The fact that babies are born entirely dependent on the care of others for their survival, both physically and emotionally, underpins the vulnerability of the child’s experience. With consistent, loving care the potential of the developing child seems infinite while conversely the consequences of abuse and neglect can seem catastrophic. The emphasis of a lot of work with children with developmental trauma is currently on their emotional and psychological wellbeing; harnessing relationships to lay down new experiences alongside their early ones.
Whilst Sarah was working in Fife CAMHS (2005 – 2013) she was part of a team developing a therapeutic service for local children who were looked after. The team were offering traditional psychological therapies and became aware of a significant group of children who weren’t able to make use of these, who were seemingly as dysregulated on a bodily level as on an emotional / relational level. Wanting to understand more about how children grow into themselves on a bodily level and why this process halted for children who had experienced early adversity, Sarah turned to sensory integration. Sensory integration theory helpfully mapped out how the brain and central nervous system develop in response to movement, but there was very little mention of the relationships and conditions necessary for babies to thrive. Similarly, in the attachment and trauma literature there was a relative dearth of information about the process by which children grow into themselves on a bodily level.
A solution seemed to be to build a model that could bring together an understanding of the body and motor development with our psychological understanding of the impact of trauma on the developing child. The result is the BUSS (Building Underdeveloped Sensorimotor Systems) model which brings together an understanding of how a baby and young child’s sense of themselves on a bodily level develops through experiences of being touched, held and of moving, all within the context of nurturing relationships. Sitting alongside a neurodevelopmental understanding of the impact of trauma on the developing brain, attachment theory, child development theory and drawing on sensory integration theory, the model focuses on the development of the vestibular, proprioceptive and tactile systems. It takes as its starting point the understanding that without nurturing relationships babies don’t progress through the stages of movement that are needed to feed the brain and central nervous system with enough information to build an internal map of the body and lay the foundation for well coordinated movement. Clinical experience suggests that these systems aren’t broken in the way that might be seen in children with sensory processing disorders, rather they are underdeveloped because of a lack of adequate movement experiences at critical stages of development. The BUSS model explores the potential for rebuilding the gaps in these systems left by early adversity, using games and activities within relationships that offer the child a loving, attuned base to grow from.
Playing games and doing activities designed to fill in gaps in essential patterns of movement, missed in infancy and early childhood, within these loving relationships has a significant effect on a child’s bodily regulation. It allows children to feel confident in their movements and the messages their body gives them about their physiological state, providing a solid foundation for the development of social and emotional skills and learning.
Improved bodily regulation has a significant impact on children’s emotional wellbeing and regulation, and parents talk about how much better their relationship with their child becomes as they help their child to feel more comfortable in themselves on a bodily level. Other parents talk about how much less angry their children become and it’s interesting to think how frustrating it must be for children who have to fight against their bodies to move around and do things. The amount of energy and effort that this takes is phenomenal, and what’s lovely to hear, as children grow into themselves on a bodily level, is how much more energy and capacity they have.
The purpose of this document is to describe the BUSS Model and how it is currently being used. It’s broken down into the following sections:-
Sarah and the Oakdale Centre have established a small training company, called BUSS Model Ltd, to work with individuals and organisations who are interested in developing their skills and experience in this way of working. We are currently working with fostering and adoption teams in Birmingham, Kirklees and Calderdale as well as doing regular training with PAC-UK, Barnardo’s, Adoption Plus and a number of independent fostering agencies.
We’ve also recently started offering training to education settings and are working with a school in Leeds who had noticed significant gaps in the bodily regulation of their children and who are keen to build foundation sensorimotor skills as a platform to their developing social and emotional skills and learning.
As well as the commissioned work with organisations, the plan is to offer a Yorkshire based open access training to individual therapists / practitioners, starting in the spring / summer of 2020 and hope to offer the same training from a London base later in the year. We are also working to develop a peer support training for parents / carers who have lived experience of using the model and are interested in supporting other families as they work through the BUSS process.
Sarah’s first book, Improving Sensory Processing in Traumatised Children, was published by JKP in 2016. Her next book, Building Sensorimotor Systems in Children with Developmental Trauma: A Model for Practice, will be published by JKP in April 2020.
The training structure is designed so that, within a locality, or local authority, large numbers can be provided with an understanding of the importance of early movement experiences (Introduction / Level 1), with a smaller number for whom it would be particularly beneficial to progress on to the higher levels of training.
Training is available for organisations and individual practitioners at all levels. Bespoke training and ongoing work can also be offered for organisations with different requirements (e.g. education).
Introduction to the BUSS Model
This is a one-day training event designed for parents, fostering and adoption professionals, care workers, schools and therapists and is divided into two parts. The morning is a taught session, describing the BUSS model, which brings together sensory integration theory (describing, on a neurological level, the role movement plays within a nurturing relationship in building foundation sensorimotor systems), child development, attachment theory, an understanding of the importance of good early caregiving experiences, and the impact of trauma and neglect on the developing brain. The teaching focuses on the foundation systems: vestibular, proprioceptive and tactile, helping participants recognise the hallmarks of a well-developed versus an underdeveloped system. With groups of fewer than thirty participants, the afternoon session can be a practical one, introducing games and activities that parents, carers, schools and therapists might use as a starting point with children whose foundation systems are underdeveloped. For larger groups, parents and carers who have used the model talk about their children and their experiences of BUSS giving practical examples and illustrations that participants may find useful.
Parents and carers are usually very positive about the training, often describing it as “a light bulb moment” and “a missing piece” in their understanding of their child. They talk about how hopeful and empowered they feel to effect positive change in their child without intensive professional involvement. Education staff who have come on this training have talked about how much it has changed and enhanced their practice. They discovered that understanding the foundation systems which underpin social and cognitive development allowed them to work much more effectively in school with children whose early development was very disrupted. Social workers and fostering and adoption professionals have found the training informative and relevant across the spectrum of children that are looked after, and have continued to put into practise the ideas and games from the training day.
There are three further levels of training available to individuals or organisations. As well as the training days, there is an expectation that participants will have time for reading as well as practising the skills from the training.
Level One Training
This is a three-day training (2 + 1) which is a combination of teaching and practical work, aimed at professionals working to support children who have experienced developmental trauma and their families. Applicants for this level of training should have some knowledge of the model but do not necessarily have to have been on the introduction day.
In the first two (consecutive) days, participants look at the development of the foundation sensory systems: vestibular, proprioceptive and tactile, the circumstances needed for adequate development and the hallmarks of systems that are underdeveloped. There will be teaching in how to differentiate between an underdeveloped sensorimotor system and a sensory processing disorder. Both days use a combination of whole group teaching, small group work, and video recordings of typically developing children and children who have experienced early adversity.
A primary focus of these two days is on child development, considering it from a relational and motor perspective.
For teams whose primary function is not supporting children who have experienced developmental trauma (e.g. education settings) there would need to be an additional day which will focus on the baby brain, attachment, neurosequential development and the impact of trauma on the developing child.
Participants will be instructed in the use of the BUSS screening tool, and how to support families in considering whether this approach might be helpful for their child. There is an expectation that participants will start to use the screening tool between the first and second part of the course.
The third day of training takes place a month after the first two days and, in addition to further teaching using case studies and video clips, offers trainees the opportunity to discuss their own observations and experiences of using the BUSS screening tools.
Level Two Training
This is a four-day training (2 + 2) and will generally be open to practitioners who have completed Level 1 training and who are eligible for HCPC, UKCP or BASW registration. In addition, it is usually helpful to include teachers at this level of training if they are an integral part of the service.
Participants who successfully complete Level One and Level Two Training will qualify as BUSS Informed Practitioners.
By the end of this part of the training, practitioners will have developed skills in assessing the foundation tactile, vestibular and proprioceptive systems in children who have experienced developmental trauma. They will be able to support families in using generic ideas to rebuild underdeveloped systems.
The training will be classroom based, using videos and practical activities and there will be a requirement for skills practice between the first and second parts of the training, using the assessment tool on typically developing children.
Level Three Training
This is the supervised practicum part of the training, and it’s usually helpful if at least two members of a team can train at this and the next level so that they can work jointly and support each other as they develop their skills.
Working either with families referred to practitioners’ own services, or joining the clinical team based at Oakdale Centre in Harrogate, participants will practise and develop skills in using the BUSS model to screen, asses and develop programmes of intervention for children and families. Communication about this intervention for families and other organisations is critical to the success of this intervention and training will be given in BUSS report writing.
Supervision will be both individual and group based and paced according to the needs of participants. Participants who demonstrate, through their clinical work, report writing and reflection as well as their competence in assessment, intervention and reassessment using the BUSS model with at least four different children / families with children of various ages between 4 and 18, will become BUSS accredited practitioners. It is anticipated that this part of the training will take about a year to complete.
Level Four Training
BUSS practitioners will be required to have regular clinical supervision from a BUSS Consultant, either individually or as part of a group, to maintain accreditation. When practitioners have been supervised working with twelve children / families, they can apply for BUSS Consultant status.
Other Clinical Applications of the BUSS Model
Babies and Young Children
We have found that it’s usually most helpful to see babies and young children under three in their own environments, whether that’s an adoptive home or a foster placement. If possible, it’s helpful for parents / carers to have attended a psychoeducation day, and if the child is in any sort of child care provision, it’s useful for them to be involved too. There are huge benefits to being able to intervene early in the life of the child.
School Readiness Programme
In Sarah’s post within the Therapeutic Social Work Team, she’s been working with the Virtual School in Leeds over the last twelve months to develop a programme of BUSS informed therapy for three year old children who are in foster care or kinship placements and who are starting school in the next year. The virtual school funded this work and there is now a small team including specialists from education and the therapeutic social work team based in a children’s centre linked to a primary school. The children and their carers/ families attend on two mornings a week. Sarah was particularly keen to pilot this work for three main reasons:
Children were followed up into their host schools and support given to the schools to continue the work on building sensorimotor systems.
We’ve currently run one cohort of this intervention, and evaluation is being conducted by University College London. Initial results look promising and funding has been agreed for this project to continue, lowering the starting age of the children to two years. It is hoped that we could develop this work in other areas, offering a combination of training and joint work.
EVALUATION AND RESEARCH
All families undergoing the 4-stage model complete before and after measures. Over the time that these have been being used, they have shown significant improvement in a child’s bodily awareness / proprioception, core strength and stability, co-ordination and ease of movement. These changes in bodily regulation have facilitated positive changes in emotional regulation and relationships, as can be seen in the accounts written by parents and carers.
As this is a new model for practice, a lot of the children and families that we work with have already been through more traditional psychological therapies. We would argue that building bodily regulation is a good starting point for any intervention and find that, where children have been engaged in psychological therapies, they are better able to make use of these once they are more regulated on a bodily level. This makes sense in terms of brain function and development and the earlier in the life of the child that we are able to intervene, the shorter the intervention tends to be.
The BUSS team is currently working with Clinical Psychologists in training from the Universities of Leeds and Hull. One trainee has just completed a one year Service Evaluation Project, looking at the efficacy of the 4-stage model in a therapeutic social work team. Interviews were undertaken with foster carers who had completed the programme and social workers in the team who had been involved in the programme. Thematic analysis of the interviews showed overwhelmingly positive results for both foster carers and social workers. The plan is to publish this in a peer reviewed journal in 2020.
The other two trainee Clinical Psychologists are looking at the BUSS model for their Doctoral Theses, due for completion in 2020. Briefly, they are considering the impact on psychosocial wellbeing and relationships of a programme that focuses on sensorimotor rather than psychological functioning.
There are two other trainees who are interested in an evaluative study of the impact of the school readiness / BUSS work that Sarah has been doing in Leeds with the virtual school. We used the Boxall Profile as pre-intervention and post-intervention measures as well as a qualitative reflection by foster carers. Weekly videos of the children completing a sensory / movement circuit tracked progress.
Feedback from teachers and therapists who have done the training:
“The best thing is that the strategies are easy to do – don’t focus on feelings and emotional issues. Children might enjoy the practical suggestions rather than trying to explain ‘why’ they’re doing something they shouldn’t.”
“Brilliant, interesting training – looking forward to next month”
“How useful it is, presenter approach”
“Useful to have overview explanation and idea of strategies”
“As a trainer, really engaging, doesn’t use jargon and makes sure info is accessible.”
“I got a real sense that Sarah wants people to learn and be confident to use this approach.”
“Trainer’s delivery very engaging.”
“Case studies very useful”
“Very good content and will be very useful for my work”
“Learning about the systems and being provided with tools on how to rebuild these systems”
“How surprisingly easy it can be to make changes”
“Very inspiring trainer: so passionate and knowledgeable with a cheeky sense of humour brought everything alive.”
“I will really be able to integrate some of this in to my Theraplay practice, as well as when training adopters.”
“It’s been a fantastic, thought provoking 2 days training – highlights simple techniques that can make such a huge qualitative difference to our children’s lives!”
“A superb second day as day one, full of super gusto, warmth, experience and accessible information.”
“Very useful to try out activities and learn strategies.”
“Thank you, really motivated to incorporate this into school”
Oakdale has been providing regular eight week Mindfulness Courses over the last five years. The mindfulness team is led by Annika Wager, an experienced and highly trained mindfulness teacher.
Our next eight week mindfulness course starts in September 2019. Please click here for more details.
Research has shown that eight week mindfulness courses are effective in improving general wellbeing, reducing stress and increasing resilience in dealing with life’s pressures. Mindfulness is a mental training that reduces the tendency to go through life on autopilot. By learning to pay more attention to thoughts, feelings and experiences as they arise, it changes the way we relate to our day to day experiences, particularly stressful ones. Participants report reduced stress/worry/over-thinking and better sleep, more emotional regulation and more awareness and control in how they manage their minds and emotions. Rather than worrying about what has happened or what might happen, mindfulness trains us to respond skilfully to whatever is happening right now. In this course mindfulness meditation is presented in a practical and experiential way. There is a strong focus on learning skills that can be applied in everyday situations at work or home.
“This was an excellent, practical and useful course with intelligent, informed and skilful guidance from someone who has personal experience of the positive benefits of the practices.”
“I now have the ability to take myself out of my internal chatter. I wish I had done this course years ago. The techniques make such a difference to the way I live my life.”
“I had tried to learn a little mindfulness from a book with little success. I would definitely recommend a course to learn mindfulness – Annika’s classes add a whole dimension that just can’t be captured otherwise.”
“Has really helped with my well-being, self esteem and being kinder to myself.”
“Loved every session, looked forward to it each week.”
The Oakdale Centre has a number of qualified clinical supervisors providing:
Professional and Leadership Coaching
Oakdale works with a number of professional coaches providing:
We often run a range of professional development groups, supporting individuals with their development and practice. We update this section as and when we have courses available. If there is a specific course you would like to see, please do get in touch.
Oakdale offers a range of training and courses for schools. Please click here to find out more.
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