Sunday, March 18, 2012

Saying Goodbye

At Klingberg we are saying goodbye to many people and many things at many levels. We are closing several of our residential programs, discharging our kids, and laying off some of our staff. It is a sad time.

I am completely committed to the principle of supporting kids in family homes whenever possible. We are developing several new programs to aid that effort. I am excited about these new possibilities.
However, it is the end of an era for us. We did very good work in our residential programs. We used a trauma-informed, Risking Connection based approach. We love our kids. We have been looking through old pictures and marveling at all the wonderful things we did together: Boston trips, picnics, camping, fancy dinners, and all the everyday moments. As we look through the pictures we remember how much we learned from each child.
Klingberg has a reputation for excellent treatment of the most severely wounded children in our state. The children who came to us were lost in a morass of self-hatred and hopelessness. Because of their pain they often had to resort to extreme behaviors. We were okay with that. When David came out with blood streaming down his face from self inflicted wounds, the nurse calmly cleaned and bandaged his wounds, and his team mate calmly asked him what was wrong. When Autumn ran away, we welcomed her back and began working on safe places she could go when she was upset. When Dawn was aggressive and mean to staff, we made safety plans, and we didn’t turn against her and carefully reviewed her diary card about what led up to the event. When Sharon recently felt that her discharge plan was shaky and pulled the fire alarm, we understood that she was trying to get our attention in the best way she knew how. Because of the assets we have, we were able to stick with kids more or less whatever they did. And this led to an incredibly high number of ultimate positive discharges (around 90%) when they were finally able to feel safe and worthwhile. It is sad to see the treatment system we worked so hard to create be dismantled.
We are saying goodbye to some talented staff, and wish them well at our sister agencies that have been lucky enough to hire them. Some staff have moved to other Klingberg programs.
We are saying good bye to our present kids, some to placements we are confident about, some to ones we wonder about. For all we have sent them off with hope and support.
So many kids come back to Klingberg to visit and talk about what their stay meant to them. Jennifer brought her daughter and was overheard to say to her: “this is where Mommy became a person.” Now when the kids come back, who will they find?
It is sad to see the empty rooms.
We are trying to do good, careful goodbyes with everyone. We are acknowledging each others’ sadness. We are working hard on moving into the future.
One of our former Directors always used to say: “Change is hard. Change is good.”
I hope so.

Sunday, March 11, 2012

Improved Advocating through Risking Connection Training

We did a consultation this week with an agency that received both the basic and train-the-trainer Risking Connection training. They have proceeded to roll out their own training and have experienced major changes in their culture. They particularly emphasized how important their new awareness of vicarious traumatization had become. Staff have been saying that they feel more committed to the organization than ever now that they regularly have a place to share the effects of the work on themselves as people.
They also mentioned something I hadn’t thought of before. They felt that they were much better advocated for their clients now that they understood the trauma framework, the concept of symptoms as adaptations, and what helps trauma survivors heal.
This is really true. First, by understanding brain science and the effects of trauma, treaters can become more articulate in describing why punishment is not the best response to problem behaviors. They can describe how making amends can teach the youth hope in relationships, and how learning skills can help him be less likely to repeat the behavior. By understanding the behavior and the need the youth was trying to meet, they can recommend a specific intervention which will help the youth learn to meets his needs in a more positive way. They are more confident because their ideas are grounded in a theoretical framework.

Often when people think of “doing trauma work” they mean that the youth is retelling the details of her traumatic experiences. Through understanding both the trauma framework and modern brain science treaters can explain the benefits of other areas of treatment. It is NOT TRUE that recreational activities, fun events, creative pursuits such as music and art, cooking, and relaxing with others are just time fillers in between the “real therapy” that happens in the clinician’s office. Using the trauma framework treaters can specify exactly what step in healing each activity is designed to accomplish. Changing the child’s template about relationships, re-building her brain, increasing her sense of self-worth and teaching feeling skills are all happening during these every day parts of life. When a treatment team is well trained they can describe and document each step of the day by describing its connection to healing.
Another area of advocacy is speaking up for the services a child will need after being discharged from your program. The trauma frame work gives treaters specific justification for gradual transitions, as few changes as possible, continuity of relationships post discharge (with boundaries), support services for biological and foster parents, special education, and respite/mentoring.

What other ways has learning about trauma improved your advocating for your clients? Please click “comment” below and let me know.

Monday, March 05, 2012

Healing the Generations 2012

I had the privilege of attending the Healing the Generations conference at Foxwoods this past Thursday and Friday. As usual, Alice Forrester and her Clifford Beers team put together a highly informative and restorative conference, with great organization and good food. The theme of this year’s conference was Trauma and the Brain.
What struck me the most was the fact that many different researchers and practioners, all coming from difference disciplines, focus and research methods all reach the same basic conclusions. These seem to be…
Relationships matter. There is so much evidence now of neglect and abuse impacting brain development, and of the possibility for healing within relationships.
Childhood stress impacts brain development in many areas, and thus has great implications for both education and physical health.
Healing cannot be maximized with just verbal interventions. Treatment that includes body based activities has the most potential. These include EMDR, yoga and meditation, but also include walking, rocking, tossing a ball back and forth, etc.
Music has tremendous power to organize, heal and sooth the brain.
I also learned about several promising treatment programs that were showing results with both children and parents. One interesting approach presented by Phil Fisher, PhD. From Harvard videotaped parents’ interactions with their children and then edited out clips of the parents doing good things, like attending and responding to their child. They played these clips back to the parents and said, do more of this. I liked the building-on-strengths approach.
Another intervention called RULER was described by Marc Brackett, PhD. It was a method for teaching emotional intelligence within schools. Dr. Brackett stressed the importance of teaching the method to “everyone with a face” including administration, cafeteria staff, teachers, etc. It sounded very promising.
I presented on Using the New Brain Science to Do More Effective Treatment…and Have more Fun at Work. I got a lot of compliments on my presentation.
One of the most moving workshops I attended was a dramatic skit about vicarious traumatization by the Post Traumatic Stress Center in New Haven. Through a play they demonstrated the feelings of vicarious trauma that are part of our work. It generated a lively discussion among the audience.
Over all, a very worthwhile experience.