Sunday, April 24, 2011

Crew Rowing and Repairing the Brain

I have just returned from Sacramento, California where I did a recertification for the Associate Trainers of Victor Services. It was very moving to reconnect with these skillful practitioners and experience how they had made Risking Connection their own and used it to transform their treatment programs.
While I was there I visited a local lake and saw some teenagers practicing crew racing, the sport with those long thin boats and many people rowing together. And it occurred to me that this might provide a useful metaphor for the task of healing the lower brain.

Imagine that you have been asked to coach a crew team. Although you have not done so before, you have seen the lovely boats slipping across the water as the coordinated rowers respond to the call of the leader. How hard could it be? So you agree.

Alas, when you first meet your team in action you find them to be much different from what you had envisioned. There they are, a bunch of rowers in a lovely boat on the water, with a separate boat calling out instructions. But, the leader sitting in the front is terrified, and keeps yelling: “Careful!!! We are going to drown! Oh no we are tipping over! Hold on!” and other such things. This constant stream of fear has all the rowers upset and disabled. Several are rowing frantically, but in different directions. Two have dropped their oars into the water and are sitting with their arms crossed. One is crying. The boat is turning in circles, lurching from side to side. The noise is so loud; no one can hear the instructions coming from the other boat.

(This is the disorganized brain. It results from early trauma and lack of attunement. No parts are working smoothly together, and the fear system is in full alert, drowning out all other input. Movement forward is impossible.)

As the new coach, what do you do? Do you tell them you will give them each $5 if they can do a better job and row from one end of the lake to the other? Or do you tell them that unless they row that distance successfully they will be on restriction for two weeks and not able to see their friends? Do you give them a lecture on how much better everything would be if they would just get it together and row smoothly?

(Our normal approaches to our children.)

I would suggest that the best coach would not start with rowing at all. He would start by doing lots of exercises on land. First, there would be activities to help the team members get to know each other and trust each other. These would start with easy things and gradually increase in difficulty. (Relationship forming) Then, he would begin having them experience physical challenges together. He would use all sort of rhythmic activities such as drumming together, dancing, playing ball to help them experience the feeling of being in sync and interacting smoothly with each other. Other games would increase their strength and confidence. Every activity would include elements of relying on each other, interacting with each other, helping each other to achieve success. When things didn’t go well they would develop a method for working them out. They would practice team coordination through carrying the boat together, lifting it up and putting it down, making turns on land while carrying it.

He would make sure they all knew how to swim.

The team would adopt a name, and begin a narrative of its journey from the beginnings to success. The team members would retell the story, always adding the day’s events, each night around a campfire.

Then, gradually, the team would return to the water. The challenges would be small at first. They would try regular rowboats in pairs. When they started the crew boats again they would be in shallow water. Each of them would practice leading the beat, the rhythm that coordinates them all, until they could feel it deep in their bodies and respond almost automatically. They would try rolling the boat and falling out until they felt confident they could handle any eventuality. This phase would take a long time.

(All the treatment activities of healing the brain.)

And then, the magical day would come when the team would get into the boat, row through the water together in a smooth and effective way. The youth in front would carry the beat. The team would respond in rhythm. The ideas from the second boat would be easily heard across the silent water. When a wave came, or it started to rain, or they had to make a turn, the team would laugh and solve the problem together.

(And thus the brain would become as powerful and skillful as it had always been meant to be.)

Monday, April 18, 2011

My Recent Travels

I have had the honor and privilege of participating in two special events over the last two weeks. The first was the Vermont Foster/Adoptive Family Association 24th Annual Spring Conference: Hope and Healing. At that conference I attended a one day workshop by Dr. Bruce Perry. I was so delighted to finally have a chance to hear Dr. Perry in person, after having read all his work and listened to him on video tape. When I remarked to the conference organizer that he reminded me of Seinfeld she told me I wasn’t the first person to notice that. As I have written in this blog, his ideas are opening new avenues of learning and teaching for me, and I hope to write more about them here in the future. Dr. Perry expanded on the idea that rhythmic, repetitive, rewarding physical activities with another engaged person are necessary to rebuild the brain stem of children hurt in early life.

The next day of the conference I delivered a keynote address and then led two workshops. The subject of my keynote was: What is Trauma Informed Care and What Does It Mean for Foster Care? The workshops were: The Trauma Survivor as Parent and Maintaining your Sanity While Walking in The Minefield: Helping Youth With Challenging Behaviors. I received much positive feedback for all of them.

Vermont has prioritized supporting and training foster parents. They offer this conference to foster parents and those who work with them every year, and it combines education with a break, recreation and connection. They also raise money at the conference through a silent auction and fifty/fifty raffle for a fund that provides extras for foster children. I found the foster parents to be very knowledgeable and thoughtful, tuned in to the adaptive nature of their youth’s behavior, and extremely caring and committed. I was also impressed with the professionals I met such as the conference organizer Karen L. Crowley, System of Care Manager, Family Services Division, Department for Children and Families. Vermont’s governor Peter Shumlin was present, as was the new DCF Commissioner Dave Yacovone. Their presence also spoke to Vermont’s commitment to foster parents. Vermont is emphasizing the concept of co-parenting between the foster parents and the bio parents, which made my “trauma survivor as parent” workshop especially relevant to the foster parents.

One foster parent asked me a question which we agreed we must defer to Bruce Perry. She has a teenage foster son who is very sexually active. She said that it occurred to her that he was engaging in an activity that is rhythmic, repetitive, rewarding and physical with another engaged person. Is he building his brain stem?

On the third day of the conference we watched a movie entitled “Ask Us Who We Are ~. From the program description of the film: “Directed and produced by Bess O’Brien. This documentary film focused on the challenges and extraordinary lives of youth in foster care. The film is a reflection on loss and the search for belonging and fining family. Although the film highlights the heartbreak that many foster care youth carry with them as they move through their lives, the documentary also reveals the tremendous strength and perseverance that grows out of their determination to survive and thrive. The documentary also focuses on the lives of foster care parents and kinship families that open their homes to children. Through small and large acts of kindness these adults can change the course of children’s lives and give them a sense of place. In addition, the film highlights two parents who lose their children.” It was very moving and I look forward to the time that it will be released for greater distribution outside of Vermont.

The following week I travelled to the Change Academy Lake of the Ozarks (CALO), a specialized therapeutic school that I have described previously in this blog. This school was founded specifically to utilize attachment principles to help children heal. They specialize in children who have been adopted. Their canine program allows each child to adopt and learn to care for a golden retriever, and take the dog with them when they leave. This is one of the powerful elements of the healing process.

I am honored to have been asked to be on the Board of Advisors of CALO. On this visit I got to know the program and people even more, and attended a conference CALO hosted. On the Board also are a parent advocate (who is also an adoptive parent), a lawyer who advocates for children and who is an adoptive parent herself, and an attachment specialist in private practice in the Washington DC area. For me it was a great treat to be among people who are so immersed in this trauma informed, relationship based way of thinking. I was soaking it in, being reaffirmed and recommitted to the importance of what we are doing. I learned some new ideas as well. And all this in the midst of the beauty of the Ozarks in the Spring, with many lovely flowering trees.

I feel very lucky to have been able to participate in these events.

Sunday, April 03, 2011

Ten Essential Elements of a Successful Transformation to Trauma Informed Care

1. Administrative buy in: The top administration, including the Board, must understand the change and see compelling reasons to make it. They will need to support the change through their actions, financially, by presenting it to the outside world, and by demonstrating patience and hope through the inevitable roller coaster implementation process.

2. An Implementation Committee: A group of people dedicated to keeping the process moving, deciding next steps, and checking to make sure there is follow through.

3. Trainers and Champions: A group of dedicated trainers and champions who are enthusiastic and eager to see change.

4. A training role out plan. This should include who will do the training, what will the schedule be, who will attend and how many trainings will be done.

5. A new behavioral management approach: a plan for moving away from a consequence based approach to behavioral issues which includes what the agency will do instead.

6. Communication: Mechanisms to communicate to the whole agency what the change is that is being made, how is going to happen, why are you doing it, and how will you measure success. Communicate with the families and involve them in the process. Also communicate to the outside world (funders, licensing, donors, the public)the changes you are making and your hopes for improvement.

7. Celebrations of success: Share and applaud ways to share particular interventions that have made a difference, good outcomes, positive feedback, and particular staff who have done a great job.

8. Attention to vicarious traumatization: Time and space for staff to talk with each other about the ways the work is affected them.

9. Measurement: Set some goals that you hope to reach by implementing trauma informed care, such as: reduced restraint and seclusions; less staff turnover; less negative discharges; and more positive outcomes. Measure these and report the findings to the agency.

10. Fun: Make the training g fun. Invent rituals, sayings and games around implementation on the units. Give little gifts and certificates to staff who interact flexibly and warmly. Play more with the kids! Add more fun interactive activities to your daily milieu life, and make sure the staff and kids play together. Make joy your primary daily goal!