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  • 07 August 2023
  • 9 min read

Addressing The Pressure On Children's Paediatric Services: Embracing Trauma-Informed Approaches

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    • Richard Gill
    • nathan crimes
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  • 366
Children's Paediatric Services“By adopting trauma-informed approaches, we can pave the way for a more effective and compassionate childcare system.”

Unregulated placements, funding reductions, and an increase in vulnerable children are intensifying pressure on paediatric services. In this in-depth piece, Nathan discusses how a trauma-informed approach could help to resolve these issues.

In recent times, local authorities have been grappling with the challenge of caring for vulnerable children under social services' supervision. The national shortage of available local authority placements has forced authorities to resort to using empty hospital estate, unregulated placements, and paediatric inpatient environments as social admissions, intensifying pressure on paediatric services.

Consequently, the wellbeing of these vulnerable children is being compromised due to a lack of appropriate placements. To tackle this issue effectively, we must prioritise meeting the needs of this vulnerable group, focusing on utilising trauma-informed approaches that place emphasis on nurturing the mental and emotional well-being of this population and support sustained emotional stabilisation. This also includes, where necessary, the robust scaffolding of placements at risk of breakdown.

The Pressing Issue

A combination of factors has contributed to the scarcity of local authority placement options. Population growth, the rising demand for specialised care of vulnerable children who require care outside of the family home, and a reduction in funding in previous years have all played a role in exacerbating the situation.

Moreover, the number of vulnerable children has increased due to issues like neglect, abuse, and family crises, further straining the capacity to find suitable placements.

As a consequence, local authorities have been compelled to place children in unregulated placements that include paediatric wards and empty hospital estates.

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The Impact Of Unregulated Placements

Unregulated placements represent a troubling aspect of the current childcare system. These placements often lack proper oversight and adherence to essential standards, leading to the potential of compromised care for vulnerable children.

The absence of necessary support and therapeutic services in such settings can significantly hamper a child's development, mental health, and overall well-being.

Without a regulated and nurturing environment, these children are at a higher risk of experiencing recurring trauma, hindering their healing and growth processes.

Addressing The Need: Sanctuaries & Admission Avoidance Work

To address the pressing issue of pressure on paediatric services and the negative impact on vulnerable children, innovative plans must be implemented. Two approaches that can significantly contribute to improving the situation are the establishment of sanctuary space model accessible to children and young people and the prioritisation of admission avoidance options targeted at children in psychological distress.

Without a regulated and nurturing environment, these children are at a higher risk of experiencing recurring trauma, hindering their healing and growth processes.

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Sanctuaries For Vulnerable Children

Sanctuaries are specialised care environments designed to offer immediate support and safety to children experiencing acute psychological distress. These sanctuaries can be strategically located within communities to ensure accessibility and timely intervention. The focus of these spaces should be on creating a calm and soothing atmosphere that facilitates emotional regulation and coping for the children in crisis.

Key Components Of Sanctuaries

• Trauma-Informed Care: Sanctuaries should be designed and staffed with trauma-informed professionals who are skilled in providing sensitive and compassionate care to children with complex emotional needs.

• Therapeutic Support: Trained mental health practitioners should be available to offer immediate therapeutic support and interventions to de-escalate emotional crises effectively.

• Family Engagement: Involving the child's family in the sanctuary process is crucial for their long-term well-being and recovery. Supporting families during times of crisis can strengthen their ability to provide a nurturing environment for their child.

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Admission Avoidance Work

Admission avoidance work focuses on preventing unnecessary hospital admissions for vulnerable children. By identifying and addressing triggers for crisis early on, professionals can intervene before a child's distress escalates to a point where hospitalisation becomes necessary.

Key Aspects Of Admission Avoidance Work

• Early Identification: Implementing early screening and assessment measures can help identify children at risk of psychological distress. Identifying and addressing triggers early can prevent situations from escalating.

• Individualised Support Plans: Developing individualized support plans for children at risk of crisis can help caregivers, educators, and social workers respond effectively to their unique needs.

• Crisis Intervention Teams: Creating dedicated crisis intervention teams that consist of professionals from various disciplines can ensure swift and coordinated responses during times of distress.

• Crisis Respite Care: Providing respite care services for families caring for vulnerable children can offer temporary relief and support, reducing the likelihood of crises that require hospitalization.

By adopting trauma-informed approaches, we can pave the way for a more effective and compassionate childcare system. Only through collective efforts and a commitment to the welfare of our children can we ensure a brighter and healthier future for them.

The Role Of Trauma-Informed Approaches

Addressing this critical issue requires a paradigm shift in how we approach the care of vulnerable children. Trauma-informed approaches offer a holistic framework for understanding and responding to the needs of these young individuals, considering the impact of past traumatic experiences on their present behaviour and emotions.

Such an approach emphasises safety, empowerment, and collaboration to create an environment conducive to healing.

Implementing Trauma Informed Approaches

• Training And Education: One crucial step in improving the situation is to provide comprehensive training and education to professionals involved in the care of vulnerable children. Social workers, healthcare providers, and caregivers must be equipped with trauma-informed knowledge and skills to identify, understand, and address the unique challenges these children face.

• Early Intervention And Prevention: Prioritising early intervention and prevention efforts can significantly reduce the number of vulnerable children facing crisis situations. Strengthening family support services, community resources, and mental health programs can address issues at their root, mitigating the need for acute care placements.

• Collaborative Networks: Establishing a well-connected and collaborative network between local authorities, healthcare providers, educational institutions, and community organisations can facilitate the sharing of resources and expertise. This integrated approach can streamline the process of finding appropriate placements and support services for vulnerable children.

• Investment In Mental Health Services: Governments and local authorities must prioritise investing in mental health services specifically designed for children. This includes increasing the number of child psychologists, therapists, and counsellors to provide timely and specialised care to those in need.

• Addressing The National Bed Shortage: Addressing the national bed shortage for children under the care of local authorities requiring care and support outside of the family home is essential on a broader scale. Governments need to work closely with local authorities to increase capacity and ensure that every child in need has access to appropriate and regulated care facilities.


The mounting pressure on paediatric services and Child and Adolescent Mental Health Services (CAMHS) has led to increased usage of children's paediatric beds, vacant hospital estates, and unregulated placements for vulnerable children. This pressing issue requires immediate attention.

To address the current strain on paediatric and CAMHS services, along with the scarcity of suitable placements for vulnerable children, innovative solutions are necessary. The establishment of sanctuaries and prioritization of admission avoidance work can significantly enhance the care of children in psychological distress and alleviate the burden on the system.

By adopting trauma-informed approaches, investing in early intervention and education, building collaborative networks, and addressing the national bed shortage, we can pave the way for a more effective and compassionate childcare system.

Only through collective efforts and a commitment to the welfare of our children can we ensure a brighter and healthier future for them.

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About the author

I am Head of Nursing, Children’s services at West Area Integrated Health Community. I have experience working as a specialist advisor for the CQC and a lead reviewer for the Royal College of Psychiatrists Quality Network for Inpatient CAMHS (QNIC).

    • Richard Gill
    • nathan crimes
  • 0
  • 366

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