Young person Child G experienced trauma and instability at an early age, including emotional and sexual abuse, and a lack of certainty about who was there to look after her. As a teenager this manifested in mental health issues and substance misuse, leading to her becoming care experienced and subject to sexual exploitation. Learning points include: practitioners to develop an understanding of trauma-informed practice to identify the emotional abuse of adolescents and recognise the impact of fractured attachments; a move from what is wrong with you? to what has happened to you? in responding to children and young people who have experienced abuse and neglect; awareness of the damaging effect of victim blaming and pathologising language; ensure definitions and advice clearly outline the unacceptability of children being physically punished, with practitioners challenging parents who suggest this is an appropriate disciplinary approach; recognise the importance of a child or young persons relationship with one or two trusted professionals; where child sexual exploitation is suspected, assessments should consider risks which emerge from vulnerabilities arising from past abuse, loss and trauma; schools to ensure that any decision to exclude a pupil (subject to a child in need plan or protection plan) is only done after a discussion with the multi-agency team; consider what practitioners and managers can do to support help seeking behaviour in children and young people; and professionals to maintain a questioning and curious response to what they are told or see. Recommendations are embedded in the learning points.
      
 Title:  Learning from the child safeguarding practice review published 23.5.23: moving from ‘what is wrong with you?’ to ‘what has happened to you?’ [Child G]. LSCB: Oxfordshire Safeguarding Children Board Author: Oxfordshire Safeguarding Children Board Date of publication: 2023  This case review report was deposited by the publishing LSCB(s) with the national SCR repository, a partnership between the Association of Independent LSCB Chairs and the NSPCC.  This report is available online via the NSPCC Library Catalogue. Copyright of this report remains with the publishing LSCB(s) listed above.                                 1  Learning from the Child Safeguarding Practice Review published 23.5.23:  Moving from ‘what is wrong with you?’ to ‘what has happened to you?’ Background to review This summary highlights the key learning points from the review for a young person, who experienced trauma and instability at an early age, including experiences of emotional and sexual abuse, and a lack of certainty about who was there to look after or care for her.  As a teenager this manifested in feelings of low self-esteem, mental ill health, self-harm, running away, struggling to manage her emotions at home and at school, and some substance misuse. This led to her becoming care experienced and subject to sexual exploitation and harm in the community. She is described by the professionals that knew her as a warm, caring, mischievous, challenging and funny young person, liked by all those she met. The findings highlight the need for a trauma informed approach characterised by an understanding of the importance of good quality attachments and relationships, where professionals move beyond, “what is wrong with you?” to “what has happened to you?” Key findings   In summary the main issues found in this review were: • The importance of relationships which are kind and caring • Recognition of emotional abuse and emotional neglect and the role that child blaming plays within this • The importance of challenging and addressing victim blaming language in professional practice • Promoting help seeking behaviour in children and young people • Taking physical harm to children and young people seriously          Themes in common with national reviews • The importance of understanding and considering the impact of adverse childhood experiences and fractured attachments on children and adolescents Themes in common with other Oxfordshire reviews: •Early identification of neglect, abuse and exploitation •Understanding behaviour as a means of communicating emotional distress •The need for a trauma informed approach •The importance of a questioning and curious response to what parents tell us •Children are safer when in education •Understanding the potential impact of transitions       2  • Where child sexual exploitation is suspected, assessments need to consider risks which emerge from vulnerabilities arising from past abuse, loss and trauma • Professionals need to maintain a questioning and curious response to what they are told or what they see • Understanding help seeking behaviour  Strengths in practice  • The young person wanted to thank those professionals who worked directly with her, for the care and attention they gave her, for speaking positively about her, and seeing the good in her. She remembers their positivity, and how it made her feel valued and cared for • School sought specialist support for her when she reported feeling unhappy and self-harming Learning Points for practitioners • Develop an understanding of what is meant by ‘trauma informed practice’ and the skills needed to take a trauma informed approach • When working with children and young people where there have been fractured family relationships, consider the impact of poor attachment on the emotional wellbeing and development of the child or young person and how this may present • Listen to what children are telling you directly and indirectly, to better understand the child’s perspective and what their life is like for them • Focus on what can be done to address children and young people’s concerns, as opposed to what cannot be done because of procedural limitations • Reports and records should be written to the child or young person, and written in plain English in a way that the child or young person can understand • Although the law suggests it is acceptable to physically punish children, practitioners should consider the impact of physical abuse on a child’s development, and sense of wellbeing, and the message this gives that it is okay to use physical force and aggression against others. Practitioners should challenge parents who suggest this is an appropriate disciplinary approach Learning points for managers • Schools to ensure that any decision to exclude a pupil (who is subject to a child in need plan or child protection plan) is only done after a discussion with the multi-agency team around the child • Promoting, and improving practice, to support help seeking behaviour in children and young people needs to be a routine part of planning and a focus on feedback and debrief when children and young people tell us about harm and abuse Key messages for the safeguarding system • Ensure that all practitioners are equipped in the context of a trauma informed response: o To identify the emotional abuse of adolescents o Recognise the impact of fractured attachments on children and adolescents       3  o Have the appropriate tools and frameworks to support their practice • Rethink our response to children and young people who have experienced abuse and neglect, to move from “what is wrong with you?” to what has happened to you?” • Raise awareness of dissociative seizures amongst staff, and that they are a well-recognised unconscious response or coping mechanism to emotional trauma  • Practitioners and managers to be aware of the damaging effect of victim blaming and pathologising language, that victim blaming should always be challenged, and records and reports reflect this • Consider what practitioners and managers can do to support help seeking behaviour in children and young people • OSCB to ensure current definitions and advice clearly outline the unacceptability of children being physically punished, and a challenge to parents who suggest this is an appropriate disciplinary approach • Recognise the importance of a child or young person’s relationship with one or two trusted professionals, particularly where there have been poor attachments and parental-child relationships. Prioritise continuity of those relationships wherever possible         Did you know? The following links offer useful further information and guidance: ✓ Communicating with children: A guide for those working with children who have or may have been sexually abused - Centre for expertise on child sexual abuse ✓ Signs and indicators: A template for identifying and recording concerns of child sexual abuse – Centre for expertise on child sexual abuse ✓ Appropriate Language, Child Sexual and/or Criminal Exploitation guidance for professionals – Children’s Society, Victim Support and the NPCC ✓ Getting help: What children tell us about accessing services after sexual abuse – NSPCC ✓ Neglect guidance, tools and resources – OSCB website ✓ Guidance on suspensions and permanent exclusion – Oxfordshire County Council ✓ Overview of permanent exclusion process – Oxfordshire County Council ✓ Trauma informed approaches: What they are and how to introduce them – Margery Infield and Katie Boswell, September 2020 If you do one thing……  Think “what has happened to you?” rather than “what is wrong with you?” Listen to children when they tell you what has happened to them, both directly through verbal communication, and indirectly through help-seeking behaviour. Take a trauma informed approach that:  • recognises the impact, signs and symptoms of trauma in children and young people and that resists re-traumatising them •  Focus on what can be done to empower and support recovery in children and young people who have adverse childhood experiences   