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Talking SENSE with young people caught up in traumatic events

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

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

Nikki Lester
Mental health nurse Nikki Lester at the Peace Centre in Warrington Picture: John Houlihan

 

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.

3

Age of Johnathan Ball, killed alongside Tim Parry, 12, by an IRA bomb in Warrington in 1993

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.’

8

Age of the youngest victim to die in the Manchester Arena attack

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.’

700

Children and adults affected by the Manchester bomb who have been supported by the Survivors Assistance Network

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.’

SAN in action: Ruby’s story

For eight-year-old Ruby, the concert on the night of the Manchester Arena bombing was the first she had attended.

She and her mother Amanda were uninjured, but the psychological impact ran deep.

Donna Craine, a SAN caseworker, saw Ruby and Amanda a month after the bombing.

Ruby was having trouble sleeping, was anxious and was no longer enjoying school – ‘symptoms you would expect’, says Ms Craine. Amanda thought her daughter had become withdrawn.

Although Ruby began to show improvement, she was still struggling and Ms Craine referred her to the NHS Resilience Hub, set up after the Manchester attack.

The hub is staffed by trained professionals experienced in working with children and adults who have suffered trauma. Where appropriate, they will refer on to specialist services.

A bullying incident at Ruby’s school related to the bombing caused a setback for her, but Ms Craine says she is improving. ‘She receives psychological support and is mostly doing okay.’

The Peace Centre, where the SAN is based, displays sponsored model peace doves in its foyer, and Ruby is raising money to have one named after her.

‘What the doves represent to her is a sense of good coming out of bad, and that’s been a theme of mine and Ruby’s relationship from the start,’ Ms Craine says.

SAN in action: worry dolls

Donna_Craine

In its work with children affected by the Manchester Arena bombing, SAN has used worry dolls to good effect.

Made from colourful textile, the dolls are rooted in a Guatemalan legend in which a princess has the power to resolve any human worry.

‘They are meant to capture the imagination, really,’ says SAN caseworker Donna Craine (left).

‘They give children an outlet for their worries or fears, in the same way as a journal or diary. Children speak to the worry dolls before they go to sleep, then place them under their pillow.

‘We organised a visit to the Manchester Arena [for those affected by the bombing] before its public reopening.

‘We took bags of worry dolls with us and gave them to the younger children who reported that they found them useful.’

 

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