I am grateful for this guest post from contributor firstname.lastname@example.org. She asks how do social workers perceive ‘trauma’ and what impact does that perception have on their decision making? Are social workers being tempted to make ‘diagnosis’ of conditions that are outside their expertise?
When we see pictures of puppies or kittens we may have a strong impulse to go ‘Aaaah’. When we hear of ‘traumatised/abused/neglected children’ we should feel a visceral sense of revulsion. Social workers working with children will see it as their professional role to make things better for the ‘traumatised/neglected child’ but what does a traumatised/neglected child look like? That can be very hard to assess. At one end of the spectrum the child may be very quiet and at the other end a child may be beyond control and have any number of difficulties from extreme anxiety to violence. Are the problems of such children a result of abuse/trauma or could there be other reasons for their difficulties?
What if a social worker takes it upon themselves to assess the problem and becomes so fixed in his/her views that he/she fails to robustly assess all possible reasons for a child’s difficulties and take any steps he or she can to pinpoint exactly where the problems are? I believe many social workers have reached the point where they are now in danger of making these calls based on their own ‘hyper-vigilance’ around trauma/neglect.
What is trauma?
I must confess I never paid too much attention to ‘trauma’ before social workers entered my life and I began to hear this word again and again. I suppose my idea of trauma would have been a natural childbirth – the most natural thing in the world even if it is challenging when you are going through it.
Social workers seemed to use trauma as shorthand to explain why someone might be having a difficulty. This version of trauma seemed to me to be closer to a therapist’s version of trauma, an emotional wound or rupture that needed to be addressed before the person could move on with their life.
I’ve since had the benefit of hours of support from therapists around the ‘fall-out’ around our family situation so I think I really do now understand trauma – the life-changing, perspective-altering, ‘no-going back, get used to it’ type of trauma but I still have serious reservations about how social worker perceive trauma and the role it plays in people’s lives. The idea of a social worker fixing emotional wounds may help social workers get through a very challenging day but it seems to me to bring with it a number of really quite serious problems.
The danger of scapegoating
I believe that social workers often deal with parents in distress/despair including the ‘just about managing’ who have tipped over into crisis. They may, for example, be caring for disabled children, in poor health, living with violence, carrying debt they have no chance of paying off or in poor/insecure housing and employment. They may also not speak English very well or be dyslexic or have learning disabilities. They may have a whole range of vulnerabilities that they need help with including help parenting a child with unexplained emotional and behavioural difficulties.
I don’t want to make this an article about the destructive effects on families of policies that are ‘rebalancing’ our society so that we all become ‘economically productive units’ but it is a fact that these policies are really hurting many of the ‘just about managing’. Social workers may feel powerless when faced with the effects of these policies and may not have the resources to meaningfully address the difficulties of those affected but it is an undeniable fact these policies are having a hugely detrimental effect on the mental health of many of our children. (See http://www.childrenssociety.org.uk/news-and-blogs/press-releases/nine-homes-by-the-age-of-nine-–-housing-instability-marks-lives-of#163961_20170330102705)
When supporting families in dire circumstances, it is tempting for the social worker to take on the role of ‘expert’, stick a label of ‘incompetent’ on the parent without acknowledging the role of factors beyond the control of social worker or parent on the child’s difficulties. Parenting classes are a rite of passage for parents in this situation. Having being on an excellent but wildly inappropriate Troubled Families Programme this is emotive territory for me. There may be no money for anything else but in my view it is unethical to send parents on parenting courses without a very clear idea of the child’s/families difficulties and how the course will help in all spheres including around personalised health support.
The ‘nature vs nurture’ debate.
Where to start…
Trying to find answers for a child’s difficulties is such a highly contested area and moves well beyond the social work world. This contest is fought out for example in the arenas of genome sequencing and brain scanning and there are also a small number of clinical trials challenging myths that have informed whole policies including policies on social work training. (See http://link.springer.com/article/10.1007%2Fs10803-015-2680-6 ) There are ‘dirty tricks’ including presenting brain scans of children brought up in environments where they have been extremely mistreated,used to evidence harm caused by parental incompetence.
This battle is also fought by people based on their own difficult experiences of childhood or of parenting a child with unexplained and profound difficulties for whom they have been unable to get help. Few players do not have strongly held beliefs or professional reputations at stake.
Clinicians are grappling with the implications of this in terms of clinical practice. Policy makers have identified a tsunami of demand and know there are very limited clinical resources with the expertise to make these calls for individual children.
As an example of the difficulties clinicians face there are two diagnoses for virtually the same set of symptoms. Attachment disorder for the children of the disorganized, unresponsive parent living in poverty that is unable to parent their child successfully (cause – parental neglect) and late diagnosis Autism/Asperger Syndrome possibly with a demand avoidance profile for the children of ‘competent’ parents. (cause – as with all the Autisms largely genetic with a possible in-vitro environmental element).
Fraudsters abound with ‘bleach cures’ and dubious ‘therapies’ and families are desperate for answers. There are virtually no diagnostic paths for Fetal Alcohol Spectrum Disorder. No matter what the circumstances of their parents, it is, in my view, likely that the low priority given to mental health services for children has all-but failed a generation of self-harming, anxiety immobilised adolescents and their families, many with unidentified disabilities and difficulties such as sensory and sleep disorders,. (https://epi.org.uk/report/time_to_deliver/) It is also likely that low self-esteem is a major contributing factor for many children/young people with ‘behavioural’ difficulties. Somewhere in the mix comes trauma – the ‘emotional wound’ type and the ‘neglect’ type and the type you ‘recover from’ and the type you ‘learn to live with but never recover from’. The good news where trauma is concerned is that recovery is often possible with the right support unlike disability which is life-long.
Imagine what is like for a parent really struggling to get help for their child to be told the child’s difficulties are ‘on your head’, caused by ‘trauma’ and by a social worker to boot and yet many social workers believe this is their call.
What is the Social Workers role?
It may or may not be true that there is widespread mis-diagnosis of ADHD, ASD, Attachment and anxiety and similar disorders but it takes another clinician to make this call for an individual child and to generalise you need evidence of widespread mis-diagnosis via randomised clinical studies or equivalent.
I believe when trying to help a young person with profound emotional, behavioural difficulties social workers should be alert, question, look for guidance from clinical colleagues, raise concerns where you have them, provide personalised support to the best of your ability, fight for their clients rights for good support including good clinical support but you should always stick to your area of competency. The ability to make clinical diagnoses as a result of trauma just does not fall within it.