Partnered with a Survivor: David Mandel and Ruth Reymundo Mandel

Season 5 Episode 11: Empowering Children: Healing from Domestic Abuse with Dr. Asha Patel

• Ruth Reymundo Mandel & David Mandel • Season 5 • Episode 11

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Unlock the secrets to supporting children affected by domestic abuse with insights from Dr. Asha Patel, CEO of Innovating Minds. In this episode, we explore innovative approaches like the Healing Together program, which integrates trauma-informed principles, neuroscience, and attachment models to help children manage their emotions. Dr. Patel shares her journey from working with high-profile offenders to founding Innovating Minds, with a mission to provide early support for children often mislabeled as "naughty" and excluded from education. Discover how digital access is pivotal for equitable scalability and the importance of training frontline practitioners to extend the program's reach.

We'll shed light on the complex challenges of providing timely support to children exposed to domestic abuse and the critical role of supportive relationships in their healing process. Misconceptions about waiting for the perfect moment to offer help are debunked, and the necessity of multiple pathways to access programs, beyond court orders, is underscored. The conversation also delves into the hurdles marginalized communities face with official systems and highlights the importance of trauma-informed and domestic abuse-informed approaches within mental health services.

Explore the profound impact of early intervention and prevention models across the UK, focusing on the integration of the Healing Together program in schools and children's homes. We examine the unique trauma children face when in contact with abusive parents and the potential for misdiagnoses. Understand the importance of recognizing trauma in the context of coercive control, beyond just physical abuse. Finally, we emphasize the power of fostering healing through mindful practices and how resilience and recovery can be significantly enhanced for both child survivors and their caregivers.

Learn more about Innovating Minds and the Healing Together programme

Related Episodes
Season 5 Episode 7: Childhood Domestic Violence Exposure is “Pivotal”: An Interview with Professor Higgins

Season 5 Episode 4: Unveiling the Impact of Domestic Violence on Children: Beyond the Myth of the Child Witness

Season 4 Episode 10: Ensuring the Voice of the Child is Heard, and Child’s Best Interests are Considered in Domestic Abuse Cases


Now available! Mapping the Perpetrator’s Pattern: A Practitioner’s Tool for Improving Assessment, Intervention, and Outcomes The web-based Perpetrator Pattern Mapping Tool is a virtual practice tool for improving assessment, intervention, and outcomes through a perpetrator pattern-based approach. The tool allows practitioners to apply the Model’s critical concepts and principles to their current case load in real

Check out David Mandel's new book "Stop Blaming Mothers and Ignoring Fathers: How to transform the way we keep children safe from domestic violence."

Visit the Safe & Together Institute website

Start taking Safe & Together Institute courses

Check out Safe & Together Institute upcoming events

Ruth Reymundo Mandel:

And we're back, and we're back. Hi, hey, there.

David Mandel:

Hey, this is Partner with Survivor. Yes, and I'm David Mandel, ceo of the Safe Retailer Institute.

Ruth Reymundo Mandel:

And I'm Ruth Ramundo Mandel and I am the co-owner and business development officer.

David Mandel:

That's great, and we're here to do another episode of the show and we're really excited about what we have going on today talking about children impacted by domestic violence, perpetrators, behavior and the treatment of those children.

David Mandel:

And we're going to talk with leading international expert, dr Asha Patel, about that. But before we get into that, let me just acknowledge that we are coming to you from Tungsten Misako land here in the northeast part of the United States Beautiful country, though it's a little bit cold and rainy and snowy and all those things right now and just want to acknowledge this is colonized land and just acknowledging the indigenous elders, past, present and emerging who might be listening to the show.

Ruth Reymundo Mandel:

Yeah. So today we have Dr Asha Patel, who's leading Innovating Minds, as the CEO and clinical psychologist, and her focus is on transforming access to early trauma-informed help for children and young people, and their approach hinges on sustainable, scalable models that maintain clinical integrity, and their team dedication has led to multiple awards recognizing the social enterprise for influence and growth, and the key competencies include digital transformation of services, enabling a broader impact and providing crucial hybrid training to frontline practitioners and Dr Asha Patel's leading minds. Innovating minds organization facilitates the Healing Together program, and the Healing Together program offers direct services to children to support their mental health and well-being. The Healing Together program is a six-week trauma-informed program for children ages 6 to 16. It combines trauma-informed principles with relational approaches, neuroscience and attachment models, and each session helps children make the link between the mind and body and teaches simple tools children can use to help them regulate.

Ruth Reymundo Mandel:

The materials are grounded in research and written by Dr Asha Patel, who's a clinical psychologist, and Jane Evans, who's a childhood trauma expert, and the program is developed by Innovating Minds as an award-winning social enterprise that supports children who are impacted by domestic abuse, and one of the important reasons we wanted to have her on this is because we sit at the crossroads between children and domestic abuse, and we were really interested in their work and in the innovations that they're bringing forward. I really believed, as well, that digital access is really important for the equity and access of people to get services. It makes it easier for them. So welcome, dr Patel. It's really nice to have you on the show.

Dr. Asha Patel:

Thank you. Thank you for welcoming me to your show.

Ruth Reymundo Mandel:

Well, we wanted to get started really with sort of understanding a little bit more about the Healing Together program and how you came about formulating that, what your motivation was in working with children, particularly who are domestic abuse victims.

Dr. Asha Patel:

Yeah, sure. So my journey started 2016 for Innovating Minds. Prior to that, I was a clinical psychologist working in forensic mental health services, so I worked with high-profile murderers, sex offenders, and really felt like I was working at the wrong end of the spectrum. So I was looking around, risk assessment and supporting their rehabilitation. But actually a lot of their journeys and their stories stem from childhood trauma. So Innovating Minds was founded to support children and families access early, early support, early trauma-informed support.

Dr. Asha Patel:

Now, a part of that journey of startup, I came across an organization called we Are and they support mothers that are affected by domestic abuse and I remember having that meeting with them and actually by the end of the meeting I was feeling so hungry and I we'd just have talked for about six hours in terms of the work that they're doing, the need for the support for the children and a lot of their mothers, because they'd been on their journey of recovery, recognised the impact domestic abuse had on their children and were not able to access domestic abuse-informed support. They were constantly told that their children were naughty children. The children was at risk of being excluded from education. They weren't able to access mainstream mental health support services because they were deemed not unwell enough in regards to not presenting with, uh, mental health difficulties or disorders, and that led that frustration and kind of that need to actually these are the children that I want to support. How do we do that and what? What is already out there? And there wasn't very much out there that was evidence-based, that was domestic abuse, informed, that didn't re-traumatize children through that experience or their other parents as well.

Dr. Asha Patel:

So healing together was formed and it was always a program that pulled everybody's heartstrings. We did it on surplus resource how could we like staff's time at the end of the day, every bit of funding we could find and children started coming to our office in Birmingham in the UK. But it wasn't scalable. I could only support 15 children a year. By second session I had a waiting list of 40 children waiting to be come on to our program and that was with no marketing, no referral source or anything.

Dr. Asha Patel:

So such a high demand, but I couldn't scale it. It wasn't an infrastructure, it wasn't something that we could keep continuously doing on that. So healing together has always had a special place in innovating minds, heart and then, as we've progressed as an organization, as a social enterprise, we've been able to transform the delivery aspect and actually in the frontline practitioners that see the children on a day-to-day basis, that are in the children's safe space, by upskilling them means actually children can access early help by the people that they already know and trust in a space that they feel safe in already.

Ruth Reymundo Mandel:

I just want to make one linguistic point, because a lot of our audience are NGO, non-profit and government workers, and that is about the notion of scalability. You know, social enterprises are very, very concerned with making sure that the service deliveries, the programmatic deliveries and the good practices that we are advocating for will reach as many people as possible. So when you hear the word scale, I want you all to actually hear bigger impact. It's a one to one equation and a lot of people who do not work in the private sector do not understand that language, so I just I wanted to explain that scaling means one-to-one impact. It means a bigger impact. It means more people served. It means more impact for them, more access. So this is the language that we use. I think you had a question. So this is the language that we use. I think you had a question didn't you?

David Mandel:

I did have a question. I think it's amazing what you're describing and I'm not surprised. There's such a need to serve children and young people in this space. Not enough services, not enough models. So you know, when you talk about the story of the inception of the program, you talk about listening to moms and listening to their experience, and one of the things that I am concerned about, and I'm curious to hear what you think about is that people are talking more and more about children as victim survivors in their own right, and they do have their own experience. But I'm also worried about I talk a lot and colleagues with Professor Kathy Humphries and we talk a lot about children in context as child survivors and victims in context of their relationships with that, let's say, that protective parent, or even in the context of their relationship with a parent who's using violence. And I'm just wondering how you think about this idea of services to children, whether you see it in isolation or whether you see it in context or in relationship.

Dr. Asha Patel:

So I think there's a place for both.

Dr. Asha Patel:

I think definitely children need their own space and their own services for them, and that's really important because often what happens in services?

Dr. Asha Patel:

They think, ok, if we're working with a parent and supporting them, that'll have a knock on effect on the child and yes, there is that would have an effect. But then also the children have their own needs and they have their own voice and they have their own way of how their body and brain needs to process the trauma that they've been exposed to and therefore that's why I think it's really important that children are seen as victims in their own right and therefore are given services or being able to access services that meet their needs as well. So I don't think it's fair for the child to be assumed, actually, that they they can't access their own services that are designed specifically for them but also at the right time for them, because maybe when safe parents going through the support that they need, maybe maybe that child's not quite ready yet, maybe it's all they're ready before and they need access to that support. So it should be individualized for the child, as opposed to always being in context of where a safe parent is.

David Mandel:

That's great. Thanks for speaking to that, because absolutely, I think one of the mistakes or one of the challenges that have been made in the domestic abuse movement over the years is this idea well, if you keep mom safe, you keep the adult survivor safe, then automatically it rolls down to the kids and that's all that needs to happen. And that hasn't translated over to the, to the real needs of children or or how child serving systems, whether it's family, court or child protection, need to understand. We're trying to understand kids' own experience of safety and well-being. So I appreciate your answer.

David Mandel:

Another question I have is really, you know, I've seen over the years people providing services to children, sometimes gatekeeping when you said something about about timing, and I would like to hear something about that, because I I've heard some people say, oh, you can't provide the service to the kids while they're still living with somebody using violence or they're they're still in contact and and and we know that most of these kids actually remain in contact. So this idea that that, oh, you wait to this magical moment where they're no longer exposed to the person using violence is my experience, is a very limiting and sort of unrealistic perspective. I'm just curious what your thoughts are about that and how you formulate your program in terms of timing, you said, and when's appropriate and when's good to do the work with kids.

Dr. Asha Patel:

So I think this is where it comes to upskilling the frontline practitioners because, like you say, there's never going to be this magic time that everything aligns and maybe all the court proceedings are over and contact no longer exists or anything like that, and therefore I think it's about upskilling the frontline practitioner to know how to safely deliver the program. So with the healing together program, there isn't any restrictions as to if the child's having contact or no contact uh with the parent that's harming. What we do say is actually that they might notice uh the changes. So the adult that is harming the perpetrator might not start to notice subtle changes in how the child is responding and that's because of their uh, they're starting to be able to regulate uh themselves. So the emotional energy they might feel, the change in that uh, which might increase risk to the child. So that's why we ask about the for the frontline practitioner, the facilit to consider those risk factors and making sure that it's continuously to deliver, to be delivered safely. The other thing that we talk about is actually how we communicate the Healing Together programme with Safe Parent and if the adult that harm is also having contact, that information that we're presenting to them lets them know in terms of what the program is and isn't about.

Dr. Asha Patel:

Now that doesn't mean that we've changed the program so the child's not fully accessing what they need to access. It's how we communicate that with both parents. So for us it's really important that a child doesn't stop being accessed to help because everybody else outside think, doesn't think it's safe or in terms of that it doesn't align. And we're waiting for this right moment for maybe the court system we know the family court system can go on for years and years and that the system can be used as a way to perpetrate more harm to the family. So actually in that process, if a child is wanting to access the program, if they feel that they're ready to, and also the program's structured in a way for its flexibility so they don't need to do all of six sessions all at once, sometimes they might start, they might do three sessions, come back to it, they might recap sessions.

Dr. Asha Patel:

We know the impact of trauma on the ability to process information and therefore repetition is also key and important. But the central of all of that is that ability to have a have that moment of co-regulation with a safe adult. So it's not just about that program information they're accessing. It's about that ability of having somebody, that they feel safe with somebody, that it's about that ability of having somebody that they feel safe with, somebody that their body and brain can feel safe with, that they can connect with and actually have that experience, and that shouldn't be taken away from a child yeah.

David Mandel:

So to me that's just for the listening audience that to me is a perfect example of that balance of children as victim survivors in their own right and then children in context of relationship. I think we know a lot about that. Healing happens in relationship and I think for professionals and I'm speaking to professionals that oftentimes we think of services to kids in isolation and what you're speaking to is the value of that protective pair. I mean, the research is pretty clear that some kids will heal in the context of a relationship with an important caring adult and may never need services and I hate to be sort of dissing services, you know, as we're talking to somebody who's doing an amazing service but I do really want to lift up that, the importance of that context and those relations, the familiar relationships, that it could be a teacher it doesn't need to be a protective person and it could be that therapist. But that this is healing for kids happens in context, happens in relationship. Well, for all of us adults too, it happens in relationship.

Ruth Reymundo Mandel:

Well for all of us adults too.

Ruth Reymundo Mandel:

I want to center a little bit around access and pathways to receiving these programs because, as I understand it, this is both a program that's been used upon reporting of domestic abuse within childs in a home in certain regions in the UK, but also that it's accessible.

Ruth Reymundo Mandel:

It doesn't need to be through a court mandate or through law enforcement services, and I just want to hear a little bit about that because I think that that's really important. Those multiple points of access are super important for both survivors' autonomy, for safety and for not gatekeeping our ability to support our children when they've witnessed and experienced domestic abuse. And you know, I'm just I'm curious to know how that's being received in your region, how the program is being utilized, how you're experiencing those referral pathways you know, and how children are being treated as victims when they are being referred out to mental health services. Because there is obviously concern where we have seen survivors come into contact with mental health services when it's not domestic abuse informed and not trauma informed that any diagnoses or behavioral diagnoses often get weaponized against them. So we have a lot of concern for how mental health diagnoses are used and manipulated by perpetrators to try to extend their power and control post-separation. So talk to me about all those bits. I want to hear it all.

Dr. Asha Patel:

Yeah, sure, so in each region across the UK offers a very slightly different model, but they all come with a focus around this early intervention and prevention model from children needing to be referred or escalated to social care services, children and adolescent mental health services, so camp services. So, for example, in Manchester City Council we have a great where public health are involved and public health have driven the initiative to train the early help support teams but also schools and grassroots organizations so where children and families might have that initial first contact, particularly within schools as well. So across the UK it's been used in schools and that means that when schools have a notification that this child has been exposed to domestic abuse in the household or that there's safeguarding that have been raised regarding domestic abuse, there's somebody trained within the school to be able to access and be able to deliver the Healing Together programme In another local authority in Warrington. What they have done is said healing together is tier one. So children shouldn't even be escalated across through the tier services because what can happen in other local authorities is the only way to access help is to put family through the full social services and therefore that helps he can experience that process of going through social services can be traumatic in itself. So actually provide healing together program at tier one service at early intervention point, and that is then to prevent that escalation of needing that additional support. We've then then got other local authorities where they're saying actually every primary school should have the Healing Together programme and they've become like champions within areas where they're actually delivering it across their schools. They've got staff that are timetabled part of their weekly timetable to plan and deliver the Healing Together programme.

Dr. Asha Patel:

So there's a real shift and a real understanding and thinking okay, how do we make it more accessible in terms of early intervention, but how do we make it more scalable and sustainable in the sense that it doesn't require ongoing commissioning.

Dr. Asha Patel:

Once somebody's trained, once they're a part of the existing workforce, that means children can access it. So it doesn't mean that on a year-to-year basis at risk of being decommissioned, but then also it comes a part of the system, because then the rest of the team around those people that are trained start to get excited about it, start to want to know more, they start to co-facilitate the program. We've also got it in children's homes as well. So salute and care and education. They work with support, children in care, children that often come from families of children being exposed to domestic abuse, children that have been neglected. So creating that whole system approach to trauma informed and domestic abuse informed. Then changes every day-to-day language the way that they start to see behavior as a form of communication. So it goes beyond the six weeks, six sessions program. It actually starts to infiltrate into the environment, into everybody's day-to-day practice.

Ruth Reymundo Mandel:

That's great.

Ruth Reymundo Mandel:

That's great and I also think it's really a key point that this is very behaviorally focused.

Ruth Reymundo Mandel:

Children learn patterns of behaviors and strategies for control from their parents and we know that in cases of femicide, that there's a certain set of the population of women who are killed by their children, and that domestic violence was in the home prevalently prior to that femicide.

Ruth Reymundo Mandel:

So it's really important that we work with children and give them tools for regulation, for behavioral modification, that we acknowledge their experiences and that we acknowledge that the behaviors that they experienced were harmful and that we give them other behaviors. We model to them other ways of relating, resolving conflict and dealing with their fear and anxiety about loss of power and control. So I'm excited to hear that there's so many different entry points for access, because we do have a bit of a global problem in that many services are only accessible if you use the main access points, which is usually law enforcement, and that those access points are very limiting and that they themselves, being the main access point, limit people engaging for help. People will avoid that. So I love that you're highly accessible, that your language is seeping in um and that there's a lot of behavioral emphasis and the thing that's a real emphasis is actually seen as life persevering behaviors.

Dr. Asha Patel:

So, in response to the trauma the children have experienced, their body is operating a way of safety, survival. Their brain is operating a way. So often we can think, okay, is it learned behavior, is it based on what they're seeing? But actually as well, it's their body and brain's mechanism to keep themselves alive as well to keep themselves safe, that they're functioning in safety, survival mode constantly, that meerkat mode that actually is behaviors that are presenting to protect themselves.

Ruth Reymundo Mandel:

Yeah, I always tell people you used strategies that may not have been beneficial in the long run, but in the short term they saved your life and that's amazing, because you're amazing.

David Mandel:

So I'm going to pick your brain as an expert in children and domestic abuse, not just as somebody who's created this innovative program and the social enterprise and scaling it.

David Mandel:

One of the things that I think about a lot and written about is one of the chapters in my book I talked about the myth of the child witness and also another chapter of the myth of trauma-informed practice, and it was both chapters to kind of explore lots of different things like the impact of domestic violence perpetrators behavior on kids and the how far it's beyond just seeing and hearing, and also explore the idea that that that sometimes there's this uh gap in the way we talk or think or practice and I'm kind of curious what you think about this, which is the concept of trauma, is historically been very centered on physical violence and kind of threats to bodily integrity, sense of self, loved one.

David Mandel:

But coercive control is a much more complex set of behaviors that, from my perspective, don't neatly fall into the trauma box, at least the way it's been practiced by many people, that so many things that domestic violence perpetrators do as part of coercive control, whether it's financial control, whether it's making false allegations to child protection, whether it's targeting professionals to manipulate or get them to collude, you know, or using culture. These things don't, in my experience, don't always line up with the trauma box. So can you talk a little bit out of your experience about what perpetrators do to impact kids? But this whole conversation about? Is it all about trauma or are the pathways more complex and varied?

Dr. Asha Patel:

Coercive control is trauma in the sense that, yes, okay, it's not a physical act, but the emotional act coming out of coercive control, the impact it has on the body in the sense that it'll be sensing danger, that constant feeling of eggshells or having to is this, this, they're nice because of something that's going to happen, but I still need to do xyz or we need to behave in this specific way will heighten a sense of anxiety in us in that there's a perceived threat and in this situation there's actual threat that is constantly there. So it is traumatic for the child to experience the uh constantly living in coercive control and being exposed to that. Even if they're no longer living uh with the abusive parent, there still acts of coercive control that takes place, but also those pathways that are formed neurologically and that there's a certain way that things have been for so long. So there's this expectation that harm is going to come to them, that their body will be constantly reacting to that and responding to that. So when we think about trauma and trauma-informed practice, we shouldn't put this hierarchy in place in terms of what form, what domestic abuse have they been subjected to?

Dr. Asha Patel:

Is it physical violence? Is a sexual violence taking place. Is it coercive control? Is it through the internet? Is it financial abuse? Because actually all of those will have an effect on somebody's body and brain, how they, how it responds and how they're safe they're. So I think us as professionals sometimes often put this hierarchy in place and think, okay, this person's probably more traumatized because they've experienced X, y, z, but actually it's about that individual's experience of that trauma. That is the most important and most thing that we need to keep at the central of this, and we don't focus on the act itself but the impact it's had on the child or on the family as a whole.

Ruth Reymundo Mandel:

Yeah, that's interesting because I think that highlights a little bit some of the differences between trauma-informed and domestic abuse informed.

Ruth Reymundo Mandel:

And I believe they're supportive of each other.

Ruth Reymundo Mandel:

We believe they're supportive of each other, they're just not the same, and that is that the focus on the impact is very important for being able to clinically support somebody, to properly clinically support them in the long term for the trauma that they've been given.

Ruth Reymundo Mandel:

And in domestic abuse informed, there is a focus on the perpetrator's pattern of behaviors as a parent, so that we can hold them responsible, and also documenting the adult survivors' strengths and protective capacities so we can also highlight how they've had to struggle under these conditions to support their child and themselves and keep themselves safe, often in ways that official systems don't recognize, especially if that victim survivor is from a marginalized community and is resistant to coming into contact with law enforcement or child protective services because of the context and the history of the thing, or child protective services because of the context and the history of the thing.

Ruth Reymundo Mandel:

So it's really important for us to understand where one methodology ends and the other one begins in order for us to know that we're actually doing two different actions that are supportive of each other, and one is very focused on healing and therapy and supporting a person through those those predictable physiological, biological, hormonal responses to trauma. And and one of the things that I think that you're doing it sounds like that'll that many people fail to do when they're trauma-informed is to accommodate for the reality that there is going to be ongoing contact and trauma from a person who either has continued and unresolved coercive behaviors or continued and unresolved violent behaviors, because collectively we're failing to hold that person behavioral, behaviorally accountable so I can I add something and then I'd love to hear dr patel's view on this.

David Mandel:

You know which is. You know, when I hear you talking ruth, I think about sort of as a clinician, somebody you know trained from a mental health perspective. You know, listening to colleagues for decades really kind of talk about trauma and being trauma-informed and oftentimes my frustration that the conversation throws all different sources of trauma into one bucket and then boils them down to the symptoms of the biological response and say, well, the way we need to treat that is all the same.

Ruth Reymundo Mandel:

So a car crash is the same as the parents sexually assaulting you.

David Mandel:

A car crash versus a refugee experience versus a community violence watching somebody be knifed on the street, and what you're bringing out I think Dr Patel, you're talking about is children in context of these relationships where the course of control has continued access. So I'm curious what your thoughts are about this wider discussion about trauma-informed versus domestic abuse-informed and how the unique situations of children in domestic abuse may differ than somebody who experienced war trauma in another country. You know, which is real but may have a very different context or constellation of factors around it. Does that make sense to that question?

Dr. Asha Patel:

Yeah, so I think the underlying principles of trauma-informed practice apply.

David Mandel:

Yeah.

Dr. Asha Patel:

Where we're talking around children being affected by domestic abuse, there's something long-term in the sense that they still might be having contact uh with them or even forced contact uh through the court system. Uh also even where there I've seen it myself where there's been um, a court order of no contact, but then social media contact can be authorized or letter writing is authorised and then asking a safe parent to mediate that contact and to monitor it. So not acknowledging that safe parent is actually evicting themselves of domestic abuse and being affected by coercive control and other forms of domestic abuse. But then children are also continuously exposed to that and also the lifestyle changes because they might be in financial hardship, they might have had to move schools, they might have had to relocate or live in refuges, they might have lost contact with the family that they used to have. From the other parent's side.

Dr. Asha Patel:

Domestic abuse informed clinicians, I think sometimes they they struggle to see actually the long-term underlying ongoing difficulties that this child has been exposed to and for the prolonged period as well. So often babies as well are affected by domestic abuse and they've gone through their development so all the way through from those critical a thousand and one days of experienced trauma. They've experienced trauma in the wound, they've then gone on into their adolescent development, et cetera, and that is all being hindered by the exposure to the trauma of domestic abuse. So often when they come into contact with mental health services and you spoke before about being diagnosed so often they can then lead to a diagnosis of something like adhd autism and there's that cross.

Dr. Asha Patel:

The presentation between the two in terms of the symptoms or the the.

Dr. Asha Patel:

What they're looking out for can often be misrepresented because of the how trauma is presenting, so it comes across as if it's autism as adhd and that's because of how trauma is presenting, so it comes across as if it's autism as ADHD. And that's because of clinicians are not always domestic abuse informed and haven't seen that relational approach in terms of actually this is trauma presenting from the domestic abuse when often the Healing Together programme is being used with asylum seekers, refugees, and is being used with asylum seekers, refugees, and is being translated into other languages. It's that around the resettlement, but also processing the trauma that I've experienced in terms of war, being affected by the war, being living in fear, but then also moving to a new country and thinking about what safety feels like again on that journey I think there's something so, um, powerfully impactful about having a person who is supposed to nurture and protect you be the the source of your harm, sort of as a primary, fundamental, you know, concrete trauma that children are experiencing.

Ruth Reymundo Mandel:

That is different. It is different than experiencing displacement, war and forced migration, as well as other traumas like car accidents so on and so forth. That betrayal, that fundamental betrayal is, is so harmful to children and their ability to healthily attach to other people.

David Mandel:

You know, and I I really feel like we need to say that out loud and and and to add to that the, the intimate knowledge, so the betrayal of the trust yeah the intimate knowledge I have, an access I have to you, you know, and then the legal entitlements that I may be given or have or be reinforced, and I've even seen courts um enforce, courts enforce or support access of non-biologically related kids of perpetrators who manipulate systems. There's one case where he was the stepfather, he had no legal rights to the child and he was the perpetrator of the violence and the court placed the child with him or supported his keeping the child from the mom because they had kind of put her in this really negative box, probably because of mental health diagnosis.

Ruth Reymundo Mandel:

That's right. That's right. That's right After he abused her.

David Mandel:

I think it's really, you know, I think this both and approach. You know, I think one of the themes here is this both and approach to this conversation.

Ruth Reymundo Mandel:

It's just the limitations of diagnoses.

Ruth Reymundo Mandel:

Diagnoses are meant for treatment protocols. They aren't meant to document patterns of perpetration or give evidence for who the person who's harming is. But at the same time, because our documentation is often used in legal settings, we have to be complete about who's causing the harm, who is the ongoing threat to the child and what their impact is. That is absolutely important and we also have to because this is a child who lives in a relational setting, who's completely dependent upon their parent figures. We also have to really map the way that the adult survivor is protecting and supporting them, because even a small amount of protection and support and acknowledgement that those behaviors are not acceptable, that they're harmful and hurtful, can help to preserve the dignity and mental well-being of a child. One of the most damaging things for a child in those situations is to feel like nobody is saying that it's wrong. Everybody's afraid to name it as being a behavior that is not acceptable because a parent is perpetrating it and there's some weird belief that naming abuse as a problem is undermining somebody's parenting.

David Mandel:

So can I flick that to you as a question, Dr Patel, which is sort of you know again, whether it's about the program or just about your expert kind of thoughts about this, which is just sort of kids and their relationship with that person using violence to the perpetrator is, I think, is an interesting area that people don't talk about enough. I think there's sometimes a simplistic view sort of that this person's quote-unquote bad, the answer is to separate the kids and then we're done talking about the kid's relationship with a parent using violence or control. We know that kids' experience is much more complex, much more layered, much more diverse across the range of kids. We know that many kids want to remain in contact. Their survivor parents want that kid to remain in contact if it's safe and sometimes contact is forced. I mean just so, can you just talk a little bit about your the program or your your experience of kids and their relationships with that person using violence or control?

Dr. Asha Patel:

yeah. So the healing together program is very much focused on understanding how their body and brain works, what happens when they're feeling safe and unsafe, and being able to use some discrete strategies to help their body to feel safe again so it can send messages to the brain. So there's nothing in there that starts to unpick about their experiences, direct experiences of domestic abuse and that is because we don't want to go through the re-traumatization of retelling their story. And that happens within the system, happens when they come in contact with professionals. They have to keep retelling their story and often they don't want to. Now, in terms of their contact and it varies for every child that I've come into contact with because the relationship has been so complex I've seen children that never want anything to do with them again and actually want the system to put that in place for them. So, but then the system keeps saying, oh, we need to get child's voice, we need to hear it again, because then it's being contested, and then the same Well, well, actually the child's not old enough and well, almost the child is now 16 or 18, so actually then we still need to ask for it. So they're desperate for somebody to say no, no more contact and that needs to be a legal process because the system around that family isn't been able to do that for them.

Dr. Asha Patel:

I've also then seen children that are really angry at mum, at safe parent, because you're the one that's made this happen. I want to see dad, I don't know why you've done this, and look at our life now it's a mess and they're desperate to have contact and mum and the support around mum is saying no, it's not safe for that child. So they're really struggling and that's maybe the younger children and often as well when children have been used as pawns within this process or placing children in a role within the household that actually maybe child is used by the perpetrator to spy on mum or kind of keep control of contacts on mum etc. But then I've also seen it play out in siblings where one sibling is treated different to the other. One is favouritised and gifted and kind of love bombed and the other sibling ignored. So I feel it's an individual for each child in terms of their experience and where they're at, with whether they want contact, what that contact looks like.

Dr. Asha Patel:

Sometimes it's not in hope that something's going to change. Like you said, it is their father. There's kind of this belief that, well, you're my parents, it should be this way. This is kind of what society tells us. They go to school, they see parents at the gates, they see family events taking place and start to question why is my family not like that? Or could it be like that? So that experience for the children, I think is very difficult for us to navigate as a system and think that there's going to be a one size fits all approach, and that's why it's so important that frontline practitioners are domestic abuse informed so they can actually start to think about these differences in relationships and their experiences.

Ruth Reymundo Mandel:

Yeah, yes, not all relationships are the same. This is very real and victim survivors respond differently to the perpetration and there's definitely no one size fits all and builds on the Safe and Together model and is compatible and supportive of domestic abuse-informed practice, which is a little bit more centered on obviously mapping perpetrators' patterns of behaviors as a parent, their impact on child and family functioning, the impact on the adult survivor and also mapping and supporting the protective efforts and strengths of the victim survivors. So talk to us a little bit about how our programs are kind of supporting each other in the environment, what you're experiencing, maybe of even professionals, some who are domestic abuse informed, some who are not.

Dr. Asha Patel:

Yeah, so I think from the and correct me if I'm wrong the Safe and Together model is looking at the systemic, the ways in terms of the system looks in terms of respond to domestic abuse, how they support the victim, survivor, how they support children, young peoples, but then holding perpetrators too accountable as well, and from a trauma-informed, from a domestic abuse informed lens.

Dr. Asha Patel:

So really thinking around the language, the documentation, the processes, the interviewing type, questions and upskilling the frontline practitioners that are having that contact with the families.

Dr. Asha Patel:

Now where I feel healing together program dovetails really nicely is the safe and together model, that holistic, systemic approach.

Dr. Asha Patel:

Work is taking place.

Dr. Asha Patel:

The healing together program now enables the children to have that direct intervention, that direct piece of work with those frontline practitioners that are also gone through the safe and together model.

Dr. Asha Patel:

So not only systemically are children benefiting their own, they're also benefiting from being directly being able to access the support and all of that gives a positive help seeking experience, which then leads to future help seeking experiences that we're trying to take these families away from, these negative help seeking experiences that they've had from professionals, which makes them more reluctant to go and seek help when they need it and, as we know the children are going to need the same long term. So actually, if we can give those them and we've seen it play out where then families have come back and said do you have anything else to offer? Actually, they've never engaged like this before. What else can our family engage in? Or a child's gone back into school, there's a reduction in child to parent violence, there's an increase in relationships, in the sibling relationships, and that there's how to feel safe again. So I think that's where it dovetails and it fits really nicely.

Ruth Reymundo Mandel:

I think about how we often have a very adult focus when we're speaking about engagement and documentation, and one of the foundational concepts of the model is the partnering concept, which means really acknowledging and affirming the experience of harm that the pattern of behaviors of the perpetrator have caused, and that includes acknowledging and affirming children's experiences. That is something that is incredibly powerful, incredibly healing. To have a professional look at you and say you did not deserve to be treated that way. That is not the way that a parent should engage with a child. Those are not behaviors that are supporting your well-being or your behavioral health. Those are not good behaviors for a parent to model to you. Those are behaviors which destroy your family and your connections and your relationships. Those are behaviors which destroy your family and your connections and your relationships. That was not your fault. You did not choose that by you saying no to your parents. That was a normal childhood behavior. Them responding with violence and abuse is a harmful behavior.

Ruth Reymundo Mandel:

All of those affirming statements should be a routine part of everybody's practice, especially if they're interviewing children. It doesn't matter if you are a mental health practitioner or not. That's basic, fundamental partnering to affirm the reality that somebody's behaviors have deeply impacted that child and have harmed them. So we do that with the adult survivor them. So we do that with the adult survivor. We need to do that with the child survivor as well. That needs to be very much the way that we approach children, rather than approaching them from a place where they feel very threatened, they feel responsible, they feel unheard and they feel potentially like nothing is going to be done to help them because they've seen nothing be done to help them. So I love how you describe the dovetailing of the two models and the language seeping in.

Dr. Asha Patel:

Yeah, I also think as well. There's something here around. We talk about these affirmations, but this is really cognitively heavy and we can't process trauma cognitively. So until we feel it, then that's when we start to actually accept it. So it's a bit like when we tell ourselves stop being stupid. So if I was coming on today, I was. I'm feeling really anxious. What if I don't? And I say stop being stupid, asha, I still feel inside extremely anxious. So, as much as I can tell myself cognitively, if you're feeling that way and you're feeling unsafe, it still doesn't connect with you and that's the whole thing around the connection with somebody and feeling it. So feeling that safety, that then you can start to start to think actually that wasn't okay, this isn't okay, they are my mum, that, my dad, uh, whoever's perpetrating the harm, but actually it still doesn't feel safe. But they can be open to that because as much as somebody cognitively tells them that and it's a cognitive process it doesn't process because that's not how our bodies and brains work right I love that.

David Mandel:

It's um that your work is is got this embodied gestalt element to it.

David Mandel:

You know, I I trained in body-centered gestalt therapy for a number of years and and there was so much work about the body experience of trauma, how the body locks. You know those, those experiences in the physical body, and how the healing needs to happen in that physical body and in relationship. You know, and those words, those connections, those looks, those gestures, those transmit safety or unsafety. They transmit love, they transmit validation, they transmit, you know, a sense of it's okay for you to feel the way you're feeling. And I love what you said earlier about professionals really need to respect the diversity of kids' experiences and not impose our view on that. So, you know, I think it's a great approach.

Ruth Reymundo Mandel:

Well, we have been jabbering here for about an hour, I think. I mean, we really got into it, I think one of the. Just to start wrapping up, what would you say to professionals about the importance of trauma-informed mental health services dovetailing with domestic abuse-informed practices, specifically for child victims of domestic abuse?

Dr. Asha Patel:

I would say be curious and think about the system that you're working in and have a look at it from a lens of trauma-informed, domestic abuse-informed, and find somebody within your organization that gets it. That's really critical. Not everybody does. Everybody does. For us it feels like common sense, for others that's not the case. Find something in your organization that gets it and see how you can champion to start changing some of these practices. Thinking about your own practice.

Dr. Asha Patel:

So not everybody has the ability to make change systemically, but you are the key resource. So start looking for that magic wand, that magic intervention. Actually focus on yourself and think about how you conduct the training, whether it's the healing, together training, the safe and together institute training to inform your practice, because their work, their connection with children and families will go way beyond and might not even ever know the impact it's had on these families and these children. Sometimes they come back 10 years later and say remember that thing that you said to me, or that thing that you did, or you used to say hello or you smiled at me. That's the thing that's going to make the difference.

Ruth Reymundo Mandel:

That's great. And then I want to let you know that we actually have a lot of kids that listen to this podcast. We have found that out, that there's a lot of adult survivors who listen with their children. So what would you say to survivors?

Dr. Asha Patel:

try to focus on being with your child, and when I say being with, it's about being in that present moment with them. So how you spend your time with them, you might be feeling guilty that you can't do loads of different activities with them. External activities it's either expensive, you're not able to, but actually those moments of being with them, of connecting with them, even if you're washing up the dishes, there's so many sensory based activities that you can do in the household that can help your child's body to feel safe, but also for you to connect with them and reconnect with them, that'll go such a long way in their journey of healing and recovery.

Ruth Reymundo Mandel:

And what would you say to child survivors as well?

Dr. Asha Patel:

Well, the child survivors. It's very much thinking about what you need and it's okay to put yourself first. Often I work with children who blame themselves for it. He thinks things could have been different. But knowing that actually you're important, your needs are important and it's okay to put yourself first and really listen to what your body is telling you. Probably for a long time you've pushed away the feelings, your gut feeling that your body's been telling you, but maybe now's the time to start listening to your body, to help you in places, whether it's school, whether it's at home, whether it's thinking about getting back into school, being around your friends again. Use your body to help you because that's a little uh coping mechanism, a little superhero that you've got that you might not recognize. That's great well.

Ruth Reymundo Mandel:

Dr asha patel, we are really happy that you joined us today and thank you for all the work that you're doing to support children who have experienced domestic abuse, and we are partnered with a survivor.

David Mandel:

And I'm still David Mandel, the CEO of the Save it Together Institute.

Ruth Reymundo Mandel:

I'm still Ruth Ramundo and you can do some low-cost domestic abuse-informed training on our virtual academy at academysafeandtogetherinstitutecom, and we will put the resources for Innovating Minds and also for the Healing Together program in this podcast episode notes so that you can take a check at their program and their offerings. So thank you very much, dr Patel, and I hope you're well and I hope your work flourishes and helps lots of kids and we are out, thank you.