From July to September 2020 Coram Creative Therapies ran three groups for parents who have adopted, adapting NVR for an online delivery. One group of parents were based in London, the other in two in the North West of England. The project was supported by the Adoption Support Fund (ASF).
The national COVID-19 pandemic lockdown from 26 March 2020 closed schools across the country. For many families with vulnerable children or children with complex needs, parents were thrust into multiple roles, asked to supervise their children 24 hours a day, to become teachers and sports coaches. While some children who are adopted would have been entitled to attend school (as vulnerable children or the children of key workers) many parents decided to keep their children at home. Some children, parents or other family members may have been shielding and other parents may have taken decided to keep their children out of school as the risks of COVID-19 to children were not fully understood at that time. Other children had access to school on a part-time basis only.
Coram were asked by the Adoption Support Fund to support some of these families through online groups, to help respond to the particular challenges of lockdown, for example, the change of children’s routines, negotiating new boundaries (time for school, time for play, and so on), loneliness, children’s anxieties about COVID-19, and the loss of support and respite for parents that school and after school activities provides.
We decided to offer an 8 week Non-violent Resistance (NVR) group. NVR is a well-researched and evidenced therapeutic intervention for children who have emotional and behaviour difficulties, alongside other complex needs.
NVR is a coaching model, supporting parents to make changes and so there is no expectation that therapists meet or work with children, making it particularly well suited to the circumstances brought about by COVID-19, when online sessions were the only practical way of working.
NVR has been delivered through face to face groups in the past, and like other services we found ourselves taking the model online for the first time. A number of treatment manuals have been developed in the UK, including by Oxleas NHS Foundation Trust. Most NVR manuals have been developed to respond to the parenting challenges of children who are described as ‘conduct disordered’ or as having ‘oppositional defiance disorder’. Some of the children we were concerned to help had complex developmental difficulties which had been described in diagnostic terms, using descriptions such as Fetal Alcohol Syndrome Disorder (FASD), Alcohol-Related Neurodevelopmental Disorder (ARND), Attachment Disorder, etc.) and others had relational difficulties as a result of their traumatic life histories. So we adapted existing NVR materials both to an online context, and to attend to the particular needs of the children before offering parents a weekly two hour group for eight weeks.
We emphasised aspects of the NVR approach that tackle everyday stressors for families, and patterns of interaction which can be triggers to more challenging behaviour, making practical suggestions to parents to reduce the risk of aggression and violence in the home. We encouraged parents to share their challenges with ‘supporters’ – carefully chosen friends and family – and proposed creative ways of increasing their ‘parental presence’ – another key NVR term – both in the home and out of the home. Involving NVR supporters in family life during lockdown certainly complicated their involvement, and so as a group of therapists and parents, we developed innovative ways for supporters to be in contact with children, to help them make changes to their behaviour.
We were introduced to parents through Regional Adoption Agencies. Coram’s therapists met with parents initially by phone, explaining the purpose of the group. We had very positive feedback from the groups, with some parents deciding to stay in contact and support each other with using NVR ideas.
This was a learning experience for the Coram Creative Therapies team and for the parents we worked with. As therapists we learned that an NVR group can be delivered online, and this could have important implications for future services. Even if a COVID-19 vaccine means life can return to (a new) normal, many parents have in the past struggled to overcome the practical challenges to accessing CAMHS, and similar services. Removing the need to travel to receive a service should improve access in the future. Similarly, teams can build up specialisms by working with a group of families with particular needs who live far apart. A team could, for example, develop expertise in adapting NVR for families with a child with developmental difficulties which are thought to be alcohol-related.
COVID-19 brought with it many challenges for therapy services. Coram Creative Therapies were amongst those who responded positively to the call to adapt our offer in order to be able to support families via online interventions. Perhaps one silver lining will be that in the future services can develop both greater specialism and greater accessibility by grasping the opportunities working online has to offer.