Atta c hme nt & Adole sc e nt Ha rmful Se xua l Be ha viour Be x Da r by NSPCC (UK) Na tiona l Clinic a l Asse ssme nt & T r e a tme nt Se r vic e
Intr oduc tion • Ac tivity - A pilo t in the use o f AAI , pa re nts’ inte rvie w a nd T AAI in a sse ssme nt o f a do le sc e nts who displa y ha rmful se xua l b e ha vio ur. Se tting - A spe c ia list ha rmful se xua l b e ha vio ur se rvic e within a na tio na l UK c hild pro te c tio n c ha rity (the NSPCC). the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Pur pose • As the ne w ma na g e r o f this multi-disc iplina ry te a m, whic h de sc rib e s itse lf a s a tta c hme nt info rme d, I wa nte d to se e ho w the DMM mo de l o f a tta c hme nt a nd F a mily F unc tio na l F o rmula tio n c o uld impa c t upo n the a sse ssme nts c urre ntly pro duc e d a nd inte rve ntio ns c urre ntly o ffe re d/ re c o mme nde d b y this te a m. • My te a m is c o mprise d o f fo ur so c ia l wo rke rs, a fa mily syste mic psyc ho the ra pist, a c o nsulta nt c linic a l psyc ho lo g ist, a psyc hia trist – a nd me ! the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Pr oble m I n the c o urse o f the pilo t I wa nte d to unde rsta nd: Ho w we ll fa milie s wo uld e ng a g e with the a dditio na l • me e ting s a nd the pa rtic ula r style o f the inte rvie w/ s Whe the r re fe rre rs to o ur se rvic e wo uld b e willing to pa y • the a dditio na l c o st/ e sta b lish the ir fina nc ia l thre sho ld Ho w c o uld the c o nc e pts a nd c o nstruc ts o f the AAI / T AAI • a nd DMM b e sha re d me a ning fully with a te a m no t ye t tra ine d in the mo de l? Ho w c o uld the F F F b e inte g ra te d in to o ur c urre nt • a sse ssme nt re po rts? Whe the r the ne w info rma tio n wa s use ful to re fe rre rs • (usua lly so c ia l wo rke rs) a nd b e ne fic ia l to fa milie s. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Me thod • One c a se / fa mily wa s se le c te d a s a pilo t whe re b y a n AAI fo r e a c h pa re nt, a T AAI fo r the a do le sc e nt a nd the par vie w wo uld b e e nts inte r c o nduc te d, c o de d a nd inte g ra te d in to o ur multi-disc iplina ry re po rt a s a F mulation . amily F unc tional F or the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Me thod All inte r vie ws a re c o nduc te d b y me a s a sta nda lo ne • pie c e o f wo rk (i.e . no ne o f the fa mily me t me in a ny o the r c o nte xt). Coding o f the tra nsc ripts is pro vide d b y the DMM • c o mmunity via Pa t Critte nde n (b y Pa t he rse lf in this c a se !) e tation o f individua l c la ssific a tio ns a nd F a mily Inte r pr • F unc tio na l F o rmula tio n is unde rta ke n b y the a utho rize d c o de r a nd sha re d with NSPCC re po rt a utho rs a nd wide r te a m in o ur c linic a l me e ting prio r to inc lusio n in the writte n a sse ssme nt. e e dba c k is o b ta ine d fro m the fa mily a nd re fe rring F • se rvic e o nc e the multi-disc iplina ry re po rt ha s b e e n sha re d. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
T he family • 16 ye a r o ld b o y • De c e a se d o lde r b ro the r • Mo the r a g e d 42 • F a the r a g e d 48 the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
F amily histor y Childr e n’s se r vic e s Ke y c onc e rns/ pr oc e sse s e ve nts F irst re fe rra l to c hildre n’ s se rvic e s PND, ma te rna l se lf-ha rm & a tte mpte d • • o ve rdo se whe n T urb o is 6 we e ks o ld Do me stic dispute s, pa te rna l a lc o ho l • F ive e piso de s unde r a Child • misuse , lo w inc o me , ? de pre ssio n, NAI s Pro te c tio n Pla n fro m a g e 1y9m Child a g g re ssio n, so iling , spe e c h de la y • to 15 yrs se xua lise d b e ha vio ur a t sc ho o l, po o r pe rso na l hyg ie ne L e g a l pro c e e ding s (i.e . re mo va l) • c o nside re d twic e a t a g e 9y7m E lde st c hild dro wns a g e d 15 (T urb o is • 11y4m). T urb o thre a te ns to se t se lf a lig ht a nd 14y 8m sho rtly a fte rwa rds Multi-Syste mic T he ra py fo r Child • Vio le nt a nd se xua lise d b e ha vio ur pe rsists • Ab use a nd Ne g le c t (MST -CAN) a t sc ho o l de live re d a g e 10y6m to 11y7m; Ra pe a lle g a tio n whe n T urb o a g e d • pe rio d spa ns de a th o f e lde st 14y5m (NF Ad due to unre lia b le witne ss c hild a nd T urb o ’ s ina b ility to unde rsta nd c o nse nt) Re fe rra l to NSPCC a g e d 15y 10m • the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Be rtino ro , 2008 Camb ridg e , 2010 Re sults? F rankfurt, 2012 Miami, 2015
Pr e liminar y findings 1 a mily e ng a g e me nt : • F • F a mily (pa re nts) re fuse to tra ve l fo r me e ting s b ut pa rtic ipa te in AAI s a t lo c a l c hildre n’ s se rvic e s o ffic e • T urb o a vo ids b e ing se e n a t ho me ; pa re nts ‘ una b le ’ to pe rsua de him. ? Sa b o ta g e • T urb o se e n a t sc ho o l, suc c e ssfully • PI a rra ng e d a t sc ho o l ‘ fo rg o tte n’ ; q uic kly re sc he dule d a t ho me b ut T urb o re fuse s to b e in c a me ra sho t; he le a ve s ha lfwa y thro ug h the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Pr e liminar y findings 2 • Re fe r r e r ’s inve stme nt • F a lse po sitive re . c o st – we o ffe r this a t no e xtra c o st due to pilo t sta tus • Ve ry suppo rtive o f a nd a c tive in lia ising with NSPCC, fa mily a nd sc ho o l to c o o rdina te a ppo intme nts the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Pr e liminar y findings 3 ate gie s : • F amily attac hme nt str • T urb o : Dp Ul(a ) se lf l&tr(dp,dn) Bro (dn) PE N A4/ 6 • F a the r: (Dp) Ul(dpl) son→F re j se lf (p) b la me o the rs We sle y (ds) ma ny tr(p) re j b y F A1C+ • Mo the r: Dp Ul(a ) se lf, T urb o l&tr(dx,dp ,dn) We sle y tr(dp) b ully, F C (p&dp) CSA (dn) PE N A7 F the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Pr e liminar y findings 4 itic a l c a use of dysfunc tion : • F F F & c r • Re je c tio n b y pa re nts le a ding to de pre ssio n in a ll fa mily me mb e rs, de lusio na l ide a liza tio n b y mo the r o f he r ne g le c tful fa the r, fe ig ne d he lple ssne ss b y fa the r, a nd c o mpulsive c o mplia nc e a nd se lf-re lia nc e b y T urb o who se e ks to c a re fo r his dise ng a g e d mo the r. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Pr e liminar y findings 5 Unspoke n and unspe akable : • • I c o nside r it po ssib le , e ve n like ly, tha t We sle y’ s de a th wa s fro m suic ide . I re c o g nize tha t no o ne ha s me ntio ne d suic ide (fro m so c ia l c a re o r the fa mily). T urb o sa ys no o ne ta lks a b o ut We sle y’ s de a th a t ho me . Sure ly no o ne did in the Pa re nts I nte rvie w with the so c ia l wo rke r. But e ve ryo ne spo ke o f it in the ir o wn pe rso na l inte rvie w. I f the re is an ide a that We sle y mig ht have c o mmitte d suic ide , it make s se nse in this family that no o ne wo uld disc uss it b e c ause it wo uld b e to o painful and it mig ht trig g e r the ne xt suic ide . the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Comme ntar y on c hildr e n’s se r vic e s involve me nt • Ba se d o n the Pa re nts I nte rvie w, the pa re nts a re c o mplia nt with So c ia l Se rvic e s, b ut ha ve no t impro ve d in the ir c hild-re a ring . • …up to no w, e ithe r the pro b le m ha s no t b e e n unde rsto o d pro pe rly o r the se rvic e s o ffe re d we re ina ppro pria te fo r the fa mily o r b o th. the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Inte gr ation & F e e dbac k • Gue ss wha t? T hing s didn’t g o to pla n! • Ca se disc ussio ns (inc luding DMM ma te ria l) will ta ke pla c e e a rly July. • I nte g ra te d re po rt to b e pro duc e d mid- la te July • F e e db a c k to b e o b ta ine d in writing a nd in pe rso n fro m pro fe ssio na ls a nd fa mily a s pa rt o f fina l re vie w me e ting the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
What c an this pilot c ontr ibute to the DMM? • Pro vide e vide nc e a s to ho w b e ne fic ia l the DMM c a n b e in unde rsta nding the pa thwa y to a nd c o nte xt a ro und ha rmful se xua l b e ha vio ur • Hig hlig ht whe re to fo c us inte rve ntio n fo r the yo ung pe rso n a nd the ir fa mily • I ntro duc e a n a g re e d fo rm o f la ng ua g e fo r e a c h c a se ne two rk fo r de sc rib ing a nd func tio na lly a na lysing a tta c hme nt b e ha vio ur. • I ntro duc e multiple re fe rring a g e nc ie s to the DMM • Pro vide a n e vide nc e b a se re lia b le e no ug h fo r sma ll sc a le re se a rc h in the future …? the inte rna tio na l a sso c ia tio n fo r the stud y o f a tta c hme nt
Be rtino ro , 2008 Camb ridg e , 2010 T o download pr ogr am mate r ials, c lic k he r e https:/ / www.ia sa - dmm.org / ia sa - c onfe re nc e / F rankfurt, 2012 Miami, 2015
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