Research led to breakthrough for recovery

Research led to breakthrough for recovery of severely maltreated, vulnerable children

A set of psychiatric scales designed to measure mental health difficulties experienced by severely maltreated children is creating new possibilities for treatment and support around the world.

The Assessment Checklist Series is a group of psychiatric rating scales that University of Canterbury School of Health Sciences Associate Professor Michael Tarren-Sweeney developed to measure a range of mental health problems experienced by maltreated children, which are otherwise fairly uncommon among children.

The series is an important innovation for the mental health assessment of maltreated children, children in care, and children adopted from care. This innovation led to an important breakthrough in the delivery of mental health care for vulnerable children in New Zealand and abroad, where the measures have received acclaim.

No other groups of children and young people in the developed world are more socially or developmentally disadvantaged than children and young people who reside in court-ordered alternate care, and those who are subsequently adopted from care.

Assoc Prof Tarren-Sweeney says surveys have consistently found that a child in care is more likely than not to have psychological difficulties of sufficient scale or severity to require mental health services, regardless of which country they reside in.

“Many of these children have complex mental health problems that are related to both their attachment development and also to trauma. It’s really about identifying and understanding the particular kinds of psychopathology that these very disadvantaged children have,” he says.

The measures were originally developed for use in research, but have since been standardised and validated for use in the field as clinical assessment and screening instruments. They are restricted to use by appropriately qualified and supervised clinicians, or relevant clinical services.

To maximise their adoption and impact in the field the measures are not sold commercially but are distributed free-of-charge to registered clinicians and services.

Several hundred clinicians and clinical agencies from a range of countries are licenced to use the measures. The measures have also become commonplace in research examining child and adolescent mental health, being used in over 30 published studies.

Supporting carers at the core of recovery

Carers, not psychologists, are central to the recovery of severely maltreated children, he says.

“The reason why caregivers are so important is because you can’t just take a child with these kind of difficulties, sit them in a therapy room, and fix the problems through individual psychotherapy.

“Because these children’s difficulties are quite difficult for carers to manage, it can often feel as though the child is rejecting of them. If foster parents, or adoptive parents, don’t understand what’s happening they can misinterpret and can take it personally,” he says.

“This is what leads to a lot of disruptions and breakdowns in placements. We know from very good research, as every placement breakdown occurs, the effects are bi-directional. It’s not just that the children’s problems bring on placement breakdown, we know the breakdown also causes the children’s problems to get worse. It becomes a bit of a vicious circle. For many children if we don’t arrest this they eventually end up living in residential care, not able to live with families, and their prospects into adulthood are very grim.

“The central key to their recovery is supporting their carers and explaining to their carers why the children do this. Then they slowly do recover over a very long period of time, if the carers are supported properly.”

He says that the connection made with severely maltreated children in need of care continues to be at the core of his motivation.

“Here is a child who was born into the world just like you or I, and this [psychopathology] is what happens to children, when bad stuff happens to them. You feel a connection, you don’t feel you want to push this child away, you want to help that child.”

Assoc Prof Tarren-Sweeney was presented with the UC Innovation Award 2016 in December. The Innovation Medal is awarded by the University Council for excellence in transforming knowledge or ideas so they are adopted by the wider community in ways that contribute beneficial value. It is the University’s highest recognition of an outstanding innovator.

Assoc Prof Tarren-Sweeney has also been instrumental in developing UC’s Child and Family Psychology programme. The programme has flourished and remains one of the highest quality and employable degrees on offer at UC.

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