Matt Forde, 'The Legacy of Trauma'

At the Harvard Centre for the Developing Child, Professor Jack Shonkoff, a distinguished neuroscientist, argues there should be no greater priority for investment in society’s health than prevention of child maltreatment. The Centre is making the case for a quantum shift in research and development in preventing child maltreatment.

He argues that the best of what we do now is a start, not a solution. When taken to scale, effects of even the best-evidenced programmes reduce to moderate. We need breakthroughs in our understanding with investment comparable to cancer research. Indeed, he argues, if we want to make real headway on that killer, we should focus on child maltreatment.

Childhood adversity is associated with increased risk of health problems and shortens lives. Experiencing multiple or severe traumatic events, such as abuse or neglect, dramatically worsens the odds of suffering adult mental health problems. In adulthood, being abused as a child makes mental health problems more severe. Recent studies show that adults who suffer depression who were maltreated as a child are likely to have more severe symptoms, more likely to suffer recurrence, and less likely to be helped by treatment than those suffering depression who have not been abused as children. Children who are abused often grow up in families where the parents have their own mental health difficulties, with roots in their own experience of childhood adversity and trauma. Serious childhood mental health problems, like post traumatic stress disorder, depression, conduct disorder and attachment disorders, are linked to abuse.

Policies across all of government affect the capacities of parents to strengthen foundations of development: stable, responsive relationships; safe, supportive environments; and healthy nutrition.

Yet child abuse and neglect is a much underdeveloped area of research. A review carried out by the University of Edinburgh for the NSPCC in 2015 found that the funding for such research is very limited across the UK, few universities are involved, a major funder is the NSPCC, government funding is scarce, and much of the research concentrates on the consequences of abuse, or the system, not how to prevent it.

In Europe the starting place common I found was exploration of social policy principles. Value positions - respect for children’s rights, universality, and equality – are common currency. There is strong evidence, not least in the child wellbeing achievements of these countries, that these principles as the most powerful levers we have for improving children’s lives.

While the USA is a leader in research in preventing child maltreatment, in the countries of Northern Europe it is evident that benefits from such learning can best be realised for children. A striking example is found in the results of the trial of Family Nurse Partnership in the Netherlands, in reducing child maltreatment and intimate partner violence. This is in the context where wider social policies are strongly associated with improving child wellbeing.

There is strong desire for greater understanding to reduce the harm to children. This spans research and social policy. In Sweden, Finland, and the Netherlands, I met researchers at the front edge of developing our understanding of child abuse, its prevalence, causes, and how to prevent it. At the University of Leiden, an impressive research group is exploring the genetic and environmental mechanisms underlying the huge harm caused by abuse, uncovering the roots of resilience, why some survive abuse and can bring up their own children safely.

In the USA, meeting with Professor Jennie Noll at Penn State, I found enlightening the thinking behind a new group to research child maltreatment. The Jerry Sandusky child sexual abuse scandal, the ramifications of which are similar to those in the UK following the Jimmy Savile case, set it off. A trusted football coach had over years abused many children, and the behaviour was said to have been an open secret.

Under Professor Noll’s guidance, Penn State’s Network on Child Protection and Well-being is a serious investment to combat child abuse. Its mission is to produce new knowledge, design and test new approaches to the prevention, detection, and treatment of child maltreatment, and translate the results into practice. The Penn State response is a good role model for institutions that have to account for their failings. Instead of ‘damage limitation’, institutions can seek to heal, by making a real investment in contributing to research and action to prevent and treat child abuse.

It seems right to ask whether we could learn from this bold approach in the UK. We are grappling with the huge inquiries into the past extent of organized abuse. These issues have to be faced up to, so that the truth can be known and victim’s stories acknowledged.

But, at the end, the question of how to prevent abuse now and in the future will remain.

Matt Forde is Head of NSPCC Scotland.

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