‘We all have prejudices and biases – we can all learn'

Ian Florance talks to Camilla Sanger.

I met Camilla Sanger at the Spitalfields offices of ChildLine, which is part of the National Society for the Prevention of Cruelty to Children’s (NSPCC’s) portfolio of services. I could see why she was so excited about how NSPCC’s work will affect the lives of millions of parents and children in a fundamental way. And I was equally interested in her own fascinating life story. Before talking about the NSPCC projects I asked Camilla the path she’d taken to get involved in them.

‘Neither of my parents had an education, and as a result they expected a lot of me. I grew up in Sussex, went to a good school and worked hard, but was fairly socially rebellious and often got into trouble. I wanted to study medicine and had a place at Imperial College, but I wasn’t well enough to sit my exams and therefore didn’t get the very high A-level grades needed. I experienced a serious short-term neurological disorder resulting in very low cognitive function and memory loss. I still can’t remember certain things. It seemed likely that, given the after-effects, there was little chance of succeeding at any sort of study, but slowly things got better. Because I’d previously done quite a bit of voluntary work and performed well in my psychology modules at college I ended up reapplying to do psychology and neuroscience at the University of Sussex.’

Camilla believes her route into psychology matches her personality: unconventional. ‘Everyone thought I was going to fail badly, and I was unsure what I wanted to do, but I became really driven at university, not least in the amount of work experience I gained outside the course. I worked in a therapeutic children’s home run by a clinical psychologist, managed a team in a sexual health clinic and did work in the treatment of drug- and alcohol-related conditions as well as setting up a charity in West Africa. A summer placement in Ghana at the end of my first year to promote mental health services really drew me to the continent. Post-degree I worked in a mother and baby unit to earn money, then went to Africa, coming back when the charity was taken over by someone else. My job history is a bit hotchpotch from there – a number of local authority roles supporting “at-risk” parents. Then I started doing psychosexual therapy and got really interested in the dynamics of couples. My supervisor at the time was a really inspiring clinical psychologist, whose similar “unconventional” story convinced me to apply for clinical psychology training.’

During her doctorate at Oxford University Camilla became more interested in women’s health issues and, after qualifying, moved to the NSPCC in November 2015. I asked Camilla what her role in the NSPCC is. ‘I lead nationally on a portfolio of research, policy and service development projects that targets pregnancy and babies – with the ultimate aim of ensuring that infants are safe and nurtured. Moving into a management job at the NSPCC is not a traditional move for a newly qualified psychologist, but to me it makes perfect sense. It has been quite a shift up to a relatively senior position, but I have not lost my drive and determination and a strong desire to succeed in the role. We need more women at the top of clinical psychology. Tanya Byron inspires me– she has used media to enhance the profile of our profession. I hope that I can do something similar in the future.’

You work in an emotionally challenging area. ‘It is, but in a very different way from direct client work. I’m removed from that, and what I now do is challenging because I know how important the issues are and that the buck stops with me – in so far as I can mould our services. I do miss clinical work… which I’m surprised about as I was sure it wasn’t for me. When I’m more settled in this job I may start a small clinic. Direct client work gives you credibility when you’re arguing a business case or conducting training, and it is a set of skills that I would not like to lose.’

During this part of our conversation, Camilla talks a lot about systems. ‘I think people need to think more creatively about how to apply clinical psychology skills in worlds beyond one-to-one therapy. I like using the ideas of clinical psychology to affect how systems work.’ Had you become more politically motivated during your clinical psychology degree? ‘I’d prefer to say that if you work in these areas it is absolutely essential that you are politically and socially aware.’

Camilla tells me the NSPCC is innovating in perinatal care. ‘I’d like to get the message about this across to as many people as possible, including our own front line staff.’ Can you define perinatal for me? ‘From conception for the first one to two years of life. It’s about the transition to parenthood starting with the parents’ influence on the fetus. Traditionally the area focused on postnatal depression, but now we take a much more holistic view of the issues involved in parents’ unique influence on child development. We know that what happens during this period can affect children up until their adolescence and beyond.’

This is evidenced by the ‘1001 Critical Days’ cross-party manifesto supported by politicians, organisations and individuals across the board (www.1001days.co.uk). This manifesto highlights the importance of acting early to enhance the outcomes for children. The title refers to this critical period between conception and Year 2. I asked Camilla to give me a flavour of the programmes and reports the NSPCC is launching. ‘There are maybe too many for one article but Baby Steps is an example – it is our relationship-focused perinatal education programme for disadvantaged parents. Recent research threw a huge question mark over the effectiveness of traditional antenatal education, and we wanted to develop a service that focused more
on the psychological adjustments of transitioning to parenthood opposed to just preparing for birth. Baby Steps was co-developed by Dr Angela Underdown at Warwick University. It starts in the third trimester and is run by two people – someone who works in children’s services (like a family support worker or social worker) and a health visitor or midwife. We know from research that during this period couples experience very low levels of relationship satisfaction so the service is aimed at couples.’

Baby Steps starts with a home visit in the seventh month of pregnancy and then includes six group sessions each week before the baby is born. After babies are born the family is visited again at home, and then there are three more group sessions, including films, group discussions and creative activities. Camilla tells me they’re interactive and designed to build confidence and communication skills. There’s a strong focus on building relationships between parents and with their babies.

‘We have over 40 service centres round the UK and Channel Islands. We piloted, evaluated and refined this programme in those centres and have now started planning for scale-up – testing out the programme in a number of external local authority areas. This latter point is important. A programme might work in the very specific environment of one of our centres but fail completely in the different context of a hospital, a children’s centre, a GP surgery or wherever. Our evaluation of Baby Steps so far is very encouraging – we’ve found huge improvement in both parent–fetus and parent–newborn attachment as well as improvements in parental anxiety. This is vital, given that parental anxiety has such a huge influence on children’s later development. And we’ve also seen improvements in parental self-esteem. The programme protected against the usual decline in parental relationship quality, and there have been fewer caesarian sections so there have been better birth outcomes.’

Another example Camilla gives is ‘Coping with Crying’. ‘Forty-five per cent of all serious case reviews are with children under one. At that age children aren’t reacting to cues and, in turn, parents can find crying difficult to cope with. There are 200 shaken baby syndrome cases a year, of whom 25 per cent die, and between 50 and 80 per cent who survive will suffer from severe and life-changing disabilities. We’ve developed a very simple programme based around a 10-minute DVD to give parents some of the risks of shaking their baby, but also some simple skills to help them cope with their baby’s crying.’

The NSPCC is also managing and redesigning perinatal services in Blackpool, one of the five deprived UK areas that have been given Big Lottery funding as part of the ‘Better Start’ initiative.

‘One of our brand-new initiatives is to address mental health in pregnancy. Parents often don’t seek help because of fears their children will be taken away. So we’re creating open rolling groups around four key theories: mind-mindedness, mindfulness, psycho-education and active relaxation. Again it’s aimed at couples, and there’s a strong peer support element to it to reduce the social isolation that is so common in depression – which is a very exciting and new development for us.’

This initiative has resulted from consultation with academics, rigorous training of non-psychologists who deliver the programme and evaluation of what works and what doesn’t. It also sums up one of Camilla’s key priorities: ‘I want what we do to be based on sound theory but to then translate this so that it can become accessible to practitioners and parents. We’re about making a real difference.’

Time was nearly up, but Camilla had one final point, drawn from her own experiences and her new, very productive job at NSPCC. ‘I think reflective supervision is critical. We all have prejudices and biases – we can all learn. How can we change and improve if we don’t get time to reflect on our practice?’

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