Talking SENSE with young people caught up in traumatic events

The Survivors Assistance Network gives practical and emotional support to young people and their families who have experienced terrorism.

At 10.31pm on 22 May last year a suicide bomber detonated a homemade device in the foyer of the Manchester Arena.

A concert by the singer Ariana Grande had just ended, and the area was busy with young fans and waiting parents. The explosion killed 22 people as well as the bomber.

Several children were among the dead. The youngest to die, Saffie Roussos, was eight years old. More than 500 people were injured and many of those caught up in the attack experienced enduring emotional trauma.

Over the following months, much of the responsibility for supporting children and parents affected by the bombing fell to the Survivors Assistance Network (SAN). This is part of the Tim Parry Johnathan Ball Peace Foundation, in Warrington, named after two children killed by an IRA bomb in the town 25 years ago.

The role of the SAN, funded by the Ministry of Justice, is to give practical and emotional support to British citizens caught up in acts of terrorism.

Trauma-informed model

In 2015, the foundation asked consultant mental health nurse Nikki Lester to work with the SAN to develop a model of practice that would maximise the impact of its work.

The ‘trauma-informed’ model she and the SAN team established was founded on five interventions offered in the immediate aftermath of a terrorist incident:

• Stabilisation.
• Education.
• Normalisation.
• Social support.
• Engagement.

Ms Lester explains that ‘trauma-informed’ is a fairly new concept in the literature. ‘It is about how services that, although not necessarily clinical, work with people who have experienced trauma can encompass a set of principles in their work.’

The principles are, she says, ‘common sense stuff’, such as establishing emotional safety, restoring choice and control, supporting ways of coping, and building strengths.

It was either prescient or fortunate that Ms Lester was asked to become involved with the SAN in 2015.

Since then, British citizens have been caught in a series of terror attacks home and abroad that have cost many lives and caused immense physical and psychological trauma. But it was the Manchester bomb that would provide the severest test to date for the SAN and the SENSE model of practice.

Reassurance

Eventually, the SAN would receive more than 700 referrals for children and adults affected by the bombing. In the immediate aftermath, however, the priority was – as the SENSE model dictates – stabilisation.

‘In the hours after a traumatic incident, what people need is often just reassurance,’ says Ms Lester, who during her career in the NHS and the armed forces has specialised in traumatic bereavement and conflict-related trauma.

Panic and anxiety are normal reactions to trauma, and the simple early intervention of relaying that understanding to people – especially parents concerned about their children – can help prevent symptoms becoming chronic.

Before its barbarous end, the Ariana Grande concert had been a family affair. Ms Lester says: ‘It wasn’t just the individuals present that night who were affected, but their families – mums waiting outside or at home, watching on the news.’

It was the first time the SAN had worked with such young survivors of terrorism, but the team adopts a family-focused model, regardless of a client’s age, so no fundamental change in approach was necessary.

‘The family has a huge role to play in how we support people after an incident of trauma,’ Ms Lester says.

‘The emphasis is on strengthening the resilience of the family in recognition that a lot of recovery takes place there. That’s our starting point.’

Emotional trauma

As with adults, emotional trauma in children may lead to anxiety, stress and depression. Challenging behaviour or difficulty expressing emotions may also be present.

‘After Manchester, there were children for whom all notions of safety were shattered,’ says Ms Lester. ‘But we also saw remarkable resilience.’

The pace of referrals remained high in the weeks after the bomb, but the support required began to change.

The SAN team worked closely with teachers and school counsellors to facilitate children’s return to school. Where appropriate, they linked up with child and adolescent mental health and other services.

‘The aim of our work was to facilitate some kind of meaning-making about the incident,’ Ms Lester says.

‘That links with being family focused and helping the family develop a shared narrative, often by bringing everyone together after speaking to the parents and their children separately.’

She adds: ‘If we can keep them intact as a family, recovery is far more likely.’