Misinterpreting trauma: why young people fall through the cracks when it comes to serious violence

Jessica Lumley, Senior Analyst

Wednesday 14 October 2020


The violent assault of a young person by one of their peers is a horrific event. These tragic incidents, whilst still rare, cause enormous distress and alarm, increasing the fear of youth violence across all sections of society.

But are we learning the true lessons of these tragedies in order to prevent young people becoming victims or perpetrators of serious youth violence in the future? What lessons can we learn from those who work with the most vulnerable young people experiencing serious violence?


As policymakers, our understanding of these vulnerable young people, their behaviours, backgrounds, and the journeys that led them to violence, are frequently still tainted by myths, stereotypes, and fear. Moreover, our research shows that these misconceptions can have devastating impacts on the available support and services designed to divert these young people away from violence. All too frequently, visible vulnerabilities are being missed or discounted whilst expressions of trauma are taken as rudeness, apathy, or impertinence, and in some cases have been used to preclude the young person from support all together.


Inspired by our research programme into the drivers of serious violence, funded by the Dawes Trust, we spoke to Redthread, a London-based charity which runs a Youth Violence Intervention Programme in hospital emergency departments, about the young people they worked with in the last year.[1]


The data and case studies[2] they provided paint a vivid picture of the profile and circumstances of young people caught up in violence: a diverse group of individuals who seem to be united only by the level of violence that surrounds them — and by having been let down by a safeguarding response whose early warning system isn’t working.


The stories of these young people defy easy definitions or solutions. Most of all they show how an understanding of serious youth violence cannot be divorced from an understanding of domestic abuse, mental health, exploitation, and deprivation. Their experiences with statutory services show how a strict separation of victim and perpetrator, of the harmed and the harmful, is still widespread and completely untenable. Our engagement with Redthread has also shown us the power of a trauma-focused perspective when approaching these young people. It has demonstrated that when the impact of their adverse experiences is truly recognised, more appropriate and effective interventions can be delivered.


Unfortunately, we are now in a world which exacerbates both the complexities in these young people's lives which draw them to violence, and weaknesses in the safeguarding system designed to protect them. For vulnerable young people on the periphery of serious violence, COVID-19 and the fallout will make things worse, further eroding their protective factors, and putting even more strain on the social safety net designed to prevent young people from falling deeper into cycles of harm.[3]



A profile of the victims of serious youth violence in London



Repeated and visible incidents of violence are being overlooked, misinterpreted, or treated in isolation


As the above data shows, one thing that seems to unite the cohort of young people engaged with Redthread for a longer period is the shocking level of violence that surrounds them.


Case study 1:


A young man was referred to Redthread after suffering multiple stab wounds. He had been released from prison only three days previous to the attempt on his life, he had no access to secure housing on his release, which meant the young person was homeless when he was attacked. After slow and sustained engagement with a Redthread caseworker, they were able to determine that the young man had a severe history with domestic abuse. From the age of 11, he experienced his mother being hospitalised by his stepfather more than once. He also reported suffering abuse himself. At no point was the school able to pick up on the signs of abuse. No child protection plan was initiated after his mother was hospitalised. By 15 he was in custody, three days after his release from prison he was nearly killed. On his closing assessment, the case worker reports him saying that it wasn’t that people were not aware of his suffering, but that they were not asking the right questions and he was not ready to give the right answers. For the case worker, this demonstrates that a child or vulnerable adult must give the right answers to elicit the support needed to protect them, and without this systems literacy a traumatised young person is frequently left to navigate their way through the support system alone.


This raises the question of how these persistent incidents of violence - that often define the stories of these young people - are being repeatedly missed by services. Our research suggests these children often remain hidden within siloed support services and that the social service system is not currently equipped - either in terms of resources or capability - to deal with the complex behaviours of a traumatised child. Given the emerging evidence which suggests that domestic abuse is on the rise since COVID-19[4], services need to be prepared now more than ever to read the signs and engage effectively. Or we risk losing even more young people between the growing cracks of the safeguarding system.



Overly prescriptive thresholds to support are preventing early identification of risk

Young people come to Redthread’s attention once they have been admitted to hospital, usually as a victim of serious violence, often with knife or gun wounds. As Crest’s previous research highlighted, these high-harm offences are the tip of the iceberg, the most visible manifestation of the problem. Case studies and data recorded by charities and agencies indicate a complex landscape of exploitation, vulnerability and a myriad of expressions of violence that goes beyond the injuries often associated with youth violence.


  • 30 per cent of the cohort with available risk data had a confirmed history of neglect and/or abuse, and as these are only the instances of abuse that had been verified, the real figure is likely to be significantly higher.

  • Domestic abuse and exploitation was the second most common reason for referral after assault, and the proportion becomes even larger (66 per cent) for female patients.

  • Mental health-related injuries were the third most frequently cited reason for the young person’s presentation at hospital in the 2019-2020 cohort. In a recent report, Redthread explained how they had seen an increase in the number of referrals of young people needing support for mental health in the COVID-19 period. And that in the Midlands particularly, they had seen an increase in self-harm among young men.


Case study 2:


A teenage girl presented at an emergency department with several severely broken bones. The Redthread team sought engagement and quickly discovered the injuries had come from riding in a stolen car with her much older gang-affiliated boyfriend. Beyond that, this boyfriend had been physically abusive and had criminally exploited her to conceal drugs and weapons. She went on to explain how she was always in trap houses whilst under the age of 16, and whilst her male counterparts were predictably cautioned and searched, she was always overlooked. Over time and with reflection, she began to be saddened by this, especially because she was being threatened and was scared herself, and nobody had taken the time to check on her. At school, she wasn’t counted as a missing child despite going missing for weeks, the caseworker reported that they did not seem concerned by her absence and treated this as a choice made freely by the child. Back even further in time, at home, she suffered a bereavement of a parental figure at a young age and in a particularly violent way, yet no protection plan or social worker had been put in place. This girl had a perfect storm of risk factors and vulnerabilities, but was just never seen. Eventually, through hard work and sustained advocacy, the case worker was able to move her to a safe location outside of London. But this was only after years of harm and exploitation that were preventable if action had been taken earlier in this story.


Now, more than ever, it is essential that the different ways in which young people experience violence and the myriad of ways this manifests in their behaviour are understood by any professional who engages with them. We are facing a potential mental health crisis as a result of the pandemic, and children will not be immune. Combined with the implications of an economic recession and mass joblessness as a pull for serious violence, and the loss of school as a protective factor, vulnerable young people face more risk and types of risk than ever.


A better recognition of the variety of the types of violence these young people have suffered will lead to more effective, earlier interventions. Expecting a young person to fit the stylised image of a typically troubled youth or exploited victim leads to mistakes. Focusing on prescriptive thresholds for intervention will only allow action too late in the stories of these young people.



Victims or perpetrators? Stereotypes and stylised images of victimhood are acting as barriers to support for vulnerable young people

Redthread’s data shows that the true profile of youth violence in London is neither a perfect exploited victim caught in the wrong crowd and devoid of agency. Nor the stylised image of a criminalised youth - vicious, gang-affiliated, alien from the children we know, and doomed from the start. Yet, our research shows that these kinds of biases are still acting as barriers to young people receiving support and meaningful intervention.


Case study 3:


A young man was referred to Redthread after suffering a stabbing injury. He was a chronic drinker and had been since a young teen, he was NEET, in insecure housing and had an unstable family home. During his engagement with Redthread, his brother was also stabbed. This young person has a criminal history for an unrelated crime. At the hospital, the young man was volatile and refusing to engage. His Redthread caseworkers believe he was feeling stigmatised by staff, they sought to break down these barriers with small gestures of respect and kindness, like a handshake. He begins to open up gradually; he wants to work, he wants to cut his drinking, he has ambitions. The young man explains that one of the key factors which prevented him from accessing or asking for help was the recent transition away from the youth justice system into the adult probation service. Whereas previously his transport was paid for, his probation officer was empathetic, and engagement was encouraged, now he is on a short leash, he can’t afford the travel, and nobody has explained this transition to him. He hasn’t had the ability to articulate this to anybody but his Redthread caseworker, his probation officer thinks he’s absconding and is considering stronger action. Fortunately, Redthread was able to prevent his return to custody by acting as the communicator between probation and the young person. He began attending his probation meetings again. Redthread were also able to find him secure housing.


The young people that Redthread work with are often vulnerable in complex and multifaceted ways, they live divergent and complex lives and they are frequently surrounded by violence in a multitude of forms. Some consider themselves to be victims and some resist the label, some have been known to services for many years and others have only just emerged in a hospital bed. This is a group of young people who seem to defy stereotyping, whose complex needs manifest themselves in a spectrum of behaviours which cannot be neatly characterised and quickly understood. For those in the field, this will not be new information. Yet a striking similarity in the stories of these young people is the repeated failures of the services that they have interacted with before crisis point to treat them as severely vulnerable. Frequently, we were told, these young people had not presented themselves as a conventional victim so have been presumed to be an architect of their own exploitation. Trauma is perceived as flippancy, coping mechanisms as a lack of respect, victims are treated as perpetrators (and some are perpetrators), and signs of grooming are still being taken as lifestyle choices made freely by the young person.


Case study 4:


A young teenage girl presented at the hospital after an incident of group sexual violence. She was in mainstream education at the time of the incident. Afterwards, the police told her that the school was unsafe for her because the perpetrators had associates that attended. The school perceived her as the risk, and actively fought for her not to return. The girl was out of education for almost a year. The Redthread case worker also found several similar incidents in this child’s story, in which professionals had considered her behaviour sufficiently adult to preclude her from intervention and support. In one instance, an officer had reported being ‘flippant’ with the recording of her rape because of her ‘street awareness’. After her hospital visit, the girl was frequently going missing for long periods of time, the police found it unnecessary for her mother to record this with them on every missing incident. Despite clear signs of CCE and possibly county lines, social care was extremely reluctant to complete an NRM for her, doing so after significant pressure from Redthread. Her parents had been poorly engaged in the process of their child’s safeguarding, there were historic reports of domestic abuse when, aged 11, she came to school with injuries. The girl was moved to another country by her parents whilst Redthread was still engaging with her.


Whilst challenging this normative perception of what a ‘real victim’ looks like is vital for all services, this must be contextualised with an understanding of the magnitude of the demand placed on the children’s service system and the lack of resources available to meet it.


There is a large amount of complex and unmet need from vulnerable young people, and this is likely to grow. In a previous report Crest estimated that as many as 5 per cent of children aged 10-17 may be at risk of serious violence, and there seems to be a growing consensus that COVID-19 will accelerate the conditions under which we expect vulnerabilities and violence to thrive.


The increased demand placed on social services combined with years of budget cuts has led to a focus on meeting statutory obligations often at crisis point and a consequential reorientation of budgets. For instance, spending on the 80,000 looked after children now represents half of all spending on all children’s services,[5] meaning that essential early intervention services are slashed, and a child only gets support when they are at the point of crisis. This goes some way to explaining how over two thirds of the high-risk cohort engaged with Redthread were already known to statutory services at the time of their injury, yet no intervention had successfully taken place.


This resource/demand imbalance is likely to worsen with a retrenchment of public services and soaring demand. The findings above attest to the disastrous impact of children being outside of mainstream education: most children are only going back to school now for the first time since March. Quite apart from the growing threat of the ‘attainment gap' for disadvantaged students, schools are positioned to be a key reporter of abuse, a safer place for those with troubled homes, and an essential focus point to keep children away from exploitation.


Domestic abuse, mental ill-health, poverty and joblessness are all on the rise, and expected to keep rising, whilst at the same time an economic recession on a scale we cannot predict looms over us. The safeguarding sector wasn’t close to full strength going into the pandemic. Now, crippled by years of austerity, it will be expected to deal with the complexities of the new booming demand in a way our research has shown it incapable of doing to this point.



So what can be done?

First and foremost we need a better understanding and appreciation of the drivers of serious violence, how they interact and manifest in the behaviour of those swept up in it, and how to take concrete actions to disrupt them. It is only with this knowledge that meaningful investments into the safeguarding system can be made. This is the intention of Crest’s upcoming research on serious violence and vulnerabilities in which we will seek to look beyond the prescriptive labels like victims, perpetrators, exploited, and criminals, to understand the true picture of who is involved in serious violence in the UK and what led them there.


This knowledge and understanding needs to then be built into how public services both recognise trauma-related behaviour and develop the necessary interventions to draw young people out of the cycles of violence. This means understanding the different behaviours that can emerge from a vulnerable young person as expressions of trauma rather than displays of impertinence, apathy, or rudeness. Redthread’s trauma-informed approach is a good example of this, which facilitates a more honest assessment of needs so that better interventions can be designed. Serious youth violence and the exploitation that goes with it present significant and complex challenges to our already overburdened safeguarding system. Combined with the fact that all of the indicators suggest we are facing the biggest challenge to safeguarding young people that most of us will see in our lifetimes - without deep changes at strategic, policy and operational levels, the vulnerable will be the first casualties.


In the third of a series of five reports commissioned by the Dawes Trust on violence, Crest are considering the role of vulnerability in driving serious youth violence. Conducting deep dives in two local authorities, we will seek to understand how traumatic early life experiences create greater vulnerability for involvement in violent incidents, identify the opportunities for intervention, and speak to those working with vulnerable adolescents, to explore which interventions will have the greatest impact and how they can be targeted and resourced.

How Redthread works with young people

Navigators

By providing a source of independent support and advocacy, Redthread are able to listen to and respond to the young people’s hopes and needs, helping them to navigate services, making positive changes that may seem modest, such as finding safe and secure accommodation, yet reducing the risks these young people face, giving them the chance to live a better life free from the continual threat of violence.


A case worker Crest spoke to described their role as ‘scaffolding’ - connecting the various statutory services and support available to the young person, allowing them to take control of their lives and move forward.


Trauma-informed approach

Redthread adopts a trauma-informed approach to their engagement with young people. This means understanding and responding to the effects of trauma, including the ways it can manifest in the young person's behaviour, and ensuring the safety and security of the young person is at the heart of what they do.


One part of this, that stood out in our interviews with Redthread, was the fact that they never close the door to a young person, there is no three-strikes policy to their support.


References

[1] March 2019-March 2020

[2] Redthread provided data on 479 young people seen by Redthread at five London trauma centres in 2019/20, as well as a smaller cut of the data containing risk level information on 57 of these young people and a series of case studies.

[3] https://www.ippr.org/blog/making-the-vulnerable-visible

[4] https://cep.lse.ac.uk/pubs/download/cp578.pdf

[5] https://publications.parliament.uk/pa/cm201719/cmselect/cmcomloc/1638/1638.pdf

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