Sunday, February 24, 2013

Current Activities

I’d like to update you on some of my activities and those of the Traumatic Stress Institute.

This past week I was honored to attend two activities that emerged from the Newtown tragedy. My boss Dr. Steve Girelli was one of the local experts chosen to be part of a panel at an event focusing on Gun Violence. The event was held at the campus of WestConn University in Danbury and the keynote speaker was Vice President Joe Biden. Many local politicians also participated including Senator Richard Blumenthal, Senator Chris Murphy and Representative Elizabeth Esty. Attending with Vice President Biden was U.S. Secretary of Education Arne Duncan. Newtown First Selectman E. Patricia Llodra was also present. The first panel focused on gun control, and some of the participants were Hartford Mayor Pedro Segarra; Lynn and Chris McDonnell, parents of Newtown victim Grace McDonnell, a first-grader; and Dale Hourigan, a state police captain and Newtown first-responder, Capt. Dale Hourigan of the Connecticut State Police and Dom Basile, an advocate for gun owners and safe storage. The second panel focused on mental health and school safety. In addition to Dr. Girelli there was Kathryn Seifert an author and psychologist and University of Connecticut professor George Sugai. It was very interesting and moving.

The following day I attended a conference sponsored by Connecticut NASW and the CT Schools of Social Work entitled: Social Workers Respond to Newtown. This involved a panel of speakers including Kenneth J. Doka, PhD is a Professor at The College of New Rochelle and Senior Consultant at The Hospice Foundation of America.  He provided an overview of “Coping with Public Tragedy” including a discussion of grief, the tasks and styles of grief, and what happens after the tragedy. Kathi Legare, LCSW founder of the Family Affirmation Center for Treatment in Vernon spoke on “Tools and Interventions for Working with Traumatized Children”, Joshua Miller, PhD, LICSW a Professor and Associate Dean at Smith College School for Social Work speaking on “The Use of Groups to Foster Resiliency in the Wake of a Tragic Disaster” and my friend  S. Megan Berthold, PhD, LCSW an Assistant Professor at the University of Connecticut School of Social Work and has over 20 years of experience as a clinician with survivors of trauma, war, and torture in different parts of the world who discussed “Attending to Our Own Vicarious Trauma: How to take care of ourselves as we treat the trauma of those in the community”. I was delighted to hear Risking Connection acknowledged by several speakers.

While we are on the subject of NASW, this coming Friday I will be presenting a day-long training for the new Clinical Solutions series. My topic is “Using the New Brain Science to Create More Effective Treatment.” There may be space left, check it out at And I will also be presenting at the 28th Annual NASW/CT Statewide Conference April 19, 2013
Coco Key, Waterbury, CT. "Weaving Threads of Resilience and Advocacy: The Power of Social Work" Gary Bailey, MSW, ACSW, from Simmons College is scheduled to be the Keynote Speaker. I’ll be speaking with a co-worker, Rebecca Desautels, LCSW,  on Sustaining Trauma Informed Care through Supervision. That’s always a great conference, and you get to see a lot of old friends.
My co-worker Steve Brown took off today for a trip to the Yukon Territory in Canada. We are doing an exciting research project there, and Steve is also meeting with the leaders of various Yukon departments as they would like to expand the use of Risking Connection there.

I am heading out early tomorrow to Los Angeles California to do a two-day Restorative Approach training at Maryvale in Rosemead, California. This is my first time doing a two day RA which is based on my book, and I am very excited about it.
On Thursday, April 11, 2013 both Steve and I will present at the MASOC conference in Worchester, which is a premiere conference about treating adolescents with problem sexual behaviors. I’m doing a pre-conference half-day on the Restorative Approach Thursday and Steve is presenting on VT during the conference. Why not come- find out about it at

Then later in April I will be presenting at the Professional Day March 21- 23, 2013
of the True Colors’ 20th Anniversary Conference: Celebrating our Heroes of the Past, Present & Future. It is held at the University of Connecticut, Storrs. I’m very honored to be part of this event.
We have quite a few more agency trainings set up. For our Associate Trainers we have a wonderful series of in person consult groups and webinars this year. The first one is on March 5th on the subject of Brené Brown on Vulnerability and Shame: What Are Millions of Viewers So Excited About? I think this will lead to an important discussion.

In addition to all this, I am teaching a course at the UConn School of Social Work- a regular credit course. I really love doing it.
We are also continuing with our project of training people to train foster parents in Risking Connection. We held a training for our Associate Trainers who wanted to learn the new Foster Parent Curriculum. That was very successful, and there was a lot of enthusiasm about the material. Out next step will be to hold a training for people who are not yet RC trainers, but who would like to be specifically trained to teach foster parents. It will be required that participants have attended a Risking Connection basic training. This will be in New Britain probably in late May. Let us know if you are interested by emailing Marci at

This seems like a lot, doesn’t it? And that’s not everything. But it is fun! Please attend one of these events, and come up and introduce yourself to me. I’d love to meet you!

Monday, February 18, 2013

Brain Based Social Work

Those who know me or who have been following this blog know that I am interested in the works of Bruce Perry and the neurosequential development of the brain. I believe that if we take his work seriously it could lead to a reveoution in the helping programs. To over-simplify, I believe that our most important task is to teach the child through experience that people cen be associated with pleasure. Then we also have to support brain development, offering that youth as many experiences as possible to promote his brain catching up to where it should be. This has all sort of ramifications.

So what do we actually do? I am giving a seminar for CT NASW: Using the New Brain Science to Create More Effective Treatment
Friday, March 1, 2013 - 9:00AM to 4:30 PM

( to register, hope to see you there), and in my preparation I decided to make a list of brain based interventions. This list is not complete by any means but it might be enough to start you thinking,

Brain Based Social Work

1.      With children and Youth

a.      Evaluation of brain capabilities
b.      Evaluation of verbal abilities
c.       Individualize approach to treatment
d.      Concentrate on positive interactions
e.      Use rhythm
                                                              i.      Walking
                                                            ii.      Rocking
                                                          iii.      Hand games
                                                           iv.      Throwing ball back and forth
                                                             v.      Use OT materials like large ball, mats  
f.        Emphasize narrative
                                                              i.      Journals back and forth
g.      Art
h.      Rythmic non verbal interaction when beginning to escalate
i.        Music and dance
j.        Sensory interventions
k.       Cooperative games
l.        Specifically inquire about safety
m.    Create opportunities for effective action
2.      With Families
a.      Playing together in session
b.      Project Joy
c.       Psycho-education
d.      Teach narrative, reading, etc.
e.      Sharing of skills
f.        Own trauma historie
3.      With adult clients
a.      Opportunities for motion
                                                              i.      Rocking chair
                                                            ii.      walks
b.      Sensory interventions
c.       Activity groups
d.      Cooking
e.      Parenting
4.  Specifically inquire about safety
g.      Create opportunities for effective action
h.      Create own narrative
i.        Not just trauma
j.        Teaching skill
k.       Effect of trauma on parenting
4.      As a supervisor
1.      Prioritize supervision
2.      Teach awareness and use of own feelings
3.      Celebrate success
4.      Hiring and promotions
5.      Awareness of VT
6.      Self and other care
7.      Notice and reward uses of brain-based thinking
8.      Acknowledge and troubleshoot obstacles
9.      Specific action on resistance
10.  Cultivate mindfulness
5.      As an administrator
1.      Enthusiastically support trauma informed care
2.      Clear vision of whyyou are making this change
3.      Measure results and share
4.      Resist  off over-using people
5.      Provide time to talk and think
6.      Promote inclusion of families
7.      Emphasize supervision and provide time for it
8.      Celebrate success
9.      Pay attention
10.  Acknowledge VT

So, what do you think? Do you have more examples? Click on#comment# and share them.





Saturday, February 09, 2013

Evolution in Thinking

Long post- please read and comment.

I would like to write about the way my thinking has changed over time about what we like to call “behavior management”, I am referring to treatment programs in which, in addition to providing treatment, staff have to respond to behavior that hurts others. The idea hopefully is that we respond in a way that helps the youth decrease such behaviors. This applies to any group care program, such as a hospital, a residential, a day program, a special ed school, an after school program…in short, many programs.
First of all, I wonder if we could invent another term. What could we call our attempt to change behavior in the day-to-day setting: behavior support? Learning to be kinder? Any thoughts?

Anyway, once upon a time I worked in a traditional points and levels residential treatment program. In fact, when I first got there it had points, level, phases, and many punishments. The most severe was called “Sub” level because it was below all the other levels. As I recall it involved spending days in a small room without stimulation. The kids were supposed to be thinking about what they did wrong and how they could do better. They weren’t.

I began to have thoughts about this being a bad plan. One of many issues was that when one kid hurt another kid, the victim looked to staff to punish the hurter. No learning what so ever about how to work things out with each other. And we were punishing the kids by ordering them to do things they couldn’t do, like stay in their room quietly for hours. When they popped out trying to re-engage staff, we would order them back in and restart their time. It was the whack-a-mole method of discipline.
We were telling the kids what not to do, but we were not teaching them what to do instead. We struggled to consider things like the function of behavior.

Even in those dark ages, we had wonderful staff who cared about the kids and who formed strong relationships with them. But this was harder when you had to rate their points every half an hour, which took quite a bit of time. And like every place else, we had our own elaborate jargon, which the kids picked up quickly. The behavior management system became the way we talked. Instead of asking “how was your day?” we asked “How many points did you earn today?” When a child became agitated, staff would often react by telling them the consequences that would occur if they kept that up or got worse. They would not ask what was going on. We were embarrassed when we told an outside consultant that our kids earned up to 180 points in school, and he said “You do know that Marcus can only count to 8?” Consistency was highly praised, although rarely achieved. There was no room for individualization.

My colleague Leeora Netter and I, as well as some other Klingberg staff, began to learn about attachment and trauma. We discovered and learned from Daniel Hughes. We knew that what we were doing was not sufficiently healing. And yet everyone was doing some version of the same thing. We had no idea what to do instead.
A neighboring treatment center, Wellspring in Bethlehem CT gave us our first glimpses of alternatives. They gave us ideas as to how to include making amends and learning skills into our responses. They served a different population, so we had to modify their methods, but they were invaluable in getting us started.

So, we began to invent a system that responded to behavior that hurt others in a new way. We wanted to incorporate the concept of making amends from the Restorative Justice movement. We wanted to include skill building, and incorporate an understanding that the kids were doing these things for a reason. In the lives of the clients there had been trauma, attachment disruptions, and neglect and we wanted to understand how that history influenced current actions. We felt our responses had to be individualized. We tried to get away from time-based restrictions and move towards restrictions that ended when a child had made amends and was cooperating with the program. We called our new system the Restorative Approach©.

This was a hard sell. Staff were sure that chaos would break out as soon as we lifted long punishments.
I made a huge book of worksheets and tasks, organized by type and origin of problems. We needed concrete tasks to replace our punishments. This led to kids basically being sent to their rooms to do worksheets. They were allowed to “work off” their earned punishment time by doing tasks. But the tasks had to take as long as the punishment would have. I began to see that the tasks were being used as punishments in disguise. Staff without realizing it believed that the tasks would work by being aversive, the way punishments do. That was not how it is supposed to be.

We were lucky enough to encounter the Risking Connectionâ foundational trauma training. This gave us the language and theory that we needed behind the Restorative Approach. I now believe that it is very hard if not impossible to implement a new way of acting in the day-to-day program without extensive teaching of theory. It is hard enough to make this change. Without changing how you understand the behavior, it is impossible.
Later we became a training center for Risking Connection. Gradually this way of thinking made more and more inroads into our daily life. There were so many ups and downs- but that is another story. But mostly when I heard a kid yelling in the front hall I would NOT hear someone say “you are earning out of bounds time and won’t be able to…” Instead I would hear them say:”What’s wrong?”

So at this point I was advocating that when a youth did something that hurt others, we assign them a restorative task. I suggested that the task contain two elements. One was the learning element. This was supposed to help them explore anything about the behavior, with the idea of helping them learn not to do it again. I had a lot of ideas for this, from research, to role plays, to interviewing others how they handle similar dilemmas, etc. The second part was the making amends part. That involved figuring out whose life they had made more difficult and do something to make their life easier. Here, too, we had a list of suggestions. The underlying idea of making amends was to teach the youth that if they hurt a relationship, it could be mended. They did not have to give up.
It is important that the response should arise from the case formulation. What had happened to this child? How did we understand his current behavior? What did we think was needed in order for him to change? And furthermore, that the response had to be individualized, based on each child’s needs and abilities.

As I trained treatment centers and people began to implement the Restorative Approach, some problems began to emerge. Most people saw the tasks as punishments in disguise. The kids would get task after task, and end up feeling as hopeless as they did with previous punishing systems. People often assigned tasks in a perfunctory way, using standard worksheets that had no relation to the child or her actions, or having everyone make a card for the person they hurt and apologize. The idea of the tasks having meaning was being lost.
Then, in a conference, I experienced an a-ha moment. After I presented on the Restorative Approach, a woman asked for my help. She said: “We have a girl in our program, Andrea, who is incredibly mean to others. She always says just the perfect thing to really hurt someone’s feelings. We don’t know what kind of Restorative Tasks to give her. We assigned her to research Martin Luther King Jr. and do an essay about him, because we thought he would be a good model for her. She did a very nice job on the essay. But she is just as mean as ever.”

That made me stop and think. We have to go back to our theory of behavior and our theory of change. Why do we think that Andrea is being mean to others? I don’t know her, but I will guess that it is because she feels horrible about herself, and wants to share that with others; and that people have always hurt her, she has not had any good friends, and so she has developed a self-protective strategy to strike first.
So what does this essay about Martin Luther King Jr. do for Andrea? This is exactly the sort of intervention I had been recommending, but I now feel that it misses the point. The essay teaches her that there are people who are good to others, and they can have a profound influence. But if Andrea takes this in at all, I doubt that she relates it to herself. If anything, it would probably be: “I wish I were a good person like Martin Luther King, but instead I am a rotten nasty person.”

Now I feel that our intervention has to be more complicated. If we have a theory that Andrea is being mean to others because people have been mean to her; is hurting others because she has been repeatedly hurt; is protecting herself from further pain, and is sure she cannot ever have real friends, what would the antidote be? It would be to be good to Andrea, to help her discover her own worth, to support her in positive friendships, and to give her experiences that show her (with repetition over time) that people can be kind.
What! My audience would say. Respond to her meanness with kindness? How is she ever going to know that you can’t just do this in the real world? She will get beaten up if she continues to act like this. When will she being to take responsibility for her behaviors?

Not only is this new thinking counter-intuitive, it is harder. Andrea would have to learn skills, and we would have to teach them to her. How do you make a friend? What can you say to people that isn’t mean? What is she good at, in which she can lead or teach others?

So am I saying that we ignore her meanness? Sometimes that might be a good idea. But when possible people can also speak from their hearts and say “that hurt my feelings, Andrea. I am much happier when we are having fun together so do you want to go for a walk?” Andrea’s mean comments are a sign that she is dysregulated, that she is scared. If adults can move closer to her at these times, be more affectionate, they will help her learn to regulate her emotions and not spiral far into her fear.
Another evolution in my thinking is coming to see fear everywhere. When our kids attack, insult, damage property, run away, they are afraid. They are confused and overwhelmed. They have no feelings management skills or trusted relationships to help manage their feelings. So they fall into deep pits of hopelessness. These symptoms are their way to climb out.

Another a-ha moment came when I was training at an agency, and during a kids pickup basketball game one boy was taunting another. The victim hit the taunter. (I wrote about this incident on 7/2/11.) The men in my training came up with ways they would handle this without hitting, and all agreed that in order to do so, one would have to have confidence. You would have to be sure that these insults were not necessarily true and didn’t represent the views of the entire world. How do we give our boys (and girls) the confidence these men have? Not by confining them to their rooms, and not, unfortunately, by having them write essays.
I came up with some questions to ask after an incident:

1.       What led up to the incident?
2.       What do we imagine the child was feeling?
3.       What do we want the child to do when he or she is feeling this way?
4.       What skills, knowledge, attitudes, beliefs…would the child have to have to act that way?
5.       How can we assist the child to take one small step towards acquiring what he or she needs?
So I was already getting too radical as I began to see punishment as largely irrelevant. Then I became involved in studying Bruce Perry’s new work on the developmental evolution of the brain. The most important part for me was the idea that for kids with early preverbal trauma, words didn’t reach the problems. Now I was starting to doubt the efficacy of verbal therapy, at least for some of our most damaged kids. Instead, I began advocating positive rhythmic play with an engaged happy adult. The template of relationships is also stored pre-verbally. So, if we engage in rewarding, repetitive play with our kids, we can reach both the reorganization of the body and the reprogramming of the relationship template.

What? These kids are so wild and crazy, so aggressive and destructive, and you want us to have fun with them?
I began to think that the most important job we have is to reprogram the relationship template. I draw on the words of my friend Martha Holden- the child care worker’s most important job is to make sure than child has a wonderful day. If what is practiced grows, should we help our kids to practice being happy? What if we believe that everyone, all of us, act better when we feel better- safer, more connected, more effective? Many agree with that statement but we do not act that way in our programs.

So now I am balancing at the extreme ends of these two continuums:
Do you think that most misbehavior is related to disrespect, disobedience, manipulation, selfishness….. or that it is related to fear, hopelessness, overwhelm and despair?

What do you think will be most likely to reduce hurtful behavior: is it rules, punishments, rewards, lectures…. Or is it love, fun, safety, and belonging?
You might think these answers are obvious, but our day-to-day actions show otherwise. And as my thinking evolves I am worried that people might think I am a bit nuts. Oh well there is no going back now.  I would love to know your thoughts on this journey and where you are. Just click “comments”……. Thank you.