evidence-based interventions to work effectively …...portsmouth city council 2 putting people...

PACE+ Approach:

Evidence-based

interventions to work

effectively with children

and young people with

SEMH Needs

Ian Hunkin

Delta Education Trust

Quality Relationships

Putting People FirstPortsmouth City Council 2

Aims:

A whistle-stop introduction to the key messages from

research regarding what works with children and young people

who have experienced relational trauma.

To have the opportunity to start to reflect on your own practice

with regard to these key messages (reassurance and ideally

action(s) to further develop your practice).

To be signposted to further information.

PACE+ Approach:

TRUST SAFETY

LEARNING


Relationship Trauma Recovery

Mainly focusing on the work of the following wonderful people:

Dan Hughes

Kim Golding

Louise Bomber

Jon Baylin

Stephen Porges

Ross Greene

Stuart Ablon

Karen Treisman

Bruce Perry

David Taransaund

Daniel Goleman

Shaun Allison

Andy Tharby

Carol Dweck

Brene Brown

Jonny Matthew

https://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwipw4mVn5DgAhWJkxQKHd3JCE4QjRx6BAgBEAU&url=https://www.goodreads.com/book/show/3335052-lost-at-school&psig=AOvVaw13ijSPOVQGtjki5CZ3nJtl&ust=1548756876530686

Putting People FirstPortsmouth City Council

Key messages from this session

Children and young people who have experienced relational trauma often have

blocked-trust and, therefore, try to control others rather than having reciprocal

relationships.

SEMH Needs are in reality relationship difficulties.

Correction with connection based on the 4Rs (Regulate, Relate, Reflect and

Repair) will be more effective than traditional behaviour management approaches.

Use of the PACE Approach overcomes blocked-trust to enable children and

young people to feel safe and, therefore, be open to learning.

‘Relational trauma requires relational repair.’ Karen Treisman

5

Changing the lives of

children and young

people who have

experienced relational

trauma

Use of the PACE

Approach by key adults

to build a trusting

relationship

Teaching the social and

emotional skills not yet

learned


The Success Cycle

Improved

Self-Image

Small Steps of Success

Positive Attitude

Success Shared, Celebrated and

Reinforced

Experience of Success

Note: Success breeds success

Self-E

steem,

Relatio

nsh

ips an

d

Resilien

ce


The Failure Cycle

Reduced confidence to try out new

skills to solve problems

Limited range of skills

Increasingly negative self-image

Situation requiring

skill(s) which are not yet learned

Attempt to get needs met with limited

success and frequent failure

Self-E

steem,

Relatio

nsh

ips an

d

Resilien

ce


The Failure Cycle

Unfortunately children and young people with SEMH Needs often get stuck in a cycle of failure.

It is my view that to support children and young people to break into the success cycle it is helpful to start with the following mindset:

“Children are invariably trying to solve a problem rather than be one. Their solutions are often misguided because their conception of the problem is faulty, or because their skills leave much to be desired (or both).”

Martin Herbert

Therefore our task becomes to teach young people the skills to be able to solve their own problems and get their own needs met in a positive way.


https://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwi08N7AjZPhAhWL34UKHc30CDcQjRx6BAgBEAU&url=https://www.amazon.co.uk/Boy-Built-Wall-Around-Himself/dp/1849056838&psig=AOvVaw0hhwWyACnsyPwb0V2CZBJb&ust=1553253205179925


Relational Trauma: The impact of ACEs

and Toxic Stress

Adverse Childhood Experiences (ACEs) including abuse, neglect,

domestic violence and significant parental adversity are sadly more

common than we probably realise:

Only 33% of us have no ACEs

>40% of us have 2 or more ACEs

16% of us have 4 or more ACEs

ACEs correlate with a number of negative life outcomes:

Mental health difficulties

Health difficulties

Behaviour and relational difficulties

Repeated stress activation (from adaptive and life saving to maladaptive

and health damaging) significantly impacts on child development

The good news is that research has clearly identified the most significant

buffer to ACEs and this is:

Safe, stable and nurturing relationships (second chance learning).

11


Children and young people who have experienced relational

trauma additionally have difficulties with:

Reduced trust in adults to care for them

Trying to be self-reliant

Gaining control of the emotions and behaviours of others

Staying hypervigilant for threat – proactive self-defence and focus on safety

In survival mode i.e. defensiveness (fight/flight or freeze) rather than being open and engaged

Blocking the social pain of rejection and also social joy and comfort

Negativity bias

‘Sociability light’ – quickly befriending strangers and avoiding closeness

Titrating closeness – just close enough for protection from danger and not for comfort and joy

Inability to respond flexibly or to manage transitions

Self-soothing

Self-provisioning

Competing with siblings and peers

Sweat free lying – creating a version of reality they need to survive

Hiding his/her inner life (not having the words to describe what s/he thinks, feels and wants – “I

don’t know”).

Suppressing vulnerable emotions resulting in times of being overwhelmed by dysregulated emotion

Self-image of being bad

Fear of not being good enough (toxic levels of shame)

Immature relationship skills (social and emotional skills)

12


‘Relational trauma requires relational repair.’

Karen Treisman

13


children and young

people who have


trauma

Use of the PACE

Approach by key

adults to build a

trusting relationship


emotional skills not

yet learned

‘Relationships are the vehicles for social and

emotional growth.’

David Taransaud


Rebuilding Trust and Connection: The good

news is we can make a difference

‘Relational trauma requires relational repair.’

Karen Treisman

We need to overcome Blocked Trust and Blocked Care.

We need to develop Attachment and, in particular, reciprocal influence.

The use of the PACE Approach to overcome Blocked Trust and form

Attachment:

• Playfulness

• Acceptance

• Curiosity

• Empathy

14


Adapting the PACE Approach for use in Schools

The PACE Approach was developed by Dan Hughes. Dan is a Clinical

Psychologist specialising in child abuse, neglect, attachment, foster care and

adoption.

The evidence base for the PACE Approach comes from research regarding

developmental trauma, attachment, inter-subjectivity (reciprocal relationships),

interpersonal neurobiology and child development.

The PACE Approach has been developed for foster carers and adoptive parents

and requires some adaptations to be used by key adults in an education setting.

We have done exactly this at The Harbour School and received praise from (see

http://theharbourschoolportsmouth.org/):

Louise Bomber

Challenge Partners

Ofsted

15

http://theharbourschoolportsmouth.org/


Intersubjectivity

An intersubjective

relationship is reciprocal:

‘I influence you and I am

open to your influence.’

Serve and return

16


Dan Hughes’ Summary of PACE

Playfulness: Light, hopeful, open and spontaneous [especially

the non-verbal elements to communicate safety].

Acceptance: Unconditionally directed at all of the experience of

the other [finding ways of demonstrating that s/he is worthwhile

and wanted including correction being carried out while

maintaining connection].

Curiosity: Non-judgemental, not-knowing, active interest in the

others experience [curiosity leads to reflection and learning –

solving problems collaboratively].

Empathy: Felt sense of the other; actively experienced and

communicated [when someone understands you it creates a

strong connection].

17


Use of the PACE Approach by key adults to

build a trusting relationship

“We have to wear down children’s

mistrust of us overtime by adopting a

PACE Approach. Therefore moving

from mistrust to maybe and eventually

to trust.”

Dan Hughes

“We need to convince the primitive

parts of the child’s brain that we are

safe through providing repeated

messages of safety through our

interactions. We need to be Amygdala

Whisperers.”

Jon Baylin

18


‘Every interaction is an intervention.’

Karen Treisman in her TED Talk: Good relationships are key to healing trauma

Brene Brown describes building trust as marbles in a jar.

19


One of my favourite recent ‘PACEful’ interactions

Ian: “How was your morning? Did Jamie fall in again?”

Child: “You’re weird.”

Ian “Thank you.”

Child: “It’s not a good thing.”

Both: Laughter

Mistrust Maybe Trust

20


Helping the child or young person to rebuild trust.

Activity:

• What actions do you take to

help the children or young

people in your care to build a

trusting relationship?

• In particular, how do you use

the PACE Approach to

overcome blocked trust?

21


‘It ain’t what you do. It’s the way that you do it.’

.………….. and …………….

22

What about when it goes wrong?


What about when it goes wrong?

Carol Dweck encourages us when we are next in a

position of disciplining a student to consider the

message we’re sending:

I will judge and punish you?

Or

I will help you to think and learn?


Judge and punish or help to think and learn?

Judge and punish Help to think and learn

1 2 3 4 5 6 7 8 9 10

▪ What do you believe is the best balance from 1 to 10?

▪ What does research tell us works?

▪ What do we do in reality?

24


The Failure Cycle

Unfortunately children and young people with SEMH Needs often get stuck in a cycle of failure.

It is my view that to support children and young people to break into the success cycle it is helpful to start with the following mindset:

“Children are invariably trying to solve a problem rather than be one. Their solutions are often misguided because their conception of the problem is faulty, or because their skills leave much to be desired (or both).”

Martin Herbert

Therefore our task becomes to teach young people the skills to be able to solve their own problems and get their own needs met in a positive way.


Limitations of a behavioural approach with children and

young people who have experienced relational trauma

Children and young people who have experienced

relational trauma have learned not to trust the

intentions of adults.

They are, therefore, more likely to seek a way to be in

charge with adults than to seek a positive relationship

with them.

Additional challenges of

fear of not being good enough resulting in abandonment

Self-image of being bad

high levels of shame

limited social and emotional skills

fragile emotional regulation ability

Correction of their behaviour is taken very personally

and can result very quickly in highly dysregulated

behaviour.

As a result we need an approach which differs from

the traditional behaviour management approach

based on the 4Rs (correction with connection).

26

Repair

Reason/Reflect

Relate

Regulate


Relate and Reflect: Solving problems

collaboratively

Using The Collaborative Problem Solving

Approach (CPSA):

The 3 step approach of CPSA

1. Empathy or Listening Step (identifying

the child’s concern with them)

2. Define the Problem Step (restating the

child’s concern and stating your concern)

3. Invitation Step (problem solve solutions

together and agree the best way forward)

Repair

Reason/Reflect

Relate

Regulate


Solving problems collaboratively

Using The Collaborative Problem Solving Approach

(CPSA):

▪ Solves problems with students.

▪ This approach used overtime with students

teaches how to solve future problems for

themselves.

▪ Enhances a trusting / helping relationship

▪ Works really well as a key part of a school

behaviour for learning policy and practice.

▪ Matches well with the PACE Approach.


The importance of empathy

‘I can’t overstate the importance of

empathy. Empathy is not just the start

of our helping it is the most important

and effective part of our help.’

Dan Hughes

‘When someone understands you it

creates a strong connection.’

David Taransaud

29


Listen first

“We all need a

good listening to.”

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Listen first

‘The single biggest

problem with

communication is the

illusion that it has taken

place.’

George Bernard Shaw



Listen first

Assumption is the mother

of all fuck ups!

32



Listen to understand

‘Most people don’t listen

with the intent to

understand they listen

with the intent to reply.’

Stephen Covey

33


How to use the Collaborative Problem Solving Approach

A useful tool in your toolkit.

Proactive as well as reactive.

Time allowing.

Repeated overtime.

Sometimes you won’t get beyond the Empathy/Listening Step in a single session / interaction (that’s ok).

Once you’ve agreed a way forward together then support the plan and make time for regular brief 1:1 check ins and potentially teaching new social and emotional skills.

If the child or young person is in the crisis phase of the stress cycle then they will need to be supported to calm down before attempting step 2 and 3 of CPSA.


Helping the child or young person to reflect and

learn.

Activity:

• What actions do you take to

help the children or young

people in your care to reflect

and learn?

• In particular, how do you use

the PACE Approach to

practice the social and


learned?

35


Key messages from this session

Children and young people who have experienced relational trauma often have

blocked-trust and, therefore, try to control others rather than having reciprocal

relationships.

SEMH Needs are in reality relationship difficulties.

Correction with connection based on the 4Rs (Regulate, Relate, Reflect and

Repair) will be more effective than traditional behaviour management approaches.

Use of the PACE Approach overcomes blocked-trust to enable children and

young people to feel safe and, therefore, be open to learning.

‘Relational trauma requires relational repair.’ Karen Treisman

36


children and young

people who have


trauma

Use of the PACE

Approach by key adults

to build a trusting

relationship



learned


A child’s relational trauma refuses to be

silenced.

It is in their behaviour, their relationships

and it blocks their learning.

This is until someone builds a

connection with them, helps them to feel

safe enough to be vulnerable, meets

them where they are at and walks with

them though their difficulties.

37

A final self-review for today:


Signposting to other information

Further training opportunities:

• PACE+ Course in Poole

Google search for the following videos:

• Karen Treisman Good relationships are the key to healing trauma

• Dan Hughes The child who mistrusts good care

• Stuart Ablon Collaborative Problem Solving [either TED Talk or

Flawless Talk]

• Brene Brown RSA Empathy

• Nadine Burke Harris How childhood trauma affects health across a

lifetime


‘Every relationship has the power

to confirm or challenge all that’s

gone before.’

Louise Bomber

39


Finally a word from our young people:

“It’s good to know that someone

actually gives a shit!”

Harbour School learner (2017)

40

evidence-based interventions to work effectively …...portsmouth city council 2 putting people...

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