Sunday, May 31, 2009

You Didn’t Give Up on Me

I did a Risking Connection training in Louisville, Kentucky this past week. In one section we ask participants to share success stories, as a way of reaffirming the worth of the work we do and combating vicarious traumatization. One person shared a letter he had recently received from a client, expressing her gratitude for the program’s help and the changes she and her son had made. The letter started, as such letters often do, with the phrase: "most of all, you didn’t give up on me."

Perhaps the most important thing we do for clients is not to give up on them. Sticking with them- staying around- something many of our kids and families have not experienced. Our kids have been in so many placements, so many families, and so many treatment facilities. In addition to undermining healing relationships, all these moves underscore the basic message- you are such a terrible person that no one is able to stay around you for any length of time.

In order for any of our techniques to work, we have to keep the kid with us. And many times I have experienced situations in which we had completely given up on a kid, and we were sure we could not help him. However, the child welfare system being what it is, the child did not leave. And guess what- time passed, and he got better.

So maybe we should pay more attention to exactly what makes it possible for us to keep a child. And when we are struggling with a particular child, maybe we should have a meeting specifically focused on enhancing our ability to keep her.

And what could we do to increase our stamina? Some ideas are:

1. Increase staff stamina by dividing the responsibility for the child among several staff every night. If (as we do) you have a concept of a "primary" staff (we call them team mates) then maybe a certain child needs two or three team mates. Maybe we should plan that any one who deals with this child for a long period gets a break off the unit.
2. If there is a particular horrid task (such as cleaning the room of a child with hygiene issues) let’s do it in teams, not one staff alone.
3. Let’s keep a note book of any signs of hope we see.
4. We must articulate clearly that even if we do not (yet) see any change, our not kicking this child out is a victory in itself, and we should congratulate each other for that.
5. Let’s regularly review what happened to this child, and how we understand her symptoms- what problems are they solving for her? How are they adaptive- helpful in the short term, even if they have negative long term consequences?
6. Let’s make sure we have a treatment theme (such as: Jeff is learning to trust adults) that everyone on the team including the child and family knows, and that we use this theme to frame all events and interventions.
7. Let’s plan some ideas for restorative tasks before the child is in crisis, during our treatment team. Each task should be an opportunity for the child to practice one small skill that he would need to develop to give up his current symptoms.
8. We can make sure to compliment each other lavishly whenever anyone is particularly caring, giving or helpful to this child.
9. Administration can attend meetings and praise the treatment team for their stamina.
10. Is there anything we can do to make the child feel more safe and connected?
11. Can we deliberately do something fun together, to acknowledge the effort we are making- a pot luck lunch, little presents, chocolate?

12. The most important thing is to acknowledge both how difficult and how valuable what we are doing is. If we can stick with the child, his or her entire life may be different.

This is not to say that children should never leave our programs, or that children never need a different form of care. That happens- but not as often as we think. More often, we are frustrated by the pain the child is feeling, and by his ways of making sure we feel the same pain. We think, if only she were gone, the unit would go so well. But if we do succeed in ejecting a child, another one always steps into the role.

Let’s talk actively about our feelings about the child, how hard working with her is, how much chaos she creates for us and others, and how tempted we are to get rid of her. Let’s talk about our feelings of sadness, of inadequacy, anger and frustration. Let’s remember how she got this way, how we understand her, and let’s make sure we have a strong team plan.

And then let’s re-engage with the child and hang in there. Then after he gradually starts to get better, and finally achieves that positive discharge, and does fairly well, we will get one of those letters:

Dear staff,
I just wanted to let you know I am doing well at my new home. I really miss you guys! I want to thank you for not giving up on me...

Monday, May 25, 2009

Facebook and Twitter

Do any of you people reading this blog Twitter? Do you have a Facebook page? I am considering using these services to further connect us, the people trying to do trauma informed treatment of children. It is hard to work this way- it is hard to start doing it, and hard to keep doing it. It will help if we support each other. Would you be interested in Twitter and/or Facebook connections? Let me know by clicking "comment" at the bottom of this post. Thanks!

Monday, May 11, 2009

Sarita’s Eyebrows

The door from the Girl’s Unit slammed open and Sarita erupted out, screaming: "I am not going to the...mall. I will not go to the mall. Every night he wants us to go to the mall. And I have to get my eyebrows done tonight. Someone needs to take me. Now. I am not going to the mall."

It was amazing how long and loud and with how many swears that girl could scream about not going to the mall. And I was in my office, working on a grant proposal, and I was on my last nerve just as she was. So the thoughts that were going through my mind were: "surely it can’t be required that she go to the mall. Would someone PLEASE come and tell her she doesn’t have to go to the mall so she will BE QUIET?!?!?"

It has since occurred to me that this was an illustration of a choice point for our treatment philosophy. How do we understand what is going on here?

One interpretation is that Sarita is a spoiled, demanding manipulative girl who just wants what she wants when she wants it. She wants everyone to forget about everything else except for what she needs. She freaks out every time any one says no to her. She thinks she’s special.

And that leads naturally to: well, she is going to have to learn. People can’t just drop what they are doing whenever she wants something. She will just have to wait her turn. We will have to teach her to stop yelling and disturbing people. That’s not going to get her what she wants. We won’t do one thing for her as long as she is making this kind of fuss.

Maybe there is another way to see it. Maybe, in fact, Sarita has very rarely gotten what she wants. In her life, few people have listened to her or cared about what she wants. She is not the center of any one’s universe. As she has grown up in situations of chaos, and then equally as she has lived in situations of congregate care, the only way she has been able to get anything has been to yell as loud as she can.

Maybe when she wants something (to get her eyebrows done) and someone else does not seem to be listening and is just proceeding with their plans (to go to the mall) the words in her head go something like this:
He is not listening.
If I don’t get my eyebrows down I will look ugly and no one will like me.
He does not hear what I need.
He does not care what I need.
No one hears or cares what I need.
I have no one, I have nobody.
I am no one.
I am nobody.

And then she starts to feel unbearable emotions- despair, hopelessness...
Which come out in the intensity and pressure of her speech.

Where would that thinking lead us?

It does not mean that it is okay for Sarita to scream and swear when ever she wants something. That would surely not give her a life worth living.

It does not mean that we should immediately drop everything and take her to get her eyebrows done in order to quiet her down.

But what it does mean is that we do not approach Sarita with lectures about how she should be quiet and stop bothering people and she can’t always get what she wants (which believe me, she knows).

Instead, we start with "Sarita, what is the matter?"

And then, our part of the conversation includes statements like:
You definitely do not want to go to that mall.
You have had it with that mall.
It’s very important to you to have your eyebrows done as soon as possible.
And where do you have to go to have that done?
So what you want to do is go to...
And you feel very strongly about this...

Because, in fact, Sarita will gradually stop screaming when she feels she is heard when she is talking.

And that is an experience we can give her.

Sunday, May 03, 2009

49 Reasons to Do Risking Connection Training

We recently had the privilege of working with two groups of people for which we had provided Risking Connection® training. In both cases we were now providing Train-the-Trainer Training, and we started by asking the participants about changes they had noticed in their work or their agency since having the original Risking Connection®. Here is what they said (and these are verbatim!):

1. The every day milieu is different-we avoid shaming the kids and remember that symptoms are adaptations.We are more hopeful and positive- we live in solutions.

2. We teach about how to maintain and repair relationships, that it is okay to make a mistake and you can fix it.

3. There is more awareness of vicarious traumatization (VT), and we use the worksheets to discuss it.

4. We have a new awareness of what the kids have been through.

5. We process our VT and it helps us not to take things personally.

6. The staff is talking more with the kids, finding out where their behavior is coming from.

7. We understand the relationship between the kids’ background and their behaviors.

8. We engage the child more.

9. We understand the difference between shame and guilt.

10. Focus on relationships and repair helps staff relationships.

11. We look at the client’s self capacities and how we can build them.

12. The direct care workers and youth counselors are more involved in the treatment.

13. There has been a decrease in AWOL and self harm among our kids.

14. We see the power of listening and validating.

15. We tried a pilot program in one classroom, we shifted the way we look at behavior and there has been a decrease in acting out.

16. I’m using Risking Connection® concepts in animal assisted therapy!

17. There is more openness to look at kids differently.

18. There is more time spent processing, which leads to better behaviors.

19. The kids are involved in their own treatment plans.

20. We are teaching the parents new ways to understand their kids’ behaviors.

21. We have incorporated it into staff language.

22. We use Risking Connection® concepts in supervision with staff.

23. I can see differences between staff who have and have not been trained.

24. We help the kids make the connection between their behaviors and their pasts.

25. We remember that a child is doing the best he can.

26. We are using this language and concepts in training foster parents.

27. It has changed how we talk about the kids.

28. We take better care of each other.

29. We use RICH with each other and the kids.

30. We have more self awareness.

31. We took the consequence list off the wall to avoid shame.

32. We talk about the function of behavior.

33. This place feels more like a real home.

34. We stress relationships with new employees.

35. We are nicer to each other.

36. We are more understanding of the parents.

37. We understand that VT is normal and we validate each other’s feelings.

38. We are saying "yes" more to the kids.

39. We are actively listening.

40. We are more hopeful.

41. We have given the kids more self determination in running their own living units.

42. We let the students talk.

43. We have more emphasis on strengths.

44. We pay more attention to staff who get hurt.

45. We are teaching these concepts to our bus drivers!

46. We have changed our hiring practices.

47. We pay more attention to providing good transitions for the kids.

48. We are more flexible.

49. I am a kinder, gentler person.

Pretty powerful!

If you haven’t had this training yet- what are you waiting for?