Child trafficking and exploitation: Laura Franklin talk

Portsmouth currently biggest port for trafficking into UK. Needs coordinated national response.

Human trafficking has several elements
Movement, control, purpose.

Last year 1746 cases referred to national agency.
Sexual exploitation most prevalent form
22% of total are children, 40% sexually exploited

60% of children go missing after care. Only one centre for trafficked children exists. Placement depends on individual needs.

Estimate 10000 victims in the UK

Some examples: Vietnamese children in cannabis plantations
Arrested and treated as criminals not victims

Trafficking may be external (cross border) or internal

Sexual exploitation a common purpose

Not an immigration issue, an organised crime issue.

Parents cannot consent to trafficking or exploitation

Different to people smuggling

Multiple forms of exploitation. Forced labor, sexual, domestic service
Multiple means of control including use of drugs, deception, debt bondage, removal of documents

Very hard to detect.

Modern slavery helpline open to all: 08000121700

Modern Slavery is closer than you think:

Indicators: any sign of abuse
Rarely leaving house
Lots of chores
A&e attendance with workplace injuries
Unusually long hours
No identity documents
STI, prevented from being seen alone
Poor accommodation
Prepared story of origin

Multi agency response required. Need for reception centres, mental health input.

Michelle Koh: psychosocial impact of life limiting illness in adolescence

Michelle presented three cases of palliative care in adolescence.

Makes point that direct anxiety about death, suffering, direct molecular effects, and family dynamic issues all contribute to difficulties.

E.g. in DMD cognitive development shows unusual cognitive and social skills

Family refusal to talk about feelings exacerbates difficulties.

Useful for clinician to put death out there as a concept, and see the response.

Families very concerned about physical reality of death. Professionals need to engage with this.

You can control symptoms and pain but not suffering.

Some families desperate for death to happen at home, for others need to be in a hospital. Key is respect for views.

Long term illness can rob the child of a peer group.

Story of a bright, willful boy who got fed up with dialysis. Team resources this, boy signed own care plan. Rapid deterioration but manages to make it to 18th birthday and buy a round of drinks!

Paradoxically uplifting story demonstrates primacy of respect for patient self definition.

Children’s journeys through grief, with Jacqui Stedmon

Attachment serves add a biological basis for all forms of grief.

4% of children lose parent before 18

Interventions need to be carefully targeted, but evidence base is poor.

The assumption that bereavement is bad has hampered progress; many children are very resilient. 2/3 do well after loss of a parent.

Bereavement a potent trigger to attachment system. (See slides)

The stages of grief narrative remains dominant, but isn’t the whole truth. More useful is an oscillation between loss orientated and restoration orientated activities.

Continuing bonds model (Silverman) rejects the idea that the end point of grief is to break the bonds with the dead person. Accommodates children’s grief in an uncritical and helpful way.

Meaning making a important part of the cognitive work of grief. A punctuation (saying goodbye) can be helpful.

Lack of evidence but experience suggests that children have a distinct individual path through grief

Trauma can interfere with grief process as person revisits traumatic memories. Triggers can be quite trivial.

Details matter in making sense.

Viewing the body can be helpful if the child chooses. Choices need to be given in a neutral way.

Peer groups can be prepared to deal with a bereaved child.

Two broad types of complicated grief in children
Traumatic and delayed or inhibited

Seems to be quite a bit of somatisation after inhibited grief, all aberrant behaviors can be linked to grief.

Assessment and understanding should include consideration of family relationships.

Disenfranchised grief, not accepted by others or self, can come out in physical symptoms.

Slides will be posted shortly. 

Virtual hospice with Bettina Harms and Becky Hepworth

Isle of Wight team.
No physical hospice available on the island. Often isolated from the mainland. Ferry required, which is expensive, and not always available.
People want to be with families, not remote.
Aim was to provide the care of a hospice without the building.

Brings existing services together with additional resources

Without the service respite access was poor.
Lack of counselling support after death
Lack of clear choice of place of death

Feeling of all services serving own population important driver for brining them together. Passion of local people invested in their own populations.  Pilot by existing hospice not successful as too far, so local services joined forces.

Commitment to home care. Training from mainstream hospice. Additional resources for children’s community nursing including respite. Support from adult services, third sector.

Physical room found in adult hospice, as a fall back, and actually used for after death care, requiring considerable negotiation and training, but now improving confidence.

Family voices important, guiding principle of service.

Bereavement with Su Laurent and Tracy Dowling

Tracy talked about the process of preparing for death, the questions (what will he look like? Will he need an ambulance?) that she asked, and the planning and listening from the team. Vital meeting in her kitchen.
Trivial things matter in this situation. Planning for details of different contingencies, including an ambulance directive for which hospital he was to be taken to. Importance of ongoing relationships and things being done by familiar people.
Impact, both positive and negative, on younger brother. Planning and discussion with siblings.
Importance of fitting language to the audience. A lot of people prefer direct language e.g. dead rather than lost or in heaven.
Advanced care planning is key, and is not death planning.
Death takes its time, often far longer than any of us expect. Weekends are especially tough during these last days. Doing things for ‘piece of mind’-we need to ask whose piece of mind?
Importance of medicine leaving the room, dropping off the trappings of medical care.
After death.
Bereavement hurts, physically and the exhaustion is worse than the exhaustion of over work experienced during dying. Often the complete withdrawal of care is devastating.
Numbers and anniversaries are important and become a way of counting and marking bereavement.
People say things to add positivity. E.g. back to work, have another baby, it’s a blessing. Language of moving on can be unhelpful. People also avoid the bereaved. Talking about the child as a person is valuable.
Bereavement team’s role: mainly to get parents together. Hearing the stories of others can give you examples of what not to do, as well as what to do.
Differences in how people are treated depending on how child died. Unexpected death in some ways better, but often complex feelings of guilt. Every bereavement is different and heading each other’s stories is valuable.