As the Interventions for Vulnerable Youth (IVY) project moves to Kibble Education and Care Centre after six years at CYCJ, Lead Clinician Dr Lorraine Johnstone reflects on the important lessons she’s learnt (and is still learning) from her time with IVY.
After more than two decades working with forensic populations, I have now come to terms with the fact that my learning curve will never level out. With each new case, there are important new lessons. With each new generation there are challenging new crimes. It’s impossible to capture them all here but I thought I might reflect on a few key things that I think I’ve learnt so far.
From working with children, adolescents and adults, I am now entirely convinced of the following.
It seems to me that those who victimise others usually are themselves victims first. Whilst our delinquency and criminogenic literatures reveal a laundry list of risk factors, I think that severe victimisation that impacts on a child’s attachment functioning during childhood merits its own unique status. My work to date has taught me that whether it is interpersonal violence, intimate partner violence, stalking, gang fighting, violent extremism or sexual offending, early experiences are critical factors in the explanatory framework. Where the parent-child dyad is unable to form a secure attachment and basis from which a child can grow, explore, regulate their emotions and develop moral affect, their ability to negotiate the social world becomes impaired, if not impossible. Feeling vulnerable and alone, they are at risk of migrating to problematic environments where they are exposed to and begin to gain experience in having their needs met in maladaptive ways.
I am also learning that where victimisation leads to developmental trauma, the formative years can herald the onset of severe and persistent risk of harm to others. Violence becomes the most effective way of controlling others, controlling the environment and making the world a predictable place.
Improved understanding and reasons for hope
I also believe that when viewed this way, we achieve two critical outcomes – a better understanding of the reasons why and the possibility for change. I think it could be argued that for some young people, violence really is quite understandable and even sensible and logical.
The impotence a child must feel when growing up in such adversity surely results in a logical choice – grow up to be a victim or victimiser. Mindful that we are beings with survival instincts, I doubt whether there really is a choice? And, I would propose that if this perspective has even a shred of validity then there is also hope. Seeing violent conduct as a response to an event (such as trauma with attachment disruption) or events means that we must have successful ways of ensuring prevention and early intervention.
Stopping early victimisation could prevent later victimisation. We need to be getting it right, we need to identify and support high risk families, we need to enhance attachment focused parenting and caregiving, we need trauma informed approaches to child rearing.
It is the impact, not the occurrence of adversity
Whilst I unequivocally welcome the ACES agenda and the trauma-informed approach, I am clear in my mind that this rhetoric, if applied uncritically, will likely to do more harm than good. We need to be very careful about how we frame and respond to traumatic incidents and the occurrence of adverse events. It is vital that systems and professionals are both aware and understand that it is not the presence of trauma per se. that predicts poor outcomes but the impact of trauma on the person’s development. This is a critical point if we are to save agencies and people from making poorly informed and potentially highly disempowering policy and practice decisions. Many experience trauma and adversity and do just fine. To lose sight of that is to marginalise and mislabel resiliency.
Prevention, Early Intervention and High Risk
I have also learnt that to focus on one part of the wedge – response versus prevention – is a futile exercise too. Vulnerable young people at every stage of the journey are equally worthy of support. It is absolutely vital that we stop holding young people in limbo, missing critical care periods where healthy internal working models (of themselves, of others and of the world as a whole) fail to develop. We need to invest in our families, we need to inform the legislative and policy landscapes, we need to ensure that any alternatives to parental care are of a very high standard, capable of making change and not something young people see as a ‘holding bay’ until they can reconcile with their early attachment figures. We need to get it right for parents, for families – as well as for children – and that might mean we need to make difficult and distressing decisions early on. Competent, robust and tested evidence must for the basis of these critical decisions. And, for those young people where harm has already happened to them and by them, the delivery of attachment and trauma informed treatments might yield better outcomes than those interventions that target thinking and reasoning. Many – if not most – people with violence risk needs do not set out to be violent and many – if not most – people would like to be able to manage their behaviour far better.
Call it out and then explain it
Whilst always maintaining a compassionate focus, the IVY project has by no means been a soft option – we call a spade a spade and where there is a risk, it is stated clearly, unequivocally and with no holes barred. There is nothing to be gained by holding too much or too little optimism (or pessimism for that matter). The approach is one where the risk is explained in a narrative form. This explanation has proven to be another key factor in moving forward. Psychologists call this explanation a ’formulation’. But it really is just the person’s individual story that identifies what, how, when and why different events and experiences contribute to the onset, development and maintenance of the seriously concerning violent conduct. That formulation is fundamental to providing the platform for young people, their families, carers and agencies in understanding this, and therefore having a real prospect of making change. In the absence of this story, there is a risk that interventions will be misguided and improperly targeted and conclusions such as ‘unresponsive to treatment’ erroneously reached.
Formulation leads to recommendations that are set within a broad, multi-theoretical framework, often with attachment and trauma given centre stage. Drawing from the evidence base, treatments are designed and delivered to meet the needs of ‘this young person, in this situation, at this present time’. They are developmentally, systemically, trauma and risk informed. If the young person and the system around them understand the journey to the past and the present, they will be better placed to change the future.
There’s still a lot to do
My final reflection is that there is still so much more to do. The panacea eludes us but the hope and energy for finding it does not. The model used in IVY provides a way of understanding and intervening that has the potential to work in an empowering and effective way whilst also being efficient (in time and money). As we move forward on the next part of our journey at Kibble Education and Care Services, we are committed to providing this input but equally so in sharing the knowledge and learning. It is imperative that policy and practice is properly informed, that the complexity of these challenges are embraced and that we avoid falling into the traps of the past where we use simple algorithms or scores to dictate a systems response.
IVY is now based at the Kibble Education and Care Centre.
About our blogger
Dr Lorraine Johnstone is a consultant clinical and forensic psychologist chartered and registered in both specialisms. Find out more.