So we set about creating a system around a family where parents are able to seek support when they need it and branch out when they feel confident. We don't believe that parents are either up to the job or not, we believe that to parent a child who has experienced significant trauma is a task that is challenging, psychologically and emotionally and that in order to do this most families will need a system of support around them to allow for this resilience to be created, but this resilience is develop through supportive relationships rather than in isolation

Relational resilience Building supportive, trusting relationships around an adoptive family to allow for vulnerability, empathy and understanding. In essence creating a system around a family that can support them in journey through adoption. Belief that every parent is doing the best they can with the resources around them. We understand that for some families there existing network around them will be a sufficient source of support We build relationships early Discover families strengths and resilience Engage with the wider system, including wider families and schools Create a safe space for families to be vulnerable Share in both their joy and their pain without judgement Our ideal is that we can bring together a safe community for people to join together to support each other.

What does this mean in practice? We endeavour to find as many ways to connect with professionals and families as possible, we do this by having an ethos of being available and contactable wherever possible. We seek to engage the network around a family to come together to support the family in throughout their adoption journey. Consultation to the wider system Early days training Six week parenting groups - exploring the impact of developmental trauma for children, considering what these mean for how the child understands self, relationships with caregivers and the world, thinking about what these means for how we parent children who have had these experiences, in order to help them to begin to build relationships and understand their own emotional world. For every parent who completes this course they are then welcomed back to group once every 6 months to re-connect with each other and these ides. Therapeutic parenting groups/graduate groups Grandparents group/Evening workshops Ongoing consultation for families Direct therapeutic work with families

What are we trying to achieve in our work? Safe and containing relationships Being alongside parents to translate the internal world of their child Support parents in implementing an attachment focused parenting style Work with families to create interdependence and psychological safety Facilitating moments of joy and connection What I mean by interdependence is creating a healthy reciprocal relationship between ourselves and the families we work with. It is a two way relationship where we learn from each other and take responsibility for our learning, sometimes in this relationship there maybe times when families need a greater amount of support and at other times less so. Our number indicate that in the past two years we have reached approximately 250 families, from our evaluations families are telling us that they are seeing real impacts in their families lives. we believe that this model has possibilities for wider implications for implementation across wales and the UK

Enhanced support in the first year Engaging with the system around a family as early as possible Four meetings across the first year Development of a psychological understanding of the child’s internal world and developing attachment relationship Safe place to explore the joys and challenges in the first year of placement We believe that the creation of a safe space is important, so they can come to a place where they feel understood, connected with and a deep empathy for the parenting task they have undertaken

Reflections on the process so far.. As our a service we believe that as a society we are asking parents to adopt some of the most traumatised children In essence we are asking these parents to be ‘super parents’ and as such support early and throughout the journey should be the expectation for all parents rather than feeling that accessing support is a sign of failure as a family.