COVID-19, Violence & The Need To Act with Urgency

Amidst the fear and uncertainty of the Covid19 lockdown in China, 26 year old Lele experienced something more terrifying than the virus itself. Her husband fashioned a weapon from a kitchen stool and beat her semi-conscious as she held her 11 month old baby in her arms. There was nowhere to go, no services to support, no possibility to flee. She had to spend several more weeks with her abuser before she could reach safety.

On the other side of the world in Greenland, the capital city banned alcohol sales to prevent growing child abuse during lockdown. In India the were 92,000 calls to a child abuse helpline in the first 11 days of lockdown. France experienced a 34% increase in abuse helpline calls by children and an even bigger increase in the number of peers and school mates calling on behalf of friends. . As closed schools and stay at home orders spread, so did the risk of abuse.This pattern played out across the world, in three ways:

The first is the way that lockdown piles pressure on households . Even the calmest, securely attached and ‘child development-aware’ parents are being tested by ‘pandemic-parenting’. Often they are working in uncertain jobs while teaching ‘cabin fever kids’ while adapting to loss of space and privacy. But most will not suddenly become abusive or neglectful. In more volatile families however, this stress can spill over into violence or exacerbate existing abuse patterns. The biggest beneficiaries of #StayAtHome are the serial abusers who practice coercive control and other forms of psychological aggression. the lockdown increase the likelihood of adverse childhood experiences.

Secondly, the means of reporting severe child abuse or neglect have been dramatically reduced. According to the US Department of Health & Human Services child protection interventions are initiated by reports from teachers, social workers or nurses. Social distancing measures have reduced reporting. From the 1980s onwards increased reporting of family violence was a major mark of success and progress in protecting the rights of women and children. Momentarily, reporting is in decline.

The third issue, is complex but equally serious. In normal circumstances less than 1 or 2 % of children are subject to interventions by social workers. Yet Adverse Childhood Experience (ACE) research across populations suggests between 15 and 20% of children are affected by chronic, multiple forms of abuse, neglect or dysfunctional parenting at home. This 15 to 20% of children are now in a state of isolation. Children have a biological imperative to have protective, soothing relationships with an adult and are simply not built to be isolated. When a positive relationship at home is absent, the child interprets it at risk. It over-activates their stress response system which wreaks havoc on all aspects of healthy development. Unaddressed it can lead to catastrophic health and wellbeing outcomes throughout life. But when the stress is buffered and soothed by a healthy relationship with a teacher, grandparent or friend and the child is made to feel they matter on an individual level-then the recovery can begin. Right now around the world, hundreds of millions of children have been cut off from those relationships.

This is deeply distressing. Accounts of childhood maltreatment often recall a despairing loneliness and unbearable slowness. Loneliness when the parent who should soothe the pain, is actually the source of that pain. Slowness during long pauses of waiting for a violent outburst or scarce moments of maybe feeling loved. The isolation of the pandemic amplifies this pain exponentially. It is malleable with no end in sight. Relationships with teachers, grandparents and friends were cut off suddenly with no date for restoration.

We need to act with urgency on all three issues. Governments and communities could appoint ministers or local leaders to coordinate child wellbeing during lockdown. A priority must be engagement with parents on managing stress, home schooling and positive discipline, tailored to lockdown conditions. Online and media platforms could be adapted to facilitate a conversation with families and disseminate pandemic-specific parenting tips, similar to the global UNICEF parenting hub. Social protection and housing support must be adapted to reduce the stress on vulnerable families. Behavioural insights and technology innovations should be used to understand how we can best support parents and protect children.

Expanded helplines and channels that enable neighbours and friends to report maltreatment anonymously need to be provided . Equally we need to encourage extended family and friends to maintain regular communication with children in lockdown with abusive or neglectful parents. One of the most moving stories of the pandemic so far is the upsurge in calls by friends of victims reporting maltreatment in France.

Innovation and adaptation could help teachers and social workers restore normal levels of communication with children, despite lockdown. If they are not giving lessons, can they call each child for five minutes? These measures need to be population-wide and not just targeted to 1-2% of children who are child protection cases.

Decades ago, it became normal to ensure every child was immunised against deadly disease with a vaccine. In the future we could hope for a world were every child is buffeted from trauma by a calm and predictable adult connection. A world in which we improve prospects for parenting in every family at the earliest possible stage and maltreatment is managed and prevented as a part of routine public health . All we can do now is demand protection for Lele, her baby and millions of abused children and women locked down, unreported and isolated around the world as part of our immediate and shared struggle to defeat Covid19

A Children’s Pandemic

A month of Pandemic measures and I already wince at a handshake or touched face on Netflix. Just yesterday, New York was bustling, packed and confident. Now it is cautious, dispersed and masked. If our relationship with the world around us has been instantly transformed, what about the impact upon children in their formative years?

It may be the single blessing of this ruthless pandemic that children are least vulnerable to the virus. But sadly not the potentially deadly ricochets and aftershocks it leaves in its wake. This week the UN Secretary General reported that health and food system impacts will increase other childhood diseases and malnutrition. The number of children living in extreme poverty is projected to increase from 386 to as much as 450 million as a direct result of a new Covid19-induced economic crisis. Extreme poverty is always a killer and likely to take more children than the virus itself. Perhaps reversing 2-3 years of global progress on preventable childhood deaths.

There is barely a child on the planet whose life has not been affected by the Pandemic in some way. 1.5 billion are at home and not school. At least tens of millions of children will be born into this crisis, mostly in conditions that would have been different if it weren’t for the pandemic. Children cannot see their friends and suffer major disruptions to learning, life and play. Sports tournaments, excursions and hackathons all shelved, teenage romance on hold. A recent study suggested that prolonged quarantine in general can make a person 4 times more likely to have poor mental health. The pandemic shocks touch all children .

Fortunately many children have the shock absorbers of a safe home, loving family and freedom from poverty, social exclusion or war. If just one from the set is missing, the impact of the pandemic is likely to be deeper and life-changing. There is now a new single thread of additional vulnerability tying together children in tightly packed slums in African cities with those in camps in Syria and Yemen. It extends to the low income children in rich countries like the UK and US and those at risk of severe acute malnutrition in the poorest countries. It also hits the approximately 5% of the world’s children with disability and the 15-20% in seriously dysfunctional, neglectful and violent homes. This pandemic has been merciless in piling more pressure on to those least able to absorb it.

The bottom billion have no means for social distancing or hand washing. Their health systems often have just a few ventilators and Intensive care beds. They are not thinking of flattening the curve, but rather a couple of dozen cases flattening their entire health system. Prevention of other childhood diseases is already disrupted, including vaccination programmes on hold in 23 countries. 30 million conflict affected children are dependent on humanitarian assistance which is likely to be battered as supply chains buckle and aid financing and fiscal space contract. 40% of the world’s children don’t even have hand washing facilities.

Remote learning is a great solution for most children, but even here in New York city it is estimated that 300,000 low income children don’t have the digital means to participate. School closures will widen the two main learning gaps. The first between countries with high performing education systems who have the agility and means to switch and those countries which cannot run their education system effectively at the best of times. The second gap is between the learning outcomes of wealthy and poor children within countries. 368.5 million of those poor children have also been cut off from essential school feeding programmes which are often the only source of nutrition. Children in need of special learning support at school or dependent on relationships with teachers and friends to mitigate the pain of violent and neglectful homes are suddenly adrift. All against a rising backdrop of increased reporting of intimate partner violence and child abuse from India to Greenland to Australia and all points in between.

If the Coronavirus was a pantomime villain waiting behind a curtain for an opportune moment to pounce, it did so with precision. Thus far, dwindling internationalism has made us too weak to address the Pandemic in the whole. But you cannot partially address a pandemic. Even during the Cold War, the USSR and the West realized this and joined forces to end smallpox. And thats what our polarised world needs to do now. If everyone is not safe, no-one is safe. The virus shows our interdependence and in the end, maybe thats its virtue.

This is not insurmountable. WHO, UNICEF, the Red Cross, scientists and artists have joined forces in the Solidarity Fund to mobilise resources for a vaccine and for prevention and response work in low and middle income countries. Scientists shared the genetic sequencing on the virus very early on and are collaborating across borders despite nationally-minded governments. There is also a global initiative to galvanise leaders into more collaborative and internationally-minded policy-making in response to the pandemic.

We have also seen national governments and societies prioritise children. 83 countries have adapted their social protection systems to help shield poor families and children from the crisis. Health, education and social work systems have often adapted to maintain basic services. Armies of school and health volunteers are helping minimise the impact of the pandemic upon children.

We should now see maintaining supply chains, aid flows and health systems in poor and humanitarian contexts as a first line response for us all, even though it seems far away. Look how far the virus has already travelled. We may also need to invest in social protection to help the bottom billion socially distance, particularly those in densely packed and poorly resourced urban slum and refugee/migrant camps.

In wealthy and poorer countries alike we should support adaptions for teachers and social workers to have exactly the same amount of contact with children as they had before the crisis and for school feeding programmes to be delivered to homes. When adapting education we need to prevent remote learning widening the gap between wealthy and poor.

Albert Camus may have appreciated the importance of teacher contact and continued learning. In 1957 he dedicated his Nobel Prize for literature to the teacher who was there for him in the midst of poverty and adversity. His masterpiece The Plague is once again a bestseller and remains a testimony to our interdependence and collective strength in the face of this crisis. In it, he wrote: “No longer were there individual destinies, only a collective destiny, made of the disease and emotions shared by all.” .

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. 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 following 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 . 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 attend university today. It is a testimony to resilience, 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, to run a market stall 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 believed that completing a university education would help me escape the legacy of my childhood and 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. I couldn’t quite believe how lucky I was just to be there. It seemed that most took it all for granted. How much luckier I was to see going to university as a massive blessing. I still feel blessed and privileged today.

What about 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. Those 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, 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 when you are trying to escape severe poverty without any 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 important determinant 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. 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. 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. 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 squeeze and further disadvantage 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. 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. 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. 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 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. 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.

NB: This is the first in a Triology. The second part can be found here and the second here. Benjamin perks can be followed on twitter

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