Recovery Support
Early access to appropriate and trauma sensitive recovery support, alongside support to families is critical for many victims of child abuse, which is why recovery is one of the four rooms that make up the Barnahus model. The model is rooted in the UN Convention on the Rights of the Child (UNCRC), including article 39: requiring the promotion of physical and psychological recovery and social integration of children who have been victims of abuse. The article states that recovery should take place in an environment which supports the health, self-respect and dignity of the child.
In Scotland, Children First has been at the forefront of protecting children and supporting families for over 140 years. Our therapeutic, rights-based holistic, trauma sensitive recovery model is grounded in relational, social work practice and ensures every child and family accessing Bairns Hoose receives meaningful support to heal.
The need for a holistic recovery approach
"From early planning, Children First prioritised embedding a safe, caring, authentic relationship at the heart of recovery, and Bairns Hoose, provision." 67
The European Barnahus model has evolved primarily to support child victims and witnesses of child sexual abuse and exploitation. As a consequence, Barnahus recovery support is usually described from a perspective that centres specialist, therapeutic, often, psychological based interventions.
In Scotland, Bairns Hoose is fundamentally different in that it supports child victims and witnesses of all forms of violence, including physical, emotional, sexual, exploitation and neglect and those who have witnessed and experienced domestic abuse. The wide access criteria for Bairns’ Hoose requires us to think differently about the support and recovery needs of children, young people and families, recognising that they will each need a support offer that is tailored to them and their unique experiences.
Children First's recovery model is designed to be needs led and as flexible and adaptable as possible. We believe that it is crucial not to position support as a one size fits all. This acknowledges the multiple layers of trauma and the interweaving factors that can impact how a child presents, their needs, their journey and much more. This also acknowledges that trauma doesn’t happen within a vacuum and that any support offer needs to be mindful and responsive to the wider context and culture.
The Scottish policy and practice context
Children’s rights and recovery are at the core of the design of the Scottish Bairns' Hoose Standards, which set out a common operational and organisational framework for all Bairns' Hooses. The Standards require Joint Investigative Interviews (JIIs) which take place at Bairns Hoose to follow the Scottish Child Interview Model (SCIM) which aims to support recovery and reduce the impact of trauma and re-traumatisation wherever possible. Interviewers should signpost families to relevant support services where possible and request follow-up support, as a core part of delivery of the Scottish Child Interview Model.
The Bairns’ Hoose standards for Scotland (Health Improvement Scotland/ Care Inspectorate, 2023) have therapeutic recovery support as a core component (Standard 9) of the model and highlight children’s right to access mental health support where needed (Standard 8). There is an emphasis on:
- Timely access to assessment and support.
- Options for short, medium and long term support.
- Tailored and specialised support.
- Access to information and a right to inform decision-making.
- Access to therapeutic support that addresses trauma.
- Support that is inclusive of family and carers.
Standard 9 of the Bairns’ Hoose standards aims to ensure that if children and young people or their family need help, they can speak with someone who understands what they are going through.
"The provision of holistic support to help the child’s recovery from abuse and trauma should be understood by the whole team as a core aim of the Bairns’ Hoose. The Bairns’ Hoose should provide a safe therapeutic environment to continue the ongoing assessment of the child’s needs. It should provide access to evidence-based support services including immediate and follow up support on the day." 68
‘You’re able to feel safe, and talk about your problems, and you know that you’re talking to trusted people. I don’t need to feel guilty about what I’m saying, or worried, or anxious... Because I don’t know, it’s just like a feeling of safety, that I know you get when you start speaking to your recovery worker.’ Child, ‘Millie’ 69
Combining rights, advocacy and trauma recovery
Prior to Bairns Hoose the ‘system’ has acted as if a child’s emotional health and wellbeing support needs and the need for their views to be heard and taken into account are distinct. In practice it can be difficult to define when a young person’s need for advocacy starts, when it ends and how this differs from their overall support needs. In recent years well intentioned efforts to enhance support for child victims within the justice system has led to the creation of victim support roles with a narrow responsibility for addressing one aspect of the process, rather than the journey as a whole. An unintended consequence of this siloed approach to system improvement is that the child protection and justice systems require children and young people to speak to a number of different people in order to access support, information and advocacy, at different points in their journey. Young people can be required to access support from different people or organisations based on their age, crime type and which part of the system an advocacy service is designed to augment. The unintended consequence is that young people can be required to repeat elements of their story in multiple contexts. Young people and their families tell us they do not want this and it can cause further trauma.
To enable children and families to access the seamless, coordinated support that they tell us they need, Children First have sought to encompass the full range of support needs of child victims and witnesses within a Bairns Hoose rights, advocacy and trauma recovery worker role. Arriving at this role has been an interactive process, part of the Bairns Hoose test, learn, develop approach. Early Children First roles had generic job titles, for example Bairns Hoose child and family recovery worker with participation work specified within the role.
To ensure that children and families do not have to recount their experiences to multiple workers, Children First designed the Bairns Hoose rights, advocacy and trauma recovery role to provide information and support and guide them through all stages of the child protection and justice processes, from start to finish. A key function of the role is to meet children and families where they are at and design an individual support offer around this.
Integrating recovery support with interviews
The Scottish Child Interview Model aims to support recovery and reduce the impact of trauma and re-traumatisation wherever possible. Interviewers should signpost families to relevant support services where possible and request follow-up support, as a core part of delivery of the Scottish Child Interview Model.
Within the Children First North Strathclyde Bairns Hoose children and their families have access to follow up support as standard. Routine discussions are had with the child, young person and their families about their support needs and where possible they are able to meet support colleagues who can give information about the options for support, minimising bureaucratic referral processes that often serve as either a barrier or delay to support being accessed.
- Meeting the child and their family when they arrive for interview and welcome them.
- Advising the child and their parents or carers about data sharing, storage and privacy notice processes and that their details will be held on the Bairns Hoose information management system to enable work with police, social work and others around decision making and to provide coordinated follow up support without them having to repeat their story.
- Informing the child and their family about how they can give feedback about their experience, including space to share their views on the day of interview.
- Seeking consent to follow up to discuss support post interview. If consent is given, the family are advised that Children First will liaise with interviewers to obtain the key details of their report, so that Children First can provide support without them having to repeat their story.
- Confirming how best to contact the parent or carer within a few days to answer any questions, offer guidance about what happens next, explore expectations for the next steps and offer support with any immediate issues.
- Offering support around issues not linked to legal processes. For example, support around information being shared on social media, within friendship groups or the wider community that could negatively impact the young person and their return to school. Liaison with parents, carers and school to agree arrangements can be helpful.
Children First Recovery model: Key values and principles
The University of Edinburgh, Bairns Hoose Phase Two Evaluation Report (2024) pg.39
identified key values and principles of the Children First Recovery Model. The authors recognised that:
“Children First’s approach to trauma recovery purposefully defines the model broadly and outside a clinical approach. It aims to offer children and their families a flexible service where support centres and responds to children and families’ individual needs. As such, while it may complement evidence-based clinical interventions, it is not a replacement for such approaches for children who may need them (Lorenc et al., 2020, McTavish et al., 2021).
A challenge associated with this non-manualised approach is communicating the model to others, however there is clear evidence from children, families and professionals that the practice is underpinned by clear and consistent values and approaches." 71
The authors identified these as:
- Relationship-based practice: development of consistent trusting relationships at the centre of practice – the means through which young people come to be fully known.
- Child-centred, flexible and responsive: tailoring support to individual needs (how, where, when the child is met and supported and what the focus and approach to the work is) and responsive practice enabled through limited case load size.
- An ecological, systemic approach: committed to recognising and responding to interdependent aspects of children’s lives (families, peer groups, communities and the wider social structures).
- Family inclusive support: acknowledging interdependencies between children’s wellbeing and that of family members.
- Trauma-informed and responsive: able to recognise and respond sensitively to trauma and work to counter re-traumatisation.
- Optimistic and strengths based: recognising children and families as experts in their own lives and maintaining a focus on the future.
- A rights-based approach: promoting children and families right to be part of decision making (participation rights).
- An open-ended support offer: support is not time bound or limited to a set number or type of sessions.
The design of Children First recovery support upholds the Bairns' Hoose standards that state that good relationships and trust between children, families and support workers are critical.
They also highlight that support should take into account the child’s wider context, community assets and support needs of the family, including support already in place, to avoid duplication of services and repeated disclosures.
“CAMHS is more like therapy, but talking to [recovery worker]…that’s someone that’s worked with another child that’s been in the exact same position as me - that feels better, because she’ll know exactly what I’m talking about when I say something… That just means so much.
Child - ‘Sarah’ 70
Children First recovery model diagram (accessible text version below)
Knowing and understanding child and family:
- Time spent
- Persistence
- Consistency
- Demonstrations of care
- Child and family as experts
Fostering safety and stability:
- Building emotional safety
- Building relational safety
- Family work
- Advocacy in regard to physical safety
Tailored support:
- Advocacy
- Therapeutic support
- Planning for the future
- Participation and influencing work
Ways in which Children First provides support to recover
- Children and young people come to the Bairns Hoose for a wide range of different reasons, having experienced different levels and types of harm. An assessment will be undertaken of their support needs, and they will be offered ongoing support, advocacy, and recovery as required.
- Children and young people will be offered therapeutic support that addresses the issues that are important to them. For some this includes support to help them manage suicidal feelings and self-harm.
- Family members, including siblings, will be offered support as appropriate.
- Children and families will be offered information, advice and advocacy to support their views being heard and needs articulated through complex child protection and justice processes.
- Support and advocacy will be offered from the Bairns Hoose itself and at other outreach locations across the localities, taking support to young people based on their preference. Timing, frequency, and duration of support is tailored to the child and families wishes and needs.
- We will liaise with other agencies when other support may be required, e.g. CAMHS.
- Where young people and their families have ongoing contact with other organisations such as ASSIST, Rape Crisis, and Women’s Aid, we ensure that our support is coordinated and does not duplicate or require a young person to repeat their story – support will be streamlined based on the needs and wishes of the young person and their family.
67 Mitchell, M., et. al. (2024) The story so far - North Strathclyde Bairns Hoose Evaluation – Phase two evaluation report. University of Edinburgh. Pg.41
68 Health Improvement Scotland & Care Inspectorate (2023) Bairns’ Hoose Final Standards, pg.54
69 Mitchell, M., et. al. (2024) The story so far - North Strathclyde Bairns Hoose Evaluation – Phase two evaluation report. University of Edinburgh. pg.42
70 Mitchell, M., et. al. (2024) The story so far - North Strathclyde Bairns Hoose Evaluation – Phase two evaluation report. University of Edinburgh. pg.19
71 Mitchell, M., et. al. (2024) The story so far - North Strathclyde Bairns Hoose Evaluation – Phase two evaluation report. University of Edinburgh. pg.39