Words and Pictures

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Words and Pictures

• See Chapter 5 in
• A.Turnell and S.Essex
  Working with Denied child abuse
  the Resolutions approach. OU press 2006
• And article in Context 97 June 2008
• Hiles, Essex, Fox and Luger.

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Resolutions words and picturesHelping to
create a coherent narrative about difficult
events.

• What would you like me to make sure I cover this
  morning?
• Basic Principles and Techniques.
• Brief exercise.
• Recent experiences.
• Questions?

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Entertaining multiple positions
simultaneously, Process leading up to Words and
Pics very important. See book Donnas case
Chapter 4.
Judge He did it
Granma Im confused and worried
Mother Hes my Husband, I dont know what to
think
Worker She should leave him!
Dad Youre sick people Out to destroy me
Like these jugglers you need to be able to
utilise and keep all the positions in play all
the time
The challenge is this often feels like youre
juggling fire
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The Benefit of the Words and Pictures Process
Some adults who, despite having had very
traumatic childhoods about which they can
nevertheless tell coherent stories, are likely
to have securely attached children One
important therapeutic implication of this finding
is that it may be helpful, perhaps even
transforming, to help the family to tell a more
coherent story about its painful
experiences, Including (traumatic events) its
illnesses. John Byng-Hall Toward a
coherent story about illness and loss. in
Multiple Voices 1997.
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Irreverence

• Certain topics are so emotionally laden that
  some people seem to think that systemic ideas do
  not apply in such cases....
• Cecchin, Lane and Ray Irreverence 1992
• We can be over or under organised by topics that
  emotionally overwhelm, how do we find a way that
  includes children and childrens voices.

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This light globe seems faulty A key issue in
Child Protection is how do we create openess
about the concerns.
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This light globe Still seems faulty
but now weve installed a whole new lighting
system!
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No Gratuitous opinions

• Could we leave whether you did it or not to one
  side, up on a shelf so to speak?
• If the dispute was easy to resolve I guess it
  would have happened by now.
• Current research indicates, I can understand from
  the research and literature why they are worried
  but i do hear what you are saying , I have made a
  note of it here.
• Dont be tempted to give a definitive position.

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Words and Pictures

• Explanations for children as to what has happened
  in their family and why they may not be living at
  home, using drawing, play people etc.
• Undertaken with children and their parents and
  often with members of the support network
  present.
• Words and Pictures are the bedrock in creating
  openess which leads the way to an agreed safety
  plan.

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DVD Case Example

• Alex and Kate Smith have two children, Jake 4
  years and Chloe 8 months. Chloe is presented at
  hospital having allegedly been dropped by Alex
  whilst in his sole care. Medical examination
  reveals linear bruising to Chloes cheek, rib
  fractures of different ages and subdural
  haematomas, which the doctors think are
  non-accidental in origin. The family are not
  known to Social Services and the Health Visitor
  reports positively about the parenting and care
  of the children until this time. Jake is placed
  in foster care and Chloe joins him when she is
  allowed to leave hospital. Alex and Kate are
  allowed contact with the children five days per
  week supervised by social workers. The matter is
  put before the Court which has to decide what
  should happen to the children. Further
  assessments reveal no other concerns and both
  parents deny they have injured Chloe.

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Genogram Alex and Kate.
Norman

Sarah
Jim
Kate
Alex
mark
Chloe
Jake
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DVD case example Julia and Gerry

• A pre-school girl from Sunday School (Kelly),
  where Gerry helped as Leader, alleged that Gerry
  had sexually abused her. The matter was not taken
  to court but Social Services substantiated the
  allegations based on the detail of oral abuse in
  the girls report. As a result of this Social
  Services were concerned for the current and
  future safety of Gerry and Julias 3 year old
  daughter Emma. Julias sister Sharon and Julias
  mother have been helpful during the investigation.

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Julia and Gerry Genogram

MGM
Sharon
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Gerry
Julia
36
32
Financial Advisor
Artist Community Projects
Sunday School Teacher
Kelly
CSA Allegation
4
Emma
3
Nursery School Day Care
Social Workers
Church
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Words and Pics exercise

• In threes think of the DVD family with injured
  baby Chloe or little Emma.
• What might you expect someone to say to Jake
  about why he and his sister were going to Foster
  carers for a while?
• What might you expect someone to say to Emma
  about why Daddy is not at home?
• ( Think how you might use age appropriate
  language and some pictures)
• Who might explain to Jake/Emma, how might you
  help them explain?

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Exercise in 3s

• In 3s think what you might want children to know
  about the concerns.
• What might they already know and how?
• Who would you want to talk to the children about
  the concerns, workers, family member?
• What would you want them to say, how much or how
  little to get across the concerns?

Susie Essex 2011
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It isnt easy.

• Children are often not asked what they make of
  what is happening.
• Children are often left out of discussions about
  what is happening and why.
• Adults are often at a loss about how much to say,
  or how little to say, and what words to use.
• By adults I include not just family members but
  also key professionals.
• If we have ideas about what to say how do we take
  family members /carers worries into account.

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Fictitious Case Example for Fabricated or
Induced Illness

• Family Members
• Mother Mari 24 Dual Heritage 2nd Generation
• Father Ralph 32 White UK
• Jodie born Autumn 2006
• Hospital age 1 month Apnoea attack
• age 6 weeks Apnoea attack and rash
• age 3 months rash possible Apnoea
• Previous Child Death Boy Eli age 10 months in
  2005
• New Baby Due Easter 2008

• The Safety Network
• Grandmother dual heritage white UK and black
  British
• Great Uncle Frank and girlfriend Jo (Grandpa died
  2005, white UK)
• Godmother Connie
• Church friends Pastor Mark and Cheryl etc.

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Words and Pictures for Jodi - 1
In 2006, in the Winter, Jodi had a rash on her
face. The doctor came to see Jodi. Grandma Sophie
was there, as Mum had called her because they
were so worried about Jodi.
The doctor gave Mum and Dad a letter, saying
Please take Jodi to Hospital.
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Words and Pictures for Jodi - 2
Jodi went to the Hospital. Mummy told them Jodi
seemed a bit floppy in the night. The doctors
said The rash might be a virus, but we need to
check. Jodi stayed in Hospital.
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Words and Pictures for Jodi - 3
The doctors were worried as this was the third
time in 3 months that Jodi had come to Hospital
since she was born. The doctors talked to
another doctor..they thought the rash might be
because someone had stopped Jodie breathing but
they couldnt be sure.
..then they talked to Social Services and other
people.
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Words and Pictures for Jodi - 4
There was a big meeting - a Case Conference. The
doctor said We are very worried about Jodis
rash. We think she might have been hurt The
Case Conference decided to ask another doctor in
London to see Jodi.
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Words and Pictures for Jodi - 5
In London, Mummy and Daddy said Jodi had one rash
and had been to hospital lots because she was
ill. The doctors seemed to say different things.
Everyone was very worried. The Social Worker
said this is confusing and worrying. I have to
make sure Jodi is safe . We need a Judge to help
sort it out. The Judge said she thought Jodi had
been hurt when mummy was looking after her. She
said she had to be sure Jodi would not be hurt
again.
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DVD clip Words and Pics
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Words and Pictures Processin outline

• Explain the process to parents and their key
  advisors.
• ( Explore these same issues with the other
  parent, kinship system, and significant adults in
  the childs life)
• Offer a first draft of the explanation to parents
  and advisors, and if possible network system.
• Edit refine and agree the final version with
  parents advisors and social services. (CYPS).
  (Pictures agreed either what will be drawn or
  done as part of the draft.)
• Provide the explanation using the words and pics
  document to the children preferably with network
  members.

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Questions for Words and Pictures

• What do you think Sharni makes of what is
  happening?
• What makes you think she thinks that?
• What questions has she asked?
• What difference would it make if she knew a bit
  more about what has been happening?
• What might she have overheard?
• What does she think happened to Asha, why does
  she think she is staying with grandma?

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Words and Pics storyboard First part Keep
Checking

• 1. Begin by briefing statutory child protection
  workers on the process and obtain their
  permission and endorsement to undertake the
  process and commitment to use the words and
  pictures within the looked-after/child protection
  system .

1. Check with the parent or parents about the
   problem (e.g., mental health problem severe
   illness child protection concerns drug or
   alcohol misuse) regarding from their point of
   view what would be most helpful for their
   children to understand about the situation.

3. Explore these same issues with the other
parent, kinship system, and significant
adults in the childs life.
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Second part, First Draft.

• 4. Explore with child/children what they make of
  what is happening, what they already think and
  know, and what they are concerned about. (
  Depending on the circumstances include a parent,
  or both parents and a supporter or childrens
  current carers/ trusted adult from the kinship
  system. For teenagers have a separate session to
  talk through what would work best for them.)
• 5. Draft the explanation utilising the families
  own language and ways of expressing concerns
  wherever possible bearing in mind the familys
  race culture and religion. Link all the above to
  any worries about the children at home, at
  school, with peers ie how the child might be
  expressing some of the worries and their
  confusions.

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Second part cond.

• 5cond.. The explanation should be balanced and
  not solely focused on the concerns/ negative. The
  explanation should be framed with a neutral or
  affirmative beginning and a positive end. The
  explanation should include meaningful positive
  events or aspects of the childs life that fit
  and add to the overall story.
• 6. Present the first draft to the parents.
  Develop and refine the Words ( and Pictures if
  drafted), so that they are comfortable with the
  draft and the explanation reflects what they have
  agreed the child should know.
• 7 Once the parents take ownership of the
  explanation, the next task is to ensure that the
  explanation captures everything the statutory
  agency wants the child to know.

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Third Part.Making sure everyone is on the same
page

• 8. Provide the explanation to child/children with
  their parents, extended family, carers and social
  service workers present. Set Context, use traffic
  lights, think carefully about teenagers.
• 9. Ensure that all other significant extended
  family members and adults in the childs life
  have seen the explanation and will draw upon it
  when they need to talk to the child about the
  problems, their parents difficulties or why they
  are in care.
• Remember no-one finds it easy to know what to
  say, or how much, this document forms the basis
  of all the work. If there are new concerns or
  more positive information comes to light, this
  can be added or included as sessions take place.

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Words and Pics Basic Structure

1. Title to be clear what this is about,
2. Start Pic sets the Context, neutral not too
   worrying,
3. Who is worried,
4. What are they worried about, clear about what the
   worries are this might be the only chance to let
   everyone in the system know the concerns,
5. Who is trying to help and move things forward,
6. End all working together. Positive picture and
   future focussed