'Recovery is possible'

Events which expose children and young people to trauma, including Covid-19 and disasters such as the Grenfell Tower fire, can have a lasting impact on children and young people – exposing them to a greater risk of mental health problems in the future. A group of 22 experts in research, practice, and policy have recently launched the UK Trauma Council (UKTC) to help address a lack of both knowledge on childhood trauma and trauma-informed treatment for children and young people. 

The UKTC is chaired and co-directed by David Trickey, Consultant Clinical Psychologist in the Specialist Trauma and Maltreatment Service at the Anna Freud Centre, and Eamon McCrory, Professor of Developmental Neuroscience and Psychopathology, Co-Director of the Developmental Risk and Resilience Unit (UCL), and a Director at the Anna Freud Centre. As well as psychologists, its council members include experts from all four nations of the UK in fields such as global health, child and adolescent psychiatry and public health.

Hosted and supported by the Anna Freud National Centre for Children and Families, the Council's overall aim is to help improve the care that children and young people exposed to trauma – including abuse and neglect – receive. It hopes to become a hub for learning about childhood trauma, creating and disseminating accessible resources on the latest evidence for non-experts, informing policy in England, Scotland, Wales and Northern Ireland, and increase collaboration among trauma experts in the UK. 

Given the complexity of the impact of trauma, and the role of social, psychological, developmental and biological factors in shaping that impact, McCrory said it was vital that the Council took a truly multidisciplinary approach to its work. 'It is not hard to imagine how childhood maltreatment, a terrorist attack or a traumatic bereavement could have common but also distinct effects depending on a wide range of factors. To understand the impact of such events, and most importantly, understand how best to help children and young people exposed to such events, we need psychologists, psychiatrists, psychotherapists, those involved in policy, service delivery, education and community health.' 

McCrory, whose research uses brain imaging and psychological approaches, investigates the impact of maltreatment on children's future mental health and more broadly explores the mechanisms associated with developmental adversity and resilience. He tells me that decades of longitudinal research has shown that childhood trauma is the largest modifiable risk factor for later mental health problems. 'My own research uses neuroscience to help shed light on how early adverse experiences such as maltreatment can increase the risk of poor outcomes later in life. However, despite important advances in research and clinical practice I saw first-hand how difficult and frustrating it can be for these to find their way to the frontline.'

This frustration was shared by David Trickey, an expert in the field of childhood trauma and post-traumatic stress disorder (PTSD). In the wake of the Grenfell Tower fire and Manchester Arena bombings, McCrory and Trickey realised there was no national platform to bring together advice and guidance about trauma despite a great deal of expertise being dotted around the UK. 'For some reason trauma as a concept had not organised clinicians, services or research in the same way as specific diagnostic categories such as Autism or ADHD.'

McCrory and Trickey, with the help of the Anna Freud Centre and early seed money, conducted a national and international survey to better understand what could fill this gap. 'The results from this consultation were compelling and clear. A national platform was needed to share experience and expertise and disseminate best practice as well as research in the field of trauma,' McCrory said. 

Thanks to funding from the National Lottery Community Fund and St. James' Place Charitable Foundation, the UK Trauma Council was set up. One of its first publications was a policy statement on the Covid-19 pandemic – which McCrory said has had a significant impact on children and young people's mental health. 'It has increased the experience of trauma for many, and compromised the support which children and young people receive from friends, family and public services. The UK Trauma Council want to actively support and help those shaping policy and funding decisions in this time of upheaval and uncertainty, so that in the months and years ahead children and young people are supported and effectively helped following trauma.' 

There can be a tendency, McCrory added, for mental health interventions to be focused on more common difficulties such as depression and anxiety. 'This we believe misses an important opportunity. Trauma is a key factor that can increase the risk of these outcomes in the first place. We need an increased focus on prevention (that is reducing the likelihood of mental health problems following trauma), as well as increased provision of the resources, skills and evidence-based forms of help that communities need to help themselves. The policy document sets out key priorities to guide policy makers so they can help turn this into a reality.' 

McCrory said recent reviews had found a gap between the emerging evidence base and frontline practice. 'This gap relates to a lack of training, knowledge and confidence in the implementation of evidence-based interventions for children and young people who are presenting with traumatic reactions. In some areas, services are struggling to provide basic levels of support – and some children and young people will not gain access to the specialist interventions needed to mitigate the effects of their trauma. There is a need to invest in training, and supervision, in evidence-based interventions for professionals within children and young people's mental health services. There is also a need to establish clear pathways for referral and models of care, so that this capacity is effectively targeted and is accessible to all children, young people and families who need it.' 

As well as its Covid-19 briefing the council has also released a set of free resources on the neuroscience of trauma, written for non-experts. McCrory said, as a neuroscientist and clinician, he had seen first-hand how difficult it could be for frontline carers and professionals to access accurate and current information from neuroscience on abuse and neglect. 

The UKTC is also set to release resources to help identify children and young people who have experienced a traumatic bereavement, and later next year will publish guidance on responding to critical incidents in schools. McCrory said schools often have to respond when individual children and young people, or the school collectively, experience trauma.  

'There is a need to help schools prepare in advance for such incidents – much can be done in terms of thinking, planning and training so that systems and responses are in place that can be activated at short notice. At times of stress following trauma, adults can make poor decisions as they themselves become anxious and stressed, making it less likely that they respond in an effective way.' 

McCrory ended on a positive note. 'A child's behaviour that can otherwise seem challenging or confusing can begin to make sense in the context of early brain adaptation, giving us a new lens through which to understand – and help – the children in our care. While the brain changes triggered by trauma can make it harder for a child to navigate and cope with everyday challenges, increasing the risk of mental health problems in the future, recovery is possible. We now know their brains adapt to help them cope. Relationships play a key role in that recovery, as they directly influence how the brain grows and develops. So parents, carers and professionals have a crucial role to play in promoting resilience. These relationships are at the heart of what drives positive change.'

- Find out more at https://uktraumacouncil.org