The Take Two program for abused children
Margarita Frederico is Head of the School of Social Work and Social Policy, La Trobe University, and Principal Consultant, Take Two (firstname.lastname@example.org). Annette Jackson is Research Manager, Take Two (email@example.com) and Carly Black is Senior Research Officer, Take Two (firstname.lastname@example.org). This article is adapted from the Take Two Second Evaluation Report 2004–2005.
A high level of loss and grief is experienced by many of the children seen by Take Two. Intergenerational trauma is common among parents and family networks. Engaging the children and their networks in the therapeutic process helps the children deal with trauma and also helps them to cope with disrupted social attachments and unstable placement with carers.
Take Two is a partnership between Berry Street Victoria; Austin Child and Adolescent Mental Health Service (CAMHS); School of Social Work and Social Policy, La Trobe University; Mindful (Centre for Training and Research in Developmental Health) and the Victorian Aboriginal Child Care Agency (VACCA). The service is funded by DHS.
Take Two has provided a state-wide clinical program since the beginning of 2004. In 2004 and 2005, 585 cases were accepted by Take Two. The average age of clients is 11 to 12 years; however, infant referrals also occur and are welcomed, given the importance of early intervention in cases of abuse and neglect. The gender ratio of referred clients is around 50 per cent. Aboriginal children are over-represented among Take Two clients, a major concern for Take Two and the child protection system.
Children's ability to communicate with others and to learn is at direct risk if they are subjected to sustained trauma and deprivation. Although there has been minimal systematic research into the speech and language deficits of children who have suffered abuse, there is some literature relating to the impact of neglect and deprivation. Children suffering severe neglect may have been inadequately stimulated and insufficiently exposed to speech and comprehension activities. Children living in violent and chaotic home environments may have been explicitly or implicitly discouraged or even forbidden to speak. Lynch and Roberts (1982) observed two groups of physically abused children who demonstrated speech delay: those who were silent and under-achieving in all areas (referred to by Ounsted, Oppenheimer & Lindsay, 1974, as 'frozen watchfulness') and children who were agile and socially competent but silent. These language delays continued to be evident in their follow-up study. The delays were demonstrated by minimal spontaneous chatter and a lack of questioning even while playing.
Coster and Cicchetti (1993) found that maltreated toddlers were lower on all measures of expressive vocabulary, as well as on the total number of different words used, compared with non-maltreated children. These children talked less about their own activities and made fewer references to persons or events outside their immediate situation (Cicchetti, Toth & Bush, 1988).
Neglect can impede a child's resources for growth and change. Examples include poor social skills, low self-esteem, passivity, limited communication, impoverished access to internal and social resources and a lack of expectation that adults will care enough to do anything different (Erickson & Egeland, 2002).
Gilligan (2000) emphasises the importance of school for enhancing resilience in children, both in terms of teachers and peer relationships. He notes that schools can signify membership and belonging to a community, achievement, social relationships and learning. School life may be the only normalising experience for many of these children, especially those in out-of-home care. In relation to young people experiencing adversity, there is evidence supporting the protective value of positive educational experience (Gilligan, 1998), and particularly in relation to young people growing up in care and their subsequent progress (Jackson & Martin, 1998).
La Trobe University's School of Social Work and Social Policy has been engaged as research consultants for Take Two, and their role has included conducting an evaluation of the service, led by Associate Professor Margarita Frederico.
The first stage of the evaluation involved analysis of referral documentation, client activity records, staff journals, program documentation and use of case studies (Frederico, Jackson & Black, 2005). A second stage of the evaluation took place the following year. New data collection methods introduced for the second evaluation include outcome measures, stakeholder surveys, a focus group, analysis of a speech and language draft screening tool, and surveys of Take Two clinicians.
One key outcome measure was a Strengths and Difficulties Questionnaire (SDQ) by Robert Goodman (1999). The SDQ was used to measure emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and pro-social behaviour. Separate versions of the SDQ were given to children aged four to ten years, their parents and carers, and their teachers. Other versions were given to young people aged 11 to 17 years, and to their carers and their teachers. A second outcome measure was the Trauma Symptom Checklist for Children (TSCC) by John Briere (1996). The TSCC is a self-report questionnaire eliciting responses related to thoughts, feelings and behaviours of the participants.
A third measure was the Social Network Map by Elizabeth Tracy and James Whittaker (1990). Participating children were asked to create diagrams to depict their social networks. In general, Take Two children were found to have limited social networks. The children's descriptions of their networks frequently highlight an absence of key parental figures. They also illustrate that family and friends are often seen as close to the child but not necessarily helpful. Siblings were a key presence, as were extended family members, even when they did not live with the child. The role of teachers in offering support was apparent in many of the Social Network Maps.
The trends in all the outcome measures and other feedback analysed so far suggest that Take Two has a positive impact on child wellbeing. The evaluation found that the program has had positive results for children (summarised in Table 40 of the second report (Frederico, Jackson & Black, 2006, p 131).
Clinicians rated overall progress as good or excellent for over half the children and as fair for a third. Children aged between three and nine years were significantly more likely to show good overall progress than older and younger age groups. For example, improvements were evident in children’s management of daily life and in their relationships with family members and peers. Two-thirds of the children who attended school or preschool showed improvement in their functioning at school.
Improvements were noted in schools’ capacity to understand and to respond to most of the children's needs. Overall, however, clinicians reported little improvement in parents' capacity to understand or meet the emotional needs of their children.
A comprehensive database is being built as part of the ongoing evaluation. The database will provide opportunity for further analyses of the characteristics of Take Two children and their families, the consequences of abuse and neglect, and an understanding of 'what works for whom' in relation to therapeutic intervention.
School staff wishing for further details of the service may contact the central office, tel: 03 9429 9266, email email@example.com, or view the Take Two web page on the website of Berry Street.
Briere, J. (1996). Trauma Symptom Checklist for Children: Professional Manual. FL: Psychological Assessment Resources Inc.
Coster, W., & Cicchetti, D. (1993). Research on the communicative development of maltreated children: Clinical implications. Topics in Language Disorders, 13(4), 25–38.
Cicchetti, D., Toth, S., & Bush, M. (1988). Developmental psychopathology and incompetence in childhood: Suggestions for intervention. In B. Lahey & A. Kazdin (Eds.), Advances in clinical child psychology (pp.1–71). New York: Plenum Press.
Erickson, M.F., & Egeland, B. (2002). Child neglect. In J.E.B. Myers, L. Berliner, J. Briere, C.T. Hendix, C. Jenny & T.A. Reid in (Eds.) The APSAC Handbook on Child Maltreatment (2nd ed.). (pp.3-20). Thousand Oaks, CA: Sage Publications.
Frederico, M., Jackson, A., & Black, C. (2005). Reflections on Complexity: The 2004 Summary Evaluation of Take Two. Bundoora, Victoria: School of Social Work and Social Policy, La Trobe University.
Frederico, Jackson, & Black (2006) 'Give Sorrow Words' – Take Two Second Evaluation Report 2004–2005, La Trobe University, Bundoora, Australia.
Gilligan, R. (1998). The importance of schools and teachers in child welfare. Child and Family Social Work, 3(1), 13–25.
Gilligan, R. (2000). Adversity, resilience and young people: the protective value of positive school and spare time experiences. Children & Society, 14, 37–47.
Goodman, R.S. (1999).The extended version of the Strengths and Difficulties Questionnaire. Journal American Academy of Child and Adolescence Psychiatry, 40(11), 1337–1345.
Jackson, S., & Martin, P. (1998). Surviving the care system: education and resilience. Journal of Adolescence, 21(5), 569–583.
Lynch, M., & Roberts, J. (1982). Consequences of Child Abuse. London: Academic Press Inc.
Ounsted, C., Oppenheimer, R. & Lindsay, J. (1974). Aspects of bonding failure: The psychopathology and psychotherapeutic treatment of families of battered children. Developmental Medical Child Neurology, 16,447–456.
Tracy, E., & Whittaker, J. (1990). The Social Network Map: Assessing social support in clinical practice. Families in Society: The Journal of Contemporary Human Services, 171(8), 461–470. (Abstract available in the Families in Society archive of past issues)
Subject HeadingsMental Health