Occupational therapy with young people in care

The presentation

Maggie Morton delivered an insightful presentation examining how occupational therapists can support young people in care through an occupational justice framework. Working with the Withers SL Group, which provides specialist education and care for vulnerable young people, Maggie highlighted the crucial intersection between trauma, exploitation, and occupational deprivation. 

Maggie began by establishing the concept of occupational justice - the fundamental right of all individuals to access meaningful occupations. For young people in care, this right has often been compromised through systemic failures and exploitation. The Withers SL Group offers integrated sites providing safety for young people who have struggled to find stability elsewhere, with dedicated care teams practising therapeutic parenting alongside education delivered in small groups. 

A key focus of Maggie’s presentation was understanding exploitation. She defined it as the act of using a vulnerable person for profit, power or status, often involving cruel treatment causing emotional, physical and social harm. Maggie highlighted the absence of a legal definition for child exploitation, making it difficult to properly address. The consequences are severe - affecting physical and mental health, education, moral development, and the ability to form healthy relationships. 

Maggie pointed out significant gaps in our understanding of child exploitation. Children may not disclose their experiences, and professionals might fail to recognise signs. She noted that sometimes the criminal justice system focuses on targeting criminals at the expense of safeguarding children's needs, as evidenced in serious case reviews. 

The presentation thoughtfully examined indicators of exploitation, including controlling behaviour, violence, association with exploitative people, changes in wellbeing, substance misuse, unexplained gifts, and absence from school or home. Maggie challenged the common misconception that only children from visibly disadvantaged backgrounds are vulnerable, emphasising that exploitation can happen to any young person, particularly during adolescence when peer relationships become increasingly important. 

A particularly powerful segment addressed how young people process exploitation experiences. Maggie explained that children who are harmed by attachment figures face a difficult choice: see the adult as bad (frightening if they depend on them) or see themselves as bad. Many choose self-blame as it offers hope - if they are the problem, they can change. This self-blame intensifies with additional factors like receiving gifts, experiencing excitement, or physiological responses to abuse that they misinterpret as consent. 

Maggie delivered a compelling argument about the impact of professional language. She presented examples from actual referrals that demonstrated how institutional language often blames young people for their exploitation: ‘she seeks opportunities to go missing’, ‘he continues to choose the gang lifestyle’, or ‘she has a 23-year-old boyfriend’. Such framing reinforces self-blame and fails to recognise children as victims. 

She advocated for alternative phrasing that centres the child's experience and appropriately attributes responsibility: ’she's being sexually exploited by a 23-year-old man‘ or "they're coerced by adults in the community into going missing from care so they can be engaged in criminal and sexual exploitation". Maggie emphasised that this language shift matters not only for the young people but also for professionals' understanding of the situation. 

The presentation concluded with practical therapeutic approaches used at Withers SL Group. Their first level of intervention involves trained care teams who interact therapeutically with young people, supported by regular child-focused meetings. They employ the PACE approach - being Playful, Accepting, Curious and Empathetic in their interactions to avoid triggering fight-flight-freeze responses. 

As an occupational therapist, Maggie utilises sensory integration approaches, recognising that many exploited young people have shut down bodily sensations as a survival mechanism. She employs the person-occupation-environment model to understand who these young people are, what they need to accomplish (often starting with simply showing up), and how their environment can support them. 

Throughout the presentation, Maggie emphasised the importance of occupational therapy in helping young people rebuild their sense of safety and develop healthier strategies for regulation. By understanding exploitation through an occupational justice lens, therapists can advocate for young people while helping them reconnect with meaningful occupations. 

In the Q&A session, Maggie addressed questions about changing negative narratives, noting that this requires consistent advocacy and challenging conversations with other professionals. When police officers use victim-blaming language, staff at Withers SL Group directly address this, emphasising that children cannot consent to their own exploitation. 

Maggie also clarified the integrated approach at Withers SL Group, explaining that as an occupational therapist employed directly by the site, she can provide holistic care addressing both physical and mental health needs. This comprehensive approach allows her to consider the whole person, which she described as ‘tremendously powerful.’ 

This presentation offered valuable insights for occupational therapists working with children in care, highlighting the profession's unique contribution to addressing occupational injustice and supporting recovery from exploitation. By reframing language, understanding self-blame mechanisms, and employing therapeutic approaches that prioritise safety and regulation, occupational therapists can play a vital role in helping young people rebuild their lives and access meaningful occupations.