Podcast Episode: Trauma-informed practice at Kibble
Category: Young people
What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.
MD - Michelle Drumm
DJ - Dan Johnson
WH - William Howden
MD Kibble is a specialist child and youth care charity and social enterprise that empowers young people through care, education and support. In March of this year we spoke to Dan Johnson, Clinical Director and Forensic Psychologist and William Howden, a children and young people’s care worker about the charity’s trauma-informed model of care and how it makes a difference to the lives of those they support.
MD Dan, William, thanks so much for speaking to me about this particular trauma-informed model of care that you’re using at Kibble. Firstly, Dan, could you tell me a little bit about what Kibble education and care is and your role?
DJ Yeah, yeah. So Kibble’s about 150 years old, give or take, I think, and we started off as a Victorian kind of philanthropic home for kids basically, and over the last 150 years we’ve turned into a large charity that provides care for children all the way from secure care to foster care to residential care to vocational training to education.
WH I think its inception was left as a legacy with a milliner’s daughter, obviously cared for street children, so she set up a fund which has grew from there.
DJ If anyone’s a history buff, on the website we’ve got like a history section, so it’s really cool.
MD Fantastic. Dan, can you just tell me, I know Kibble has created a particular trauma-informed model of care. Tell me more about this, its origins, its principles etcetera.
DJ Yeah. So I’m a forensic psychologist, so I’ve worked here for nearly ten years. In the last couple of years, I’ve been fulfilling the clinical director role, and part of that is about us on a journey towards really authentic meaningful therapeutic trauma-informed care. So that means loads of different things to loads of different people, but we’ve tried to really boil it down and distil it into something that’s quite tangible. I keep saying that word. So it’s not just talk, you know? Something really like visible and practical and useful and that we can roll out across all our different services. There’s numerous ways you can define it I suppose. Trauma-informed in itself is a kind of way of thinking where we look at young people, we look at the difficulties they’re explaining, always within the context of what they’ve experienced, what their life has been like, and it’s all on the sort of belief that if you go through difficult harmful adverse traumatic experiences, that can continue to affect you in the here and now.
DJ So the soundbite is it’s not what’s wrong with you, it’s what’s happened to you.
DJ That kind of sums up that way of thinking. I’ve been to so many places that call themselves therapeutic and when you ask them to show you how or why, they kind of look a bit nervous and scratch their heads, right? So we’re saying, “Right, let’s boil this down”, and we’ve said we want to deliver six essential elements, and I usually lose people when you start listing six things, so I’ll be really brief, but the first one is that we want everything we do to be theory and evidence-based. So there’s loads of literature out there that we need to use, not just freestyle. We want the right environment, so I think sometimes we forget that the physical space we live in can be really, really, really important and can affect the psychological space that you then create. The third thing is our staff are like the most important thing we’ve got to be able to deliver care, so we want to make sure that they are skilled, they know what they’re doing, also that they’re supported, ‘cause this is not an easy gig. There’s a lot easier jobs out there.
DJ The fourth is we want all our services to be really integrated. So in care typically you have education, you have the therapist, you have the health, and they all kind of don’t work together.
DJ So we want to really bring these guys together, and the fifth is that we use that trauma-informed, that attachment-informed way of thinking to create a shared understanding of that child and why they’re doing what they’re doing, so education doesn’t think this child’s behaving a certain way because of learning difficulties and care thinks it’s something else and the therapist thinks it’s something else. We want to pull them all together and make sure everyone’s on the same page, and the last one is that we research and evaluate what we do so we know what works, why it works, where it works, and whether we need to keep doing it or stop doing it.
DJ We’re on a journey towards that. We’re not delivering all those in all our services. We started off in Willie’s service first, but I’m confident if somebody walked into Willie’s house now and said, “Show me how you’re therapeutic”, we could demonstrate how we’re fulfilling each of those six elements.
DJ And that’s the important bit.
MD And how does it work in practice then exactly?
DJ So yeah, I suppose the best way to explain that is what staff we use. So in our earlier services we have a staff team that’s really quite a high ratio from young people to staff. We have a psychologist that works there one day a week roughly, and what we have is lots of training for staff. We also have regular therapeutic meetings, but that’s basically trying to achieve that shared understanding of the child and make a very clear trauma-informed plan after that, and that usually says, “What’s the child experienced? How might that be affecting them in the here and now? Why does that mean they’re doing this behaviour? What do we need to do about it?” We have a counsellor that provides the staff voluntarily, or is it mandatory these days …??
WH I think it’s voluntarily but it will become mandatory.
DJ So who provides, we call it reflective space, but basically protected time with the councillor to reflect on their work, not on whether the mortgage is being paid or anything like that, but how the work is affected and how they can then be more effective in the workplace really. The psychologist works with the managers as well. The psychologist does an assessment on each young person, but that’s not like an old-school assessment. It’s looking at how do we explain this child’s behaviour from a multi-disciplinary point of view. We’ve got a researcher in as well who not only measures how the kids are doing all the time, but also how the staff are doing, how therapeutic or trauma-informed the staff’s behaviours are and how that changes over time.
WH Really comprehensive, Dan.
DJ Thanks Willie.
MD Willie, do you want to say the role that you play here?
WH The role I play, first and foremost, I’ve worked for Kibble for 15 years. I work in a range of services ranging from service provisions, secure care, and now I’m with the younger ones at Arran Villa. We initially set up our house as a pre-fostering service linked in with intensive fostering services to try and find younger children families, and that was good. The outcomes were good. I think it was identified that the children that were referred to us were very traumatised children, and some of the placements that they were sent to failed, hence Kibble, the forward-thinkers, we introduced a trauma-informed care service.
WH The staff are all trained.
MD What is your experience of using this model?
WH I think it’s been a wake-up call for everybody, particularly the older staff who’ve worked in residential care for a number of years, who’ve dealt with crisis, crisis as opposed to underlying behaviours in children, look at what’s behind this behaviour, and obviously incorporating a therapeutic environment, where we are, where we’re placed, what we do. It all encapsulates exactly what trauma-informed care means to us in order for us to help the children.
MD Mmmhmm. Can I ask you then how the model has changed your practice and your thinking around it?
WH I think the initial trauma-informed care training has been a wake-up call for everybody that’s worked, particularly beneficial for the newer adults that come in to work with us because this is the first young service that we’ve got for five to twelve year olds. It’s the first service, in fact, I don’t think any local authorities had did this. So everybody’s interested. Everybody wants a bit of it, but for us, not only it’s a change in direction in the age group but it’s also a change in direction our approach.
WH I think Dan’s team came in and they gave us a comprehensive overview of trauma-informed care, so we’ve got a better understanding.
MD Of the theory.
WH And we continue to use the theory bases, and for us it keeps rolling on and on about therapeutic means. We dissect each individual through adult team meetings. We get catch-ups. We’ve got a therapist in the house, therapy at school.
WH So for us there’s always a support base for us if we’re ever clearly struggling, ‘cause the five children that we have are very traumatised children indeed. However, we see significant differences, and that’s probably all down to relationships due to our training.
WH For me, the therapeutic means are a game-changer in respect of everybody’s in the room, and that includes a therapist, our key workers, our responsible adults, our teachers, our seniors, and everybody brings something to the table in respect of your headings: what’s happening, what can we do, what can we do better. I get quite excited listening to Kyle Blears, who’s the intervention worker for the young child that I work with, and his perception is totally spot on but totally off the mark of what I was thinking about. So he’s brought a different perspective in what was going on in this young person’s life, ‘cause he might open up to one person, so it gives us a new perception of what’s actually happening.
DJ This is minimum once per month, where everybody at the school get together and say, “Right, what are we concerned about? What’s driving this? What experiences are driving this?” This is the trauma-informed bit, right? “What has this kid experienced that is affecting this behaviour in the here and now? Based on that understanding, what are we going to do about it?”, and then everybody theoretically goes and does the same thing, and that’s quite different from residential care to be honest because it’s so hard. I mean the amount of resources just to get everybody in the same room once a month, just to organise that logistically. I mean Claire had a nightmare sorting that out at the start. It’s a big ask. It’s a challenge but we think it’s pretty essential to deliver what these kids need.
MD Mmmhmm. What are the changes you’ve seen in a younger person using the approach as opposed to maybe using a different one?
WH Well I can’t really compare our approach as opposed to a different one for the simple fact that these younger children, all we know, we’ve had five children for some time. They’re in the house, they’ve got a sense of belonging. I think that’s probably the biggest thing, is the relationship. If you use it to the three pillars of trauma-informed care is safety, connections and coping.
WH The safety is the first because when we were a pre-fostering service the children knew they were going to move on soon, and that was a real source of anxiety for some of the kids. I mean they had no stability, they didn’t know what was going to happen from going onto the next. So knowing that they’re staying there, having the relationships with the highly trained staff, and ways and means of coping, we see significant differences in the children.
MD Mmmhmm, and is this a unique approach then?
DJ No. It depends what you mean. So the idea of trauma-informed is everywhere these days, isn’t it, and we’ve had the good fortune to go and visit places that have been trying to respond to traumatised children’s needs for a long, long time. I was lucky to get a funding from a church fellowship, so I went around all Scandinavia and America four years ago now, and Kibble has been really good and just do what I really think is essential, to fund not just the therapy team or the education to do with care, but to find representatives from each service to go and see the model in different places. So basically a lot of us went over and saw this in practice in America and sort of took our own vision and said, “Right, let’s go and do that in our villa.”
DJ And that was essential. I think that was really, really fortunate. I think it’s new for us. It’s probably unique, the way we’ve delivered it, in terms of the staff and the meetings and all that kind of stuff and the environment, but it’s probably similar to other places that are trying something with the same goal, if that makes sense?
DJ So people talk about trauma-informed like it’s a really set clear thing, and I suppose someone said an analogy to me recently, which is you could say that people have tried to be inclusive about disability for example, and that’s an ethos, that’s a way of thinking, it’s a value, but your service might do that and my service might do that, but we’d probably do it slightly different. Does that make sense?
DJ It’s not a really clearly defined model. It’s a sense of values and ethos and beliefs and theories. Yeah.
MD And I guess that’s important then, so for other organisations to be able to pick up some of the principles?
DJ Oh absolutely, yeah. I mean it’s phenomenal because there’s so much there out on the internet, especially from American places like Trauma Informed Oregon, that have been implementing this kind of state-wide for a long time. So there’s loads of not only clarifying what they think it is, but guidance on how you should implement that, what are the special considerations for certain types of services, be that drug use or mental health. So there’s so much literature, there’s so much useful practical stuff out there that I’d encourage anybody to Google it, and the evidence base for trauma-informed isn’t the same as it would be say for CBT or something like that, because it isn’t so defined and discreet as something like a therapy. It’s much more a way of, how do I say this that doesn’t sound cheesy, but a way of being and a way of delivering, a bit like social pedagogy.
DJ It’s hard to evaluate something like that, although there are some new studies, some recent studies that are showing that it can improve practice basically.
DJ We go and in and we say, “Look, this looks really cool. What do you think?”, but we don’t have to deliver care at 4 o’clock in the morning when a kid’s really distressed, and for me it’s like, “It’s over to you guys.”
DJ I mean it’s saying, “This looks like good stuff. Do what you can with it”, really.
DJ Don’t know what you think, Willie?
WH I think I and every particular adult walks a particular way, but in the same sense using the same theory we’ve been trained to do, and we work to everybody’s strengths in the house, and that strength is depending on the relationship with each individual child.
WH There’s a range of good behaviours displayed on a daily basis, and no two days are the same.
MD Sure. Mmmhmm.
WH Trauma comes in different forms, but for me it’s dealing with the younger children as their trauma is so close to a memory in their life. It’s raw and it’s displayed as a raw emotion sometimes, and how we deal with that is an individual basis.
MD Yeah. What are some of the other challenges then?
WH Some of the challenges for me is we’re quite lucky that we’ve got a real consistent team that’s been derived over the last year, two years. Everybody knows their role and remit. However, there are a lot of workers that come in that don’t really fully understand and they struggle with that. At the end of the day, we can deal with the children but some of the adults have to realise that it might not be for them.
WH I mean this particular age group, this particular job. There’s not really much else I can say because we just go in every day and there’s no two days the same. Our approach is what’s in the mind-set of the child, the presenting behaviour, what’s behind the behaviour and how can we resolve that.
WH Because five minutes later it’s resolved. It’s over and done with.
DJ One of the challenges I would say is that all these kids are with us because I mean ultimately their behaviour’s really, really concerning to the system, to social work, and so the challenge is it’s really easy to be trauma-informed and nurturing and kind and all that when a child’s equally the same to you, right?
DJ When a child’s smashing up a room or running away or i.e. when being trauma-informed is most needed, it can be most hard. Some of the principles for example are that you empower children, you listen to their voice, you acknowledge their difficulties, all that kind of stuff. That’s fine if there’s no concern. If a child has just assaulted a member of staff by pulling them across a room by the hair, it can be very challenging to all of us to think, “Well how can we respond to this in a trauma-informed nurturing supporting way?”, because we’re so used to, as a society, and to want to consequence or punish, and that’s the real challenge, to keep it going when it’s hardest.
MD Mmm. Are there other organisations who are also using this trauma-informed model of care?
DJ There’s hundreds, yeah, yeah.
MD Oh there is?
DJ Well that’s really interesting because this goes back to my point where it’s really not clearly defined for some people.
DJ I would say we’re kind of trauma-responsive, right?
DJ We’re all informed about it. We’re trying to do something about it. We’re trying to respond to these kids, but you’ll see out there, folk who do like a half day’s training and say, “Right, we are informed”, and they are informed but to what degree? It’s much more of a continuum than a category.
MD Yeah. It’s almost like a culture change, isn’t it?
DJ Aye, absolutely. Yeah, totally.
DJ It definitely is a culture change.
MD And that takes time and resources.
DJ Well totally. I would say we’ve been on that journey for ten years-ish, right, ‘cause we had Bruce Perry, who’s a bit of a hero in this sector, come over like ten years ago and talk to us, and we’re an organisation of six hundred and something staff. We’ve got 130-odd young people. For us to go from nothing to fully trauma-responsive is a long-haul journey. You don’t do that overnight, not if it’s authentic and meaningful anyway. So we’re definitely on a journey. We’ve started it in our earlier services. Our secure unit, our safe centre is well on the way and there’s other pockets, but we’ve still got a lot of work to do. Anyone that says they’ve revolutionised it and done that in 6 months or something, I’m like, “Have you?”
MD Yeah. So what really needs to be in place to get it going?
DJ Everyone seems to think that training is the answer to everything. I’ve had this chat with lots of people, including our own D manager over the years, and training’s definitely essential but it’s nowhere near sufficient, right? So people need to know about trauma, the theory and all that, but just ‘cause you go on a couple day’s training course doesn’t really change anything.
DJ And so what you need is a committed group of people who are regularly held accountable to saying, “What does this look like in practice? How are we doing this and how are we not?”, and I’m going to be honest, most of the time we’re all looking at ourselves saying, “That’s not trauma-informed. We need to do better on that. That’s not good enough.” It’s only when you kind of stop the bus occasionally and say, “Well what were we like six months ago?”, then you think, “Oh, there’s some progress here. We’re doing things better.” I suppose the point I’m trying to make is the children’s behaviours, the way the system works by like purchasing and commissioning, it can all feel as a real challenge and barrier to doing what we’re hoping to do with trauma-informed care.
DJ And it’s a constant battle. I don’t know why I’m rambling here, Willie. What do you think?
WH I think us obviously, we’re pioneers of the training that Dan’s groups gave us, and we continue to re-evaluate ourselves, and that’s done through the evidence-based practice, particularly at the end of every shift, quite a lot of stuff that we do that we can discuss it as a team. We used to do that in residential care. We used to have like a reflection at the end of your shift, but we tend to have a set series of questions and obviously it gives everybody a voice to speak up and obviously at the end of the week you can actually get through that and just say, “Right, you can see what that pattern led to”, depending on which shift you were on, but for us it’s being continually reflective, just thinking about what we did that was good, what did we do that was better, what could we do to improve things. Do you know what I mean?
WH And only by doing that and only by having everybody being proactive and thinking that can we move on, particularly if it’s an individual case. Every child goes through a week or two weeks of crisis, depending on what’s gone on in their life, and all we want to do is help that young child. So we’ll reflect on that to see who’s best practiced to suit that, to work with that child. I think it’s easy to find faults in what we do when it’s not going so good, when there is a lot of pressure, and there are days when there is a lot of pressure, and I think it’s very, very easy to see signs and symptoms of fault.
WH And it’s being accountable for what you do really. So hence if you’ve got a really secure staff team who have really worked together for a long period of time, it’s better to be open and honest than have ferments. Do you know what I mean?
MD Yeah. Yeah.
WH In a team.
MD It just sounds to me like there’s a positive culture and ways of working that people have bought into?
WH I see that most days.
WH I see positivity out of every situation that arises during the day, but that’s all down to the staff. I mean all these children need are consistency, predictability.
MD And a real emphasis on staff feeling valued I guess in terms of this work, ‘cause it’s challenging work?
WH I think when you see through the issues and you’re moving on and you’re seeing outcomes, I mean you’re here as an applicant agency for our children, do you know what I mean? They need inclusion. They need to feel a sense of belonging and I think we’ve got that. I mean particularly not only in our villa but in the community. I mean we’ve got them heavily involved in hobbies and activities and stuff. It alleviates anxiety and you can see significant differences.
WH Feeling involved, that culture of being involved in sub-groups and social groups.
DJ I suppose there’s some points to make, which is for any trauma-informed care there’s a bit of a buzz, well there has been for a couple of years to be honest, and people kind of come at that thinking it is something that you can introduce or not and walk away, and it’s a hard shift if you’re going to do it properly and it takes, to really respond in a helpful meaningful way to children who have experienced trauma requires lots of professional challenge, lots of difficult decisions and conflicts. So while we’re working together in our villa, on a daily basis we’re all thinking, “Is this right? Are we doing it?”, and it’s kind of like it’s an idea that can sometimes feel very hard to actually achieve.
DJ And sometimes you can’t just, sometimes there’s reality, you know, social work will only pay so much for a placement and all that kind of stuff. There isn’t a wonderful house everywhere to go to and all that, but for me the important thing is that we are doing as much as we can to approach that ideal and try and get to where we want to go, and we’re doing what we can. That’s what we need to sort of rest easy on.
MD Yeah. So you’re sharing a vision basically for where you want to get to?
DJ Yeah. Yeah, and for me like there will be times, and I’m sure any parents will reflect on this, where you want to do the right thing for your child and you feel compromised and you don’t feel like you can quite do it, but for me as long as when we’re looking at a child’s behaviour and saying, “We’re not attributing that to, oh that’s just a diagnosis”, or, “That’s ‘cause they’re at it.” We’re saying, “What is behind this? What’s driving this? What need are they trying to achieve?” That to me is the key thing, and I hear staff talk like that in a lot of places I go to, and that’s the rub basically, isn’t it? That’s the main thing.
MD Does it link in well with the ACEs assessments?
DJ Yeah. So you’ve got these kind of trauma ACEs like split in Scotland a little bit. That’s when we say it’s too far, which is ludicrous really ‘cause it’s the same message, which is if children experience harmful things they’re going to have difficulties later on. I think anyone knows that, right? Anybody. A guy on the street would tell you that, and it’s more the way that can be interpreted or implemented in practice. So if someone looks at the ACEs research and thinks, “Oh, if you experience these 10 adverse experiences you’re more likely to have harmful behaviour, therefore I will give kids questionnaires on those ten ACEs and get them to score themselves”, I would say the theory’s great. It’s the interpretation of that that’s the problem, right?
MD Right, yeah.
DJ We don’t want to be going and asking a six-year-old to do that. So the theory’s a good one. It’s so simple as well, the way the ACEs work, anyone can get it, but that’s also its weakness because folk just take it and run with it.
MD Yeah, simplify it too much.
DJ Aye, and think it’s just something that can be used at the individual level. I suppose another thing that I’d say on what is trauma-informed is it’s acted as a bit of a vehicle to sort of bring in change. So there was this demand for us to be trauma-informed, both bottom up and top down, from outsiders, and so that just acts as like an excuse or a reason to say, “Hang on, we’ve been doing this for years. How can we do it different? How can we do it better?” Tell me if you agree with this, Willie, but it kind of pushes it through. So I’ll give you an example. In secure units in Scotland children are searched when they come in and out of secure units, and that can mean like a few times a day, right?
DJ And some bright spark said, “That’s awful because these kids have been traumatised. They’ve been sexually abused or whatnot.” It feels counter-productive to be searching them, yet we need to keep them safe as well. Someone said, “How can we do that better?”, and someone came up with the idea of an airport scanner, right? So I don’t think we’d have thought of that if this kind of trauma-informed vehicle and culture change hadn’t come in.
DJ Does that make sense?
MD Yeah. Yeah.
DJ It’s like it acts as a reason to say, “Let’s do things better.” There’s a demand to do this where that might not have happened otherwise I think.
MD Mmmhmm, and have other organisations here in Scotland and more locally sort of taken some of your approaches and ideas?
WH I think all the local authorities are going that way now, trauma-informed care, early intervention, younger years. It seems to be that they’ve all downsized their huge residential units to 4 and 5 bedrooms, particularly in my local authority, and now they’re diversifying, because I at one stage had a five-year-old in a house with a sixteen, seventeen-year-old.
WH The kind of rational thinking behind that now is like let’s just have separate services, and I think that’s the way everybody’s going to go.
DJ There’s plenty people that have taken on trauma-informed thinking, you know, we’ve obviously collaborated with plenty of people, we’ve trained quite a lot, but we don’t own it if that makes sense? It’s out there. It’s like the degree to which you use it as well, so we’ve invested quite a lot of resources to make sure it’s really on the end of the scale if you like of meaningful and authentic. Others might be doing it less or even more intense. I don’t know.
WH I mean even if every local authority made a small change in the way they looked after children, and make a significant difference to their wellbeing and outcomes.
MD Are people’s roles a little bit different then?
WH I think that’s the same with every organisation in social care. Things move on. They evolve. We’ve come a long way since the 80s, 90s. I think particularly I’ve seen rapid changes in the last fifteen years in the way that the organisation works, the organisation deals with children, the referral system, outcomes, after sixteem, eighteen, twenty four.
WH But I think the significant change for us at Arran Villa was we could use the word we claim their children. Our children are not going anywhere until a placement’s been found that suits their needs, as opposed to it suits the organisation’s needs.
WH I was quite critical with it, but at the end of the day you really have to have the child at your heart in the first and foremost and everything. You do.
WH In order to do this job you have to be passionate about this job. You have to be motivated in everything you do. You can’t become complacent.
MD And have you any plans going forward at the moment to develop your services?
DJ There’s loads, yeah. So the six elements that I’ve talked about, we’ve implemented those into our early year’s services. We’re in the process of implementing them in our secure unit and then the third phase will be our open campuses, which is eight children’s homes. There’s lots of soft changes, but that’s the hard implementation if you like, and then we’ve got community services after that.
DJ So as Willie mentioned earlier, we’re also opening an under twelves children’s house next to the forest school. Forest View it’s called. The school is not in a forest. We’re also really concerned about the amount of chronic severe and repeated self-harm in a group of young people who are attending to go to secure care, which it’s not really designed for.
DJ So we’re in the process of developing a new service and in discussions with the Scottish Government. So it’s like to open a service that would really be designed for their unique needs.
DJ Many other things.
DJ Besides all that.
MD So there’s lots going on?
DJ And upstairs in the top corridor there is a picture, there’s the plans of Kibble from like 1899 or whatever, and there’s sixty beds in basically a warehouse.
DJ Just sixty kids all sleeping in this huge dormitory, and you think, “That’s a long way to what we are now.” There’s still an equal distance to travel, right? There’s still so much more that can be done, and this is part of what’s, you know, this is another thing that’s driving that progress hopefully.
MD Yeah. Fantastic. Well I’d like to take this opportunity to thank you both for your time today. It’s been really interesting to talk about this.
WH Thank you very much.
DJ Thank very much, yeah.
MD Thank you.
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