Ordinary People in Ordinary Places Talking about Violence and Neglect

“How can I help my child to be self confident when I do not feel self confident myself ?”
This is not an intimate conversation between friends. It is not a soul-searching parent in private counselling with a psychologist. It is one of many written questions delivered by a 400 strong audience to the stage of a provincial theatre in North Macedonia. Following dance and comedy, the audience engage with an expert panel on hirtherto taboo themes such as neglect & violence. And you can hear a pin drop.

As with most middle and low income countries, there is little public discussion on childhood adversity. Policy makers rarely prioritise investment to address its lifelong impact and costs. The “Parenting Is Always Learned” campaign has two aims. The first is to introduce the science of brain development to ordinary parents in ordinary places in simple language. The second is to break taboos on family crisis and Adverse Childhood Experiences.

We asked Sasko Kocev, a comedian and actor to moderate the event. We were amazed to the extent this created a conducive environment for discussing a taboo and difficult theme in a non-judgemental way.

It made sense later when we read research in the Power Of Moments by behavioural scientists Chip and Dan Heath. It suggests that laughter creates social bonds and synchronises audience engagement . We are all affected by Adverse Childhood Experiences. Most people have experienced them in their own childhood. Those who haven’t are likely to have their lives entwined with someone who has. Violence and neglect are not a “Them” problem, they are an “Us” problem. Comedy reminds us of our imperfections, at the very least, that we are all a bit broken.

A young dance troupe perform a powerful representation of themes such as alienation and domestic violence. The second half of the event is an interaction between the experts & the audience using anonymous questions.

Adverse Childhood Experiences are as present in North Macedonia as they are anywhere. A World health Organisation supported survey found that 64% of young adults had one adverse trauma in childhood and almost 1 in 10 had four or more. The most common was emotional neglect at 30%. I once asked the entire psychology faculty second grade if the data surprised them. It did not.

A campaign alone will not work. Parenting Is also Learned accompanies reforms of health, education and social protection systems. This includes home nursing visits that promote nurturing caregiving and universal pre-school education.

Often childhood trauma such as emotional neglect is transmitted from generation to generation. It is difficult to talk about neglect as we often have to examine our own behaviour or that of our parents. By acknowledging adversity is often transmitted unintentionally, we can discuss it without judgement. This is essential for breaking taboos and enabling consolidated action on childhood adversity.

The answer to the question posed at the beginning of the article is not easy. How do parents ensure they don’t transmit poor attachment, insecurity or anxiety on to their own children.” But senior British psychologist Peter Fonagy researched the way that being “reflective” prevents such transmission. The more parents become aware and reflective of their own feelings and the way they may impact others, the less likely they are to transmit negative models of care.

And as the name of the campaign suggests, we can learn parenting skills. As the curtains go down and we exit the stage there is a queue of parents and young people seeking to share their experience and ideas. Its 10pm, we have gone on for an hour longer than expected, yet many people don’t want to leave.

As Victor Hugo said, there is nothing more powerful than an idea whose time has come. The idea whose time has come is that we can nurture the first generation to grow without violence and neglect.

“Because I Grew Up In An Orphanage”

On Identity & Being Raised In Care of the State

I wouldn’t need a large abacus to count the number of times my experience as someone raised in care of the state has been well represented in a film. But one fleeting moment in Robert Altman’s 2001 murder mystery Gosford Park, an elegant pre-cursor to Dowton Abbey, nailed it.

During a large and free-flowing dinner table conversation about family, Mr Stockbridge (played by Clive Owen) stunned fellow diners when he answered a question with a simple “because I grew up in an orphanage“. The ensuing silence told more of our story than any scripted dialogue ever could.

Anyone from state care who had to describe their background because of a routine question about childhood in a polite conversation knows that silence. Until very recently and in middle age I still grimaced when such discussions arose at the diplomatic functions I attend with my job. If I am honest about it, at different stages of my life I have felt intrinsic shame, stigma and especially guilt for the discomfort it may cause to others and this has often fed into a deep, internal narrative that I am not really good enough to be here . But I also felt compelled never to hide who I am or where I come from. Being from state care is as important for my identity as being a Belgan or being a Hindu may be to someone else. It is where I spent my formative years, it is what shaped me and I want to be a good role model for kids in care today. It is at my core . I just would rather not talk about it.

6% of UK 18 year olds from state care go to university compared to around 27% of the general population. When I was 18 ( a very long time ago) it felt more like 0%. We were from a minority that was more likely than any other to end up in prison, a gang, trafficked, addicted or die early and very very unlikely to go to university. Unlike other marginalised minorities, we had no underpinning culture, flags or narrative to carry a sense of pride in our identity. I am so proud of the 6% of 18 year olds from care who end up in university today. It is mainly a testimony to their own resilience and brilliance, but also the fact that the system has been somewhat reformed in the past couple of decades. The odds are still stacked against them, they make it through anyway.

Like many of my generation, I left a children’s home aged 16 with a €200 leaving care allowance, a modest bag of life possessions and a complete absence of any form of love or belonging at all.

I have never complained about where I come from. This was the way my life was, it was normal to me. Coming from the bottom 1% of a society where identity was shaped by class and family, and then trying to advance though university & career etc often left me feeling unsteady on my feet and like an outsider or an imposter. I still feel like an outsider today to be honest, but I wouldn’t want to go back and change anything.

There are also things I am proud of. Because I had no parental support at all, I woke up at 4 am on weekends, when the other students were coming back from parties, and ran market stalls in Camden Town, I drove a mini-cab around London late at night and did shifts in an old peoples home and a college kitchen to pay my way through university. I really believed that a university education would help me escape the legacy of my childhood and I would do anything to reach that goal. I remember going to my first day of university, buying my own pens and books with money I had earned and not quite believing that I was lucky enough to be there. I was surrounded by people who seemed to take it all for granted. How much luckier I was then them, that this could feel like such a blessing in my life. I still feel blessed and privileged today.

But then there is love. In state care, one often grows up with this internalised sense of being unloveable, not even by one’s parents. Biologically all children are programmed to seek loving protection and nurture from parents, when it is absent they interpret it as danger. Adults from care backgrounds often have low self esteem, insecure attachment, post-traumatic stress and over-active fight or flight systems. This has a profound impact on your identity and sense of self.

You can strive to be a success on the outside as a young care leaver, but inside there are all these jagged edges and broken parts that, if you are aware of them, you would like to put together again. But because you are trying to escape extreme poverty and have an absence of support networks, you are just thinking about survival. Profound emotional insecurity can be a barrier to the relationships that the research now tells us are the single most most important determinants of both healing from trauma and building the resilience to overcome barriers and get on in life. Often the strategy the subconscious gives us is to separate the left and the right side of the brain-to run on the gas of the cognitive: job and education and forget the oil of love, emotion and belonging. But just like a car, you will break down in the end.

Nobody politically can articulate this. The main political discourses in our society don’t do emotional. They only do economic and power.

The left often argues that a care leaver is a victim of discrimination and poverty. But as Nimco Ali wrote recently about race & gender & being a refugee “The left wants to frame my life experience via the prism of helplessness and victimhood. I am meant to be consumed by all that has happened to me — to long for all that I have lost and wait to be rescued, but I have always refused to do that“. For me, it has taken me most of my adult life to feel really comfortable talking about being from care. But I can be shut down in a moment if someone tries to frame my narrative as a victim, and that often comes from the left.

Economic models from the right make life difficult for already marginalised care leavers. I know this from the rock face because I left care during Thatcherism. And then they argue that if an individual care leaver (actually a tiny fraction) can progress through hard work, then anyone can. But evidently they cannot and do not because the impact of trauma and neglect is very individual and complex and based upon the interaction of experience, resilience & biology. In 2019, policy makers should really know this, we shouldn’t have to explain it. And anyway, as Colin Powell once said, “how can you ask someone to pull themselves up by the bootstraps when they don’t have boots“. Care leavers badly need support networks.

Discrimination, poverty and hard work are high stakes challenges for any care leaver, but the main issue remains love, or the lack of it. There is a broader need for a politics that can talk about love, wellbeing, trauma, violence and hope. The social and emotional drivers of all of our behaviour and decisions. And this makes democratic sense because care leavers are not alone.

Until recently there was a common public perception that childhood trauma, neglect & violence were marginal issues addressed through the care, social work and juvenile justice systems dealing with maybe 1 or 2 % of a given child population. But the World Health Organisation and other bodies have undertaken surveys in multiple countries on general populations which reveal that on average, around 60% of adults in family settings were affected be one serious adverse childhood experience (ACEs) and around 15% by 4 or more. The 15% with 4 or more ACEs, like care leavers are much more likely to have really bad life outcomes in health, crime, education and all aspects of wellbeing. In psychology research, 42% of adults across countries are said to have insecure attachment due to absence or inconsistency of parental love in the first two years of life. Insecure attachment severely affects their ability to have quality relationships. The common perception about the marginality of trauma must have ran counter to people’s lived experience and their ability to articulate it. That is now changing.

I was raised in care of the state. I am neither proud of it or ashamed of it. But I would like to live in a world where future care leavers don’t suffer long silences & superficial victim or bootstraps narratives. Where investments are made to ensure those from public care & others affected by adversity everywhere-can reconnect, build and heal free from shame and public stigma. This would be socially just, fiscally prudent and frankly just plain easier and better for the whole of society.

Stopping childhood adversity from becoming a life sentence

ImpactInsider from UNICEF connect By Benjamin Perks20 March 2015

Even the most hard-nosed economist will now concede investment in good early childhood has the biggest return on public investment.

But what about a reverse argument that failure to invest in prevention of bad early childhood experience is the most costly oversight a government can make?

This is the subject of my recent TedX talk in Podgorica, Montenegro, on the global prevalence of Adverse Childhood Experiences (ACEs) like neglect, abuse and dysfunctional parenting, and how they drive poor public health, low productivity and other costs amongst adult populations.

Despite massive advances in addressing childhood adversity in many high-income countries – globally the issue remains largely taboo, difficult to discuss and emotive. But the field of childhood adversity has been revolutionized through the study of ACEs – here is how it began…

A couple of decades ago in San Diego, public health practitioners baffled by constant patient drop out from obesity programmes decided to probe whether there were any shared underlying factors among those affected. They were astonished to find out that those who dropped out almost all had one thing in common: sexual abuse in childhood.

This begged the question – were there other areas of poor health in adulthood or social outcomes where the people affected had largely been victims of childhood adversity?

What followed in the mid-90s was a longitudinal Adverse Childhood Experiences Study, of more than 17,000-mostly middle-aged and middle-class West-coasters in the US, through a collaboration of Kaiser Permanente clinics and the Centre for Disease Control in Atlanta.

Firstly, the findings revealed the shocking and heart-breaking prevalence of 10 classified types of Adverse Childhood Experiences which were broken down into three areas:
1) Abuse: Sexual, physical, emotional;
2) Neglect: Failure to meet basic physical needs, leaving a child uncared for, or unloved;
3) Household dysfunction: Witnessing, addiction, crime, parent-to-parent violence, mental illness etc.

Respondents were given an “Ace Score” of 1 to 10. Two-thirds of respondents had experienced at least one ACE and 12% of respondents had an Ace Score of 4 or more.

20% had been victims of child sex abuse – a number almost identical to the much later Council of Europe estimate that 1 in 5 European children suffer from sexual violence.

The statistics on all forms of violence also broadly correlate with prevalence levels that can be seen from the global UNICEF report on violence against children: Hidden in Plain Sight.

If researchers were knocked sideways by the shockingly high levels of prevalence, including in middle- and high-income households, they were also astounded to find an almost “dose-response” correlation with high adversity and poor life outcomes, in health, education, addiction and crime throughout the lifecycle.

According to a leading ACE researcher and public health practitioner, Dr Nadine Burke Harris, in California somebody who had experienced 7 of 10 forms of childhood adversity has a 20-year shorter life-expectancy than someone who has experienced none.

It took a different type of research, from the field of neurobiology, to explain why high childhood adversity converted to poor outcomes in adulthood – through the impact of what the Harvard University Centre for the Developing Child has termed ‘Toxic Stress’ upon the physical and brain development of children.

As devastating as all of this is, we now have the knowledge and the science to build a global effort to reduce the impact of childhood adversity and violence against children. If we can reduce the dose of adversity and toxic stress we are not only fulfilling our human rights obligation to protect children, but also potentially ensuring long-term reductions in poor public health, low productivity, high crime etc.

UNICEF works throughout the CEE/CIS region in Regional Knowledge Leadership areas to help governments to simultaneously do three things:
1) Build violence prevention mechanisms, from pre-natal visits and throughout a child’s life cycle;
2) Provide interlocking services of child protection, health, education and justice that will protect the child victim of adversity and help him or her recover; and
3) Break the public taboo on childhood adversity which prevails in almost all of the countries in our region.

In Montenegro in late 2013 we had the first national discussion on child sex abuse as part of a national survey on violence against children in parliament. Services are being strengthened, reporting seems to be on the increase and there is more public discussion. But we are mindful that this is just the beginning.

This way of approaching adverse childhood experiences is flowing from high-income countries where it is studied and researched, to middle income countries where there is some type of functional child protection system. However, according to Theresa Betancourt of the Harvard Centre on the Developing Child there is an obvious need to better understand and work on childhood adversity, mental health and toxic stress in low-income countries or conflict zones, where HIV/AIDS or the recruitment of children into armed conflict, can have a deep psychological and physiological impact on children’s wellbeing.

Courtesy of the wonderful fostering promotion group ReMoved, my TedX featured the story of a resilient, fictional young girl with an Ace score of 6 called Maja. She could be any child-in any corner of the world. Frightened of her own father, uncertain of when she may reach safety or if she will ever be properly loved and cared for.

We can make a massive difference in the life of Maja and millions of children like her by attacking childhood adversity, making the invisible visible and creating a world truly fit for children.

Benjamin Perks is the UNICEF Representative in Montenegro


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Why state care should not mean more childhood adversity

Insider on unicef Connect By Benjamin Perks2 April 2015Share this story:

A three-month-old baby lies in a crib at a hospital in Ukraine. She was abandoned by her mother in the maternity ward.
© UNICEF/NYHQ2005-1796/PirozziA three-month-old baby lies in a crib at a hospital in Ukraine. She was abandoned by her mother in the maternity ward. 

For most mothers, the first embrace and skin-on-skin contact with her newborn, moments after delivery, is one of the most precious and magical moments in the journey of parenthood. But sometimes, perhaps because of family breakdown, addiction or perceptions about a disability, a mother turns away from her baby and abandons him or her at birth.

And so begins the worst possible life-start for many of the 1.3 million children who reside in the care of the state across Central Asia and Central & Eastern Europe.

In those fragile early days of life, the pathway to state care is lonely and brutal. The child will often be taken from the maternity ward to a large-scale state residential institution adorned not with family memories, warmth and affection but rather regulated by administrators with filing cabinets, staff shifts and often even staff uniforms.

Upon arrival, the baby will be placed in a cot like this:

And they will lie and wait and wait and wait. They will wait for the communication, affection and love that a newborn is pre-programmed to expect. But this is unlikely to ever come as large scale institutions have staffing structures that rarely allow for more than a couple of hours attention for each baby each day.

And this is just not enough to enable the healthy physical, emotional or cognitive development of the child.

And as days turn into weeks, and weeks into months, the baby learns to stop crying for attention and to stop expecting affection and love; the parts of the brain that regulate emotional relationships stop flourishing. Statistically, the child is unlikely to ever recover from this early neglect and may remain vulnerable for life.

Could it be different?

For many decades now there has been a consensus across pediatrics, psychology and neuroscience that one-to-one continuous contact between an adult (it doesn’t need to be a biological parent) and a child is needed for normal emotional, physical and cognitive development.

Can we rewind the clock and review the decisions that result in a baby, like the one in the photo, having such an unfair start in life?

What if during routine prenatal visits, a community nurse had the required skills and mandate to identify the risk of abandonment prior to birth, to counsel against it, and to link the mother to family support, social protection and other support?

And what if this could be reinforced by the doctor and the nurse in the maternity ward (over 97% of births in this region take place in a health facility)?

And if all of this failed, what if the baby was delivered to a warm and caring foster care family trained and motivated to give attention, love and affection to the child, while the social worker tries to find a long term home, either within the extended family or if not possible, within a suitable adoptive home?

In my recent TEDx, I talked about the lifelong impact of adverse childhood experiences (ACEs): sexual, physical and emotional violence, living in dysfunctional households plagued by poor mental health, addiction or domestic violence. The other major type of adverse childhood experience is neglect, and the plain truth is that the decision to place a child in a large scale institution results in neglect.

Even with the best of intentions, the human resource structure of large-scale institutions prohibit healthy childhood development, resulting in the neglect of children. It is therefore harder to imagine a decision that has more of an impact on the human rights of an individual than the decision a government makes about what to do with a child placed in the care of the state.

Prenatal interventions; better equipped maternity wards; family support services including cash benefits; even expanded emergency and regular foster care, either within or beyond the extended family; are much less expensive than large-scale institutions a) because the unit cost of childcare is less and b) because long-term health, social and other costs caused by poor outcomes for vulnerable adults from institutionalised backgrounds are high.

The wonderful 19th century French historical novelist Victor Hugo said, “nothing is more powerful than an idea whose time has come”. Thankfully, institutionalisation is an idea whose time has gone.

In December 2012, 20 UN member states across the region supported a Call to Action to eradicate placement of children under 3 in large scale institutions in collaboration with the Office of the UN High Commissioner for Human Rights, UNICEF & the European Parliament. This has to be a departure point for eventually eradicating the placement of any child in a large scale institution.

Under the leadership of the Montenegrin Prime Minister, a multi-sectoral drive for family-based care has seen a 56% reduction in the number of institutionalised children; strengthened kinship (within extended family) care; and a 7-fold increase in the number of children in non-kinship foster care in Montenegro.

Fostering campaign promotion poster -UNICEF Montenegro/Duško Miljanić
Fostering campaign promotion poster – UNICEF Montenegro/Duško Miljanić

A campaign to change negative public attitudes to children with disabilities – who comprise around half of those in state care in our region – has resulted in a dramatic increase in school inclusion and community-based services, thus reducing abandonment.

A long time ago, a model of state care was designed for children who had been abandoned. Strengthened prevention mechanisms are irreversibly reducing such cases. At the same time, public awareness of family violence is increasing and reporting is on the up.

Thus, the child protection system will gradually shift from providing care to abandoned children to protecting those at risk of harm within the family. At the heart of this shift has been the principle that children always need solutions where there is a consistent and solid presence of a trusted adult who will always put their interests first.

Anything less is tantamount to child neglect.

Benjamin Perks is the UNICEF Representative in Montenegro

Why we need to invest in early childhood in Montenegro

Experts speak from UNICEF Connect By Benjamin Perks28 May 2015

©UNICEF Montenegro/Dusko Miljanic

Anyone who has been anywhere near a three-year-old recently will attest to their inexhaustible curiosity. They ask as many as 100 questions an hour – and around about the age of three, those questions switch from “what and where” to “how and why” questions – in a search for meaning in the world around them.

Early childhood is the optimum time for cognitive and sensory development and the years from three to five are when the executive function, also known as the human ‘air traffic control system’, is growing most actively.

Thus, the way parents, peers and the wider society responds to a three-year-old’s searching questions will be a major determinant of his or her education and life success, as well as their long-time contribution to economic, social and democratic development of their society.

This is why Nobel Prize winner, and one of the world’s leading economist, James Heckman calculated that the biggest return on investment from the public purse occurs in the earliest years of childhood.

Recent research has dramatically expanded our understanding of early childhood development and much of this new knowledge was sorely missing when the current education model of most countries was designed in the 19th century.

But today the disparity between those who don’t go to pre-school and those who do, seems clear. There is, for example, a correlation in mathematics outcomes for 15-year-olds who did not go to preschool being a year behind, among the 55 countries included in the OECD/UNESCO PISA study.

Thus in the last few decades there has been a huge drive in the world’s wealthiest countries to secure a pre-school place for every child. In the European Union, for example, the pre-school coverage rate is around 92% with a target of 95% coverage by 2020. Some countries such as Ireland and Latvia have had rapid growth in the past few years.

But what about low- and middle-income countries? In the draft United Nations Sustainable Development Goals, universal access to pre-school is set as a target for 2030. But there is a long way to go.

In the Central and Eastern European & Central Asia region – much of which borders the EU and is working towards integration with the EU economy – some countries have a coverage rate as low as 10%, much lower than the EU target of 95%. Here in Montenegro there is 52% enrolment of three- to six-year-olds in pre-school, but only 40% attend in real terms.

©UNICEF Montenegro/Dusko Miljanic
©UNICEF Montenegro/Dusko Miljanic

There is indeed a gulf between Montenegro and the European Union – which it eventually hopes to join. But there is also a geographical gulf and a poverty gap because a child born into the poorest section of society or the least developed municipality is nine times less likely to attend pre-school than one born in a wealthy family or municipality.

As in many countries, there are three drivers of poor attendance. The first is a lingering belief that pre-school is primarily for the purpose of daycare – not child development – and that this can be better provided at home by the extended family. There is a lack of understanding of the unique value of a professional and evidence-based pedagogical learning programme for the child.

The second is poverty and the inability to pay even relatively low fees for the service. This is coupled with the non-income dimensions of poverty such as the absence of a means of transport from often disparate rural locations to pre-schools in urban regional centres.

The third is the evolution of pre-school as a largely urban phenomenon for working families, which combine the functions of paedagogical development of children with daycare facilities such as kitchens, dining rooms and sleeping facilities where a child may stay all day, but where only 40% of the space and time is used for child development and where the investment and running costs can by disproportionately high.

The government of Montenegro has committed to increasing the enrolment of children in pre-school from 52% to 95% by 2020 with the technical support of UNICEF, through the establishment of a free-of-charge three-hour daily programme for all children, focusing on the poorest first. This will be achieved through innovative financing models and the establishment of pre-school facilities in primary schools, health posts, and other grassroots facilities in the disparate areas that are not covered by the current urban kindergartens. Shifts will also be developed in existing kindergartens to accommodate children during the afternoons for the three-hour programme.

Montenegro also joins Chile and South Africa as one of the three countries where UNICEF is working in partnership with the H&M Conscious Foundation to encourage an increased investment in ECD.

In addition, a public awareness campaign is underway to increase demand in areas where it is low. If such models can be replicated and mainstreamed through the aspiration for the sustainable development goals of the United Nations, we have a chance of reversing both the impact of inter-generational inequity between low- and high-coverage countries; the massive disparities between wealthy and poor children within countries like Montenegro; and the lost opportunities for all societies through a collective failure to respond to our latest knowledge on the essential need for early development of the brain when it is growing most rapidly.

Benjamin Perks is the UNICEF Representative in Montenegro

Adolescence — a second chance for children affected by adversity, poverty & exclusion

Experts speakBy Benjamin Perks16 July 2015

As you read this, a teen somewhere is making a decision they may regret for the rest of their lives, one with high costs for themselves, their families and their communities. Joining a gang or a terrorist organization or committing a serious crime.

Every teen everywhere faces a turbulent transition to adulthood: the rapid development of identity, blossoming of emotions and onset of puberty. Neuroscientists explain the turbulence as caused by asymmetrical adolescent brain development. The socio-emotional processing system starts to respond to incentives and provocations from the early teens, but the cognitive control system, which is needed to filter those decisions is not fully developed until the early twenties.[1]

Over the past twenty years, there has been good news and bad news in research on adolescence. The bad news is that many more children than we ever thought before are entering adolescence with broken childhoods characterized by heartbreaking adverse experiences: abuse, neglect and dysfunctional parenting driven by addiction, violence or unaddressed mental health issues. This is multiplied further in areas affected by conflict, crime, and poverty. Science shows that the more adversity experienced in childhood the more difficult it is for the adolescent to navigate his or her way around the opportunities and risks they face and to make sensible decisions that don’t harm them or their communities.

The good news from neuroscience is the discovery of neuro-plasticity — that teenagers can strengthen the performance of their “executive function”, the part of the brain that coordinates behavior, choice and reaction, through learning non-cognitive or character skills. Thus, as much as adolescence is fraught with risk and possible lifelong consequences, it can also provide a second chance to get teens back on track to lead a stable, fulfilling and happy life.

To divert for a moment from vulnerable children to all children, character skills are increasingly recognized in many countries as being as critical as IQ in determining academic and lifelong success for all. They are seen as essential for long-term economic competitiveness and socio-economic development and are being mainstreamed in K through 12 education. Character skills include instrumental skills such as optimism, curiosity, motivation, perseverance and self-control that drive overall performance in school and life. But they also include integrity and locally-determined values that ensure performance is harnessed to the common good and can contribute to shared expectations and values within communities.

In Harvard sociologist Robert D. Putnam’s recent best seller ‘Our Kids – the American Dream in Crisis’ on inter-generational poverty and the decline in social mobility, he reviewed all of the recent American studies on childhood and concluded that in addition to the impact of poor nutrition and material poverty on children’s life chances, parenting and schooling had a massive impact: “Well educated parents aim to raise autonomous, independent and self-directed children with high self-esteem and the ability to make good choices, whereas less educated parents focus on discipline, obedience and conformity to pre-established rules.” [2]

Whether talking about teenage ‘child soldiers’ in war-ravaged, poverty stricken countries, or abuse victims, or gang members in high-income countries, we need to look beyond obvious interventions that tackle material poverty or provide vocational learning or housing. If traumatic childhoods have left them with a chaotic and untrusting view of the world — they will find it very hard to hold down a job, or maintain a house, or build healthy relationships. We need to complement material interventions with the development of the type of character skills that will help them become more autonomous, self-directed and build more self-esteem to make good choices.

In Montenegro we have joined forces with Birmingham University to support the Ministry of Education in developing character education in schools and within a global partnership with ING to support the development of such skills with especially vulnerable youth in a non-school setting. This includes young people leaving state care, Roma and other minority children, and young people in conflict with the law.

Character education is only one part of a range of interventions that are needed to help young people get back on track. Vocational training, support for accessing basic health and other services and even psychological therapy are also essential. But character — skills including integrity — are an essential part of the jigsaw. While there is now a strong global investment case that public funds in early childhood promote positive life outcomes and long-term competitiveness, adolescence is our second — and perhaps last —chance to harness the public good to ensure our most vulnerable teenagers build better lives — and eventually better societies. Let’s not waste that chance.

Benjamin Perks is the UNICEF Representative in Montenegro.

[1] The Influence of Neuroscience on US Supreme Court Decisions about Adolescents Criminal Culpability. Nature Reviews Neuroscience. Laurence Steinberg. 2013
[2] P199. Our Kids-the American Dream in Crisis Robert D Putman Simon and Schuster

Equity, poverty and love

InsiderBy Benjamin Perks18 November 2015

UNICEF/NYHQ/HartleyA young girl from girl from the Roma ethnic group stands in a field near the town of Podgorica in Montenegro. 

“…….seeking but a moment’s rest among the long-forgotten haunts of childhood, and the resorts of yesterday; and dimly finding fear and horror everywhere….” [1]
–Charles Dickens  Martin Chuzzlewit  London,1843

Everyone knows poverty drives inequity. Here in Montenegro one of the ways we address this is by supporting dramatic expansion of pre-school education for the poorest 3-6year olds, who are currently 10 times less likely to attend which ensures worse life prospects and an inter-generational cycle of poverty.

But is childhood adversity: violence, neglect and dysfunctional parenting, also a driver of inequity?

152 years passed between Dicken’s writing Martin Chuzzlewit and the discovery of a neurobiological explanation of how and why broken childhoods haunt and destroy adult lives-even into old age.

The Adverse Childhood Experience (ACE) study, launched in 1995, continues to demonstrate in many countries huge inequity between adults who were affected by high levels of child abuse, neglect or dysfunctional parenting, and those who were not. High childhood adversity leads to markedly worse outcomes in health, education, employment and crime. It is much more prevalent than we thought and occurs across wealth quintiles.

In addition to being one of the world’s finest novelists, Charles Dickens also gave an authentic voice to those whose childhoods had been pulled apart by the desolate loneliness and crushing injustice of childhood adversity and inequity as he had experienced first-hand himself [2]. As with Dickens, the passion of many UNICEF staff to tackle childhood inequity stems from our own childhood memories and in my case the experience of growing up in loveless institutional children’s homes has always been a major driver of my work.

At any given time across the region of CEE/CIS we have a million children in state care, a fact that will place them on a lifelong path of inequity.They come into state care because of childhood adversity or because they are abandoned, mainly into large-scale children’s homes. A placement in a children’s home is a secondary trauma for any child. It does not provide healthy attachment with an adult and this is particularly catastrophic for children under 5 when brain development is most active and dependent on consistent interaction with an adult.

Comparative brains scans as well as measurements of development-inhibiting cortisol levels between those in institutional care and those in strong families reveal a neurobiological inequity that will eventually translate into long term economic and social inequity.

A children’s home is a place where a child lives in a state of neglect – unequal not just in terms of poverty, but in terms of love, affection and attention. This is why 21 countries in our region have joined forces with the UN Human Rights Commission and UNICEF to eradicate placement of children under 3 in large scale institutions. In Montenegro there will be a complete end to placement of under 3s in state care by 2017. There is a similar campaign in Latin America where around 240,000 children live in state care.

The right to family life is being secured through stronger social work systems, which can keep families together, and promotion of fostering and other family based alternatives for children who cannot be cared for in the biological family. This has already yielded a 40% decrease in the number of children in institutional care in the past five years in Montenegro.

Children in state care are just the tip of the childhood adversity iceberg, the overwhelming majority of childhood adversity is suffered by children in families. We are thus working with health, education, justice and social work sectors to build systems which protect children and promote better parenting through pregnancy until adulthood. We work with government and women’s groups to break the taboo on childhood adversity-learning the lessons from similar efforts in the UK and Scandinavia a couple of decades ago. I recently did a TedX talk on this & was inundated with messages from Montenegrin adults who had been affected by childhood adversity and many had never told anybody. We launched the first study on child abuse in the parliament recently and next year we will launch and measure the impact of a public campaign on childhood violence and adversity. The aim is to reduce the space in which adversity is unreportable and invisible or even acceptable.

But how can we close the equity gap for adolescents whose lives have already been plagued by adversity?

Neuroscience may have taught us the bad news that when childhood adversity collides with adolescent brain development-it can put children on a lifelong negative trajectory : inequity, gangs, violence, but it has also taught us that the character and decision making skills required to prevent such a trajectory can be learnt thoughout childhood: grit, optimism, integrity and self-control for example . In collaboration with the Government, Birmingham University and ING, we are working with youngsters who have experienced high levels of adversity to teach these characteristics. We hope that this will help them to make better decisions , get back on track and close the equity gap between them and children from more stable backgrounds.

As international civil servants it is easier to talk about poverty than it is to talk about love. When we talk about adverse childhood experiences we are talking about love, a lack of love, or children being violated by those who should love them. We need to find ways of talking about childhood adversity as a major driver of inequity-despite the discomfort.

I would never want to lose sense of who I am and where I come from. Every month I join a group of young people who grew up in children’s homes in Montenegro and help them draw out their own potential to build better material and emotional future.  I see my own reflection in their eyes and hope they will have a better tomorrow.

[1] Dickens, C. The Life and Adventures of Martin Chuzzlewit (1843), Chap. 25

[2] Tomalain C. Charles Dickens A Life 2011 Viking

Benjamin Perks is the UNICEF Representative in Montenegro