Sunday, July 28, 2013

What Do Really Mean When We Say We Provide Trauma Informed Care?

Here is a manifesto I wrote recently- let me know if you would like to add anything. 

We act on our belief that everyone is doing the best they can. Every client. Every staff.
We base our interventions on our knowledge that people act better when they are safer, more connected, and happier.
We inform our decisions with our knowledge that fear does not produce lasting growth.  Kindness produces lasting growth.
We believe that change happens within relationships.
We know how neglect, trauma and attachment disruptions change the body, and use that knowledge to design our treatment.
All behavior is communication and is adaptive. It is an attempt to solve a problem in the best way a person knows. Therefore, we attempt to understand behavior before we attorney to change it.
With our clients we are collaborative ad respectful. We are also that way with each other.
We individualize our approach because each person is different.
We are patient and flexile, trying to help the person reach their goals in less destructive ways. We avoid shaming. 
We teach skills and help each person discover and use their voice.
Our most important job is to demonstrate that some people are trustworthy, kind and genuinely caring.
We do this work with our hearts and it effects us as people. We pay attention to vicarious transformation and takegood care of ourselves and each other. We offer forums, fun, and recognition.

Sunday, July 21, 2013

The Role of Support Staff in Trauma informed Care

I recently had a meeting with the support, non-direct care staff in an agency. This included development, IT, administrative services, plant management, security, compliance, medical records and other. I gave them the handout I am sharing here. Please let me know by clicking "comment" whether you agree or can add ideas I have missed. 

You may be the most important person in this child's life. You may be rebuilding his or her brain in your interactions.When you talk with the child, your job is to change this child or family member's template or expectations about other people.The client has learned that people hurt them. You can help them learn that some people don't hurt them. Some people are kind, trustworthy and like them.

In order to offer the most powerful change to this client:

·         Be pleasant and kind. 
·         Learn about the child's interests and follow up on them. 
·         Involve the child in meaningful work and in contributing to others. 
·         Do not keep secrets with the child. If the child tells you anything important, tell his Treatment Team and tell him that you are going to do so. 
·         Do not tell the child that you are going to adopt him, take him home, become his mentor, or anything like that. If any thoughts like that occur to you, do NOT say anything to the child but instead talk to your supervisor and the Treatment Team to see if it is possible .
·         Do not do anything with the child outside of what is normal and arranged by the team. If you think of something, such as giving the child a gift or making an incentive plan with him, ask the team BEFORE you mention it to the child.
·         We can only treat the children and families as well as we treat each other. So be a positive, pleasant team member. Assume good intentions on the part of other staff. Try to help each other whenever possible.
·         Teach the child skills that you know if you get a chance (example: knitting).
·         Say hello whenever you see the child. If you know of a neutral or positive event in his life, ask him about it. Do not talk about problems unless child brings em up. 
·         Compliment child whenever possible.
·         If the child acts out remember it is about his past and not about you. Stay calm and regulated or leave the area if you can. 
·         The stories and experiences of these children will affect you too. Make sure you have someone to talk to about vicarious traumatization, and be alert for its effects on you. Take care of yourself and each other. 

Remember that you have the most important job in the world. You can change a familys life through supporting the people who provide their therapy. You can change a childs life through your interaction with him or her. Your job is essential!

Sunday, July 14, 2013

How Administrators Can Sustain Trauma Informed Care

Recently I developed a list of steps administrators can take to create and sustain trauma informed care. I am sharing it here. Please let e know your reaction and tell me any other ideas I may have missed. 

The following are specific steps that Senior Administrators can take to create and sustain trauma informed care in their agencies.

Develop a mechanism to learn of moments of success, such as patience and understanding helping a child or family, and praise the staff member personally

Establish communication forums such as Lunch with the CEO and listen.

Take clients to lunch. Ask them how you could improve your agency.

Call families who have been involved with the program a few weeks or a month. Ask them how it is going and how you could improve.

When you are asked to consult on a case, ask how the staff understands the behavior.

Develop and sustain employee recognition events and employee and client fun events.

Establish client councils

Have a client on your Board.

When you observe or must respond to a problem situation, praise any one who did anything caring and collaborative with the client.

When things go wrong, seek systems solutions. When possible, do not blame individuals. Make sure to maintain a "we are in this together" stance.

Occasionally join in program fun events.  

Convey hope

Establish contact with every staff member who is hurt.

Speak warmly and hopefully of the youth.

Remind staff about their reason for doing this work, the mission, the importance to the youth.

Make resources available for change effort.

Articulate overall program expectations, such as what is meant by imminent danger and when restraint can and cannot be used, or when to call the police.

Congratulate team members on their stamina in sticking with a certain child, reminding them that it is the most important thing they can do.

Be clear and specific in your intent to establish trauma informed care.

When you make a mistake, admit it. Make amends.

Include descriptions of your success with trauma informed care in all your external communications.

Learn which staff are good at this and support them. And promote them.

When making key hires and promotions, consider the person's familiarity with and commitment to trauma informed care.

Create policy to support this way of working, such as guide to behavior management and treatment philosophy.

Strongly support training.

Consider the agency structure and change if necessary to (as much as possible) unified teams with clinical leadership.

The stories and experiences of these clients, and the pain of the staff, and the complexities of this difficult work we do, will effect you too. Make sure you have someone to talk to about vicarious traumatization, and be alert for its effects on you. Take care of yourself and each other.

Wednesday, July 03, 2013

Doing What You Are Told

I am re-reading the Language of Flowers by Vanessa Diffenbaugh. If you haven’t read it, do so immediately! It is a wonderful story and conveys the inside experience of the children we work with.

This time I was struck by a simple sentence “Doing what I was told had not resulted in my getting what I wanted.”

When children are raised in a good enough family, they are often told no, or told to do things they don’t want to do. As life goes on, they gradually see that the adult saying no was often right and had their best interests at heart. Even when they don’t agree with the adult’s evaluation of the situation, they see that the adult has good intentions. Overall, they learn that the adult’s advice is trustworthy and they can turn to the adult for help. The adult is not only a source of love and comfort, they are a source of wisdom and knowledge.

Some of the children we work with have not had that experience. Many of the adults they have loved and lived with have not had their best interests at heart. Or, it has been variable- at times the adult is thinkingof them, at other times their own stressors get in the way. So the child is told no, don’t tell what I have been doing to you. Don’t tell your school what is happening here. Be quiet so Daddy won’t hit you, or hit Mommy. It’s okay that Daddy hits Mommy because he really loves her. I’m not drunk, I’m just sick. Don’t disturb Mommy when her boyfriends are here.

The adult offers neither comfort nor wisdom. The child is on his own. He must develop a way to protect himself.

So later, when a nice person says “no” and really does have his best interest at heart, he cannot see it. Instead he sees one more person taking something from him to meet their own needs.

Behavior is communication. Think of a child whose behavior you are struggling with. Just for a few moments, imagine that every single thing that child is doing is completely legitimate and is a communication to you about their life so far. What is the child saying? What is she telling you about the people she has known? What is she showing you about how she has had to survive?

So validate. But not by rote or because you have been told to do so. Validate because you know in your heart that she is telling the truth about her actual experience. And by doing so you have begun the transformation.