Sunday, November 09, 2014

Partner for Healing

I would like to invite all followers of this blog to join me at:

Please join our new community.

We are dedicated to supporting you with usable tools to solve problems, assist in training, and increase the effectiveness of the treatment that you offer to trauma survivors.

Already we have offered a checklist for how administration can support trauma-informed care, and another one for support staff. We have shared a training tool for tackling staff resistance. We provided an infographic about what trauma-informed care really is, and another providing steps for beginning your transformation. We just added a blog post about how being a trauma survivor affects being a parent. More valuable resources will be coming on topics like trauma-informed treatment planning, behavior management in foster care, and vicarious traumatization. 

You can't afford to miss all these free tools! Please head to:


Partner for Healing

and join us now.

We have developed an online support service to help you offer the effective and powerful healing that you want to provide.

We are on your side as you do the difficult work of offering hope and healing to survivors of trauma. 

We offer you practical information about:
  • Treatment
  • Program design
  • Team dynamics
  • The latest brain research and how to apply it
  • Vicarious traumatization
  • Vicarious transformation
  • More 
Our mission is to translate current science and theory into practical tips that you can apply immediately in your job as a healer. 

We are there with you, like an adviser sitting on your shoulder, giving you tools to deal with the complex problems you encounter every day. 

You will learn practical techniques and know what to do next. Your team will receive tools and training materials to help you become a positive and effective team. We will share skills that are useful both professionally and personally. 

Programs experience less turnover when workers feel competent, successful, and are an appreciated member of a cohesive team. We will help you get there!

Our website will contain free information and tools to help you. Our subscribers will receive additional resources. Soon we will also offer courses and membership options for agencies and individuals.

 I hope to see you there!

Monday, September 01, 2014

Aren't We Just Putting a Band-Aid on the Problem?

On 3/31/13 I wrote a post "A Small Thought About Band Aids" (

Now I have written a poem in response to the concern that certain interventions are "just putting a band aid on the problem".

Before I share the poem with you, I want to mention that we are VERY CLOSE to opening our new service. It is entitled "Partners for Healing" and will be your tool for more compassionate and effective healing.

After the poem I will give you an opportunity to sign up to learn more about your Partners for Healing, and receive a free infographic of the poem.

Aren't We Just Putting a BandAid on the Problem?

Let me be your band aid
Stretch over you
Protect you
Keep out the dirt and germs
Strengthen you
Cushion you - imperfectly-
From that jolt of pain 
When your wound hits the world. 
Let me cling to you
Enclosing you
As you heal.
As your skin knits together.
As your pain subsides.

As you become whole. 

I'd be very interested in your reactions to this poem. Click on "comment" below and tell me what you think.

Sunday, August 03, 2014

Get Ready for an Entirely New Service

We at the Traumatic Stress Institute have been working hard for six months or so on an entirely new service to better support you, all our friends in trauma informed care. In order to do this right, I am learning all sorts of new web skills. I'm having a great time.

Just to make sure we respond to your most important needs, can you take this one question survey?

One Question Survey

I've also created an infographic on beginning trauma informed care. Get your free copy here:

Click here to join our community and recieve a free infographic.

And here is the link to a list for updates about our new service.

Get updates on upcoming new service

Stay tuned- I think you are going to be delighted with this new product!

Sunday, July 13, 2014

What Does a Trauma-Informed Culture Look Like?

We just finished a Joint Commission survey. We did very well. One of my best moments was when the surveyor remarked that this was a special agency. A staff member asked him what he saw that made it special. He replied, "many agencies teach their staff about trauma-informed care. In this agency, that approach is deep in the culture."

So I have been thinking: what did the surveyor observe that enabled him to know that?

He experienced:

The outpatient therapist talking about how the mother of her client had suffered early trauma, and how this was complicating her response to her daughter.

An in depth discussion of a diabetic girls' eating a large muffin snack at school, that included systems issues, peer issues, biological factors, her loneliness and hopelessness, and the pediatrician's personal experience with diabetes and eating muffins.

A group home therapist who was worried that a client who was " doing everything right" still wasn't letting any one get close to her.

Leadership response to discovered problems that focused on systems issues rather than scapegoating.

A discussion of whether a girl with a self- harm history should be allowed to work with knives in the kitchen that reject the simplistic solution of trying to keep her away from any sharp objects.

Group home staff sharing the pain of watching a girl make plans to live with her father and being afraid he will disappoint her.

An in home service discussing their struggles to implement an evidence based practice while maintaining the provision of concrete help they know makes such a difference to families- even when getting new beds is nowhere in the formula.

The longevity of staff at the agency.

The willingness of a program to take a kid back after a lengthy hospitalization despite their doubts to save her from placement in a shelter.

Foster parents who readily related the behavior of their foster son to his past experiences of being hurt.

The warmth and connection between staff, and staff with clients.

And there are probably many more things. I felt proud observing all this. It was one of those times when I could appreciate all that we have accomplished.

Sunday, June 15, 2014

My Head is Spinning!

I have recently attended two high powered conferences in a row. The first was Bessel van der Kolk’s 25th Annual International Trauma Conference: PSYCHOLOGICAL TRAUMA: Neuroscience, Attachment, and Therapeutic Interventions on May 28 - 31, 2014 in Boston. The theme was What We Have Discovered Over The Past Quarter Century About Traumatic Stress and Its Treatment.

Then I presented at Bruce Perry’s Neurosequential Model of Treatment Inaugural Symposium:
Brain Development and Trauma: Implications for Interventions and Policy, June 10 – 12, 2014 in Alberta, Canada at the Banff Centre. What a lovely place!
So my head is spinning with new ideas and new takes on old ideas, which I will be sharing with you in the upcoming weeks.
First let me focus on a basic premise of the Neurosequential Model. We cannot think when we are dysregulated. We can think best when we are in relationships to others. So, in every situation, for us and for our clients, follow the sequence:




We can use many methods to regulate ourselves and our clients. The best are “bottom up”; that is, using the body and rhythmic, repetitive activities. This includes rocking, walking, petting animals, doodling, jumping, music, throwing a ball back and forth, etc. Regular small doses of such activity can keep us regulated throughout the day and avert many crisises.
Once someone is regulated, emphasize relationship. Connected people are at their best. People who feel noticed, heard and safe can think creatively.
Then, and only then, problem solve.
And as soon as problem solving becomes stressful, return to regulation and repeat the sequence again.
More to come….

Monday, May 26, 2014

Five Benefits of Risking Connection© Training

This week I taught a Risking Connection© Basic three-day training for a Connecticut agency. 

This agency provides various types of home-based services, school-based mental health clinics, out patient clinics, parent resource centers, and day care. It was a joy to teach such caring and thoughtful people. At the end of the training we did an exercise that involved people saying what they would keep from the training. Here are the top five things staff will keep:

  1. I learned tools that help me understand my clients’ behaviors in a new way
  2. I have new ideas for how to help my clients more effectively.
  3. I feel more connected to my agency and the individuals within it.
  4. I feel more valued by my agency.
  5. I learned it is okay to be a human being with human feelings, and how to take care of myself to remain energized and hopeful.

It is always inspiring to participate in the increase of hope and energy that this training creates.

Sunday, May 18, 2014

Participate in Improving our Field

My colleagues and I are engaged in an effort to develop a reliable and validated measure of beliefs favorable to trauma-informed care. When complete, this measure will help establish the effects of training, will assist in agency self-assessment, may be used in hiring decisions, and could have many other uses. As part of the process we are asking many professionals in the field to take a longer version of the survey, which will help us determine which questions work best. Would you like to join us?

Dear Colleague,

At this time, there are no reliable and valid measures of trauma-informed care. For this reason, we are working on an instrument to measure staff beliefs related to TIC. When finished, this could be used to measure such things as the extent to which a school or agency is trauma-informed or the outcome of trauma-informed change interventions.

We need your help. We need as many health and education professionals as possible to participate in a brief online survey. The online survey takes 20-30 minutes and has been approved by the Tulane University Institutional Review Board. All participants who complete the online survey will have the option to enter their name into a raffle. After the study is over, four participants will be randomly selected to win a $25 giftcard to Barnes & Noble.

If you are interested in participating, please click on the appropriate link below.

Please also distribute to other listservs or to health care and education providers in your agencies.  



Thanks in advance for your help.



Steve Brown, Psy.D.
Director, Traumatic Stress Institute
Coordinator, Risking Connection Training Program


Courtney N. Baker, Ph.D.
Research and Methodology Consultant, Risking Connection Training Program
Assistant Professor
Tulane University

Sunday, May 11, 2014

How to Help Kids With Discharge

Jennifer's home passes have been going well. She and her mom Nancy have had some fun together. When disagreements have occurred they have worked them out. Jennifer has been going home for long weekends and even a week over school vacation. The team decided it is time to set a discharge date, and chose the end of the school year. Then Jenn blew up. On her next home pass she went out and didn't come back until late. Her mother was clear she had been drinking and smoking. When Nancy came to visit, Jenn told her she hated her and didn't ever want to go home. She said she wanted to go to independent living. As soon as Nancy left Jenn called her and begged her to come back and take her home immediately, and started swearing at her when she wouldn't.

Going Home is Hard

The ambivalence our kids feel about going home is agonizing and acute. What are some of the contributing factors? They all involve various sorts of fear.
  • Fear that they will not be able to handle it, will hurt the people they love.
  • Fear that the people they love can't handle it and are happier without them.
  • Fear of reconnecting and being hurt again.
  • Fear of school, expecting shame and being an outcast.
  • Fear of not being able to do the academics.
  • Fear of the outside world, being unprotected, violence.
  • Fear of being unable to resist the temptations of peers and the world.
  • Fear that the people who hurt them are still around.
And we could go on. How can we best help our kids survive and accomplish a positive discharge?

Don't Do This

Here's what we shouldn't do:
  • Tell them they have to decide
  • Persuade or pressure them to go to their family.
  • Threaten them.
  • Be upset that they are deteriorating.
  • Punish them.
What we should do, in a word, is explore. Help the child express all the complicated feelings they are having. Maintain a totally validating stance- after all, their mixed feelings are completely understandable and legitimate.

How We Can Help

How can we explore? It sometimes helps to talk about other kids or some kids- move it a few steps away from them. Here are some techniques:
  • Divide a big flip chart size paper into quarters. Title one quarter "what some kids like about home"; another "what some kids find hard about home"; another "what some kids like about... (Whatever the alternative is)" and another "what some kids find hard about (alternative)". Generate as many ideas as possible.
  • Draw a picture of a road branching into several roads. Label them with the youth's possibilities. Have her draw whet she imagines on each road.
  • Tell her some things you have heard from other kids about what makes going home scary.
  • Try and get the world (state worker or whoever has this power) to be clear about what the steps are if she does not go home. Be realistic not threatening.
  • Remember she knows more about her home than you do and she may have some very good reasons to be concerned.
  • If possible help mom to talk with her about ambivalence and how to get through it.
  • Explore what she gets from her mom and what she doesn't. Normalize that no one has perfect parents. Talk about ways she can manage when mom drives her crazy, and where she could get whatever mom cannot give her.
  • Work on helping her become more comfortable where ever she would go to school. Can she start there while still living with you?
In other words don't judge, don't hurry, resist the pressures of the world to fix her ambivalence and decide. Explore. I swear that will be actually FASTER than trying to pressure her to decide.

Continue as much contact as possible between her and her mother. As time goes on, this will resolve. Either she will get past her understandable terror, or she will let you know in words and actions that home is not possible at this time. If that is the outcome, try to preserve as much connection as possible between her and her mother and help them figure out how they can love each other even if they are not living together now.

And you will have given this youth a priceless gift.

Sunday, May 04, 2014


Have you seen the moving new video ReMoved yet? It is available at:

It is about a young girl’s journey into and through foster care. It is $25 to purchase for training use. I have now used it in quite a few training settings. 

Here are some discussion questions I have used:

1.    When Zoe was living with her family what was one of her sources of satisfaction?
2.    What did you notice during the scene when the police came?
3.    Why did Zoe throw the record player over the fence?
4.    What do you notice about Zoe's feelings management skills: feelings management, sense of worthiness, and inner connection?
5.    What happened when Zoe's foster mother gave her the dress?
6.    What did Zoe think when she saw her foster mother on the phone? What did you think?
7.    What did Zoe's foster mother give her that helped her heal?

Let me know what you think of it and how you use it by clicking on “comment” below.

Sunday, April 20, 2014

An Integrative Work-Life Balance

A very important part if the message that I teach is that working with trauma survivors is emotionally difficult, and that it is imperative that we take care of ourselves and each other. We are daily immersed in the pain of our client's lives. This includes sharing their past stories of abuse and neglect and their present experiences of rejection and inadequate resources. It includes being the recipients of the symptoms our clients have evolved to survive. It includes the anguish of caring for clients who connect and then leave. All these and many other experiences combine to create vicarious traumatization ( VT).

We have written extensively about how agencies can imbed attention to VT into their practice. This is essential. Recently people in our field have been paying more attention to VT, or burn out, or compassion fatigue. I am worried about an approach in which an agency says: here is a large caseload, and you are expected to work extra hours, and you will be on call, and we can't give raises for years. But we care about you and know this work is hard- so please take care of yourself and get a massage. On your own time and with your own money, of course.
Agencies must be responsive to the many ways in which they can help decrease VT in their employees.

Today, however, I want to challenge another part of standard anti-VT wisdom. One piece of advice that we often include is: learn how to leave your work at work, don't bring your work home.

However, this does not reflect the reality of any one that I know. Especially not anyone in a managerial position. These days our work and personal lives intertwine. We may be on call or provide back up in emergencies. We often work on projects at home. We can access our files and information from any where. We can always be reached. And our work interests us. Our minds are often engaged in solving a work problem, creating a new service, figuring out how to help a certain client more effectively.

It is important that we acknowledge and grapple with this current reality, rather than pretend that there could or even should be a clear and simple dividing line between work and life. Let's try to figure out this more complex question: how do we honor and protect all parts of our selves within this system?

The first step is to acknowledge the reality. Leaving work at work is not the goal for many of us. Then, consider your own unique self. What is energizing for you? How would you like this balance to be in your life? For some, it might be carving out certain time periods to step away from work. For others, it might be a mindfulness practice that increases one's skills at staying in the moment. Identify activities and connections that are essential to your own happiness and be watchful that these are not neglected. Maybe it includes thinking about what kind of work you do best at home, and scheduling time for that.

It is also important yo look at the at-work part of the equation. If there are projects (for me it is concentrated writing) that are best done at home, can you stay home during the work day? Can you adopt a Seize-the-Moment philosophy and actually leave when there is nothing urgent pressing? Can you incorporate flexibility during work hours to accomplish home chores?

Develop an awareness of what is creative thinking and what is obsessing. What are your techniques for ending obsessing, whether it be about work or home problems?

And cultivate the opportunities for weaving the best of yourself and your greatest joy into both work and home. Do you love nature? Can you figure out a perplexing work problem while walking in the woods? Do you create music? How can you bring that into your work place? Did you learn a new skill at work? Would it help with your own kids? Does seeing the kids you treat heal inspire you? How can you utilize that inspiration in your own struggles?

Let's continue this conversation about how we can stay sane, hopeful and energetic within our real work- life intertwining. Please share your thoughts by clicking "comment" below.

Sunday, April 06, 2014


I have been reading Drive: The Surprising Truth About What Motivates Us by Daniel H. Pink (Riverhead Books, New York, 201). It is very interesting and relevant to both staff and clients.

He starts be reviewing scientific evidence which demonstrates that contingent rewards don’t work and in fact can be dangerous. Pink summaries these findings in a chart “Carrots and Sticks: The Seven Deadly Flaws” The flaws are:

  • “They can extinguish intrinsic motivation.
  • They can diminish performance.
  • They can crush creativity
  • They can crowd out good behavior.
  • They can encourage cheating, shortcuts and unethical behavior.
  • They can become addictive.
  • They can foster short-term thinking.”

 Pink shows that rewards and punishments only work when the behavior you are trying to increase is formulaic and repetitive, involves no problem solving or creativity. I can’t think of anything that we ask our staff or clients to do that fits that description.

So what do we do instead to improve performance? Pink describes that people respond to  autonomy, mastery, and purpose. How can we increase those for both our clients and our staff?

If you would like to hear the master himself, check out this TED talk:

Let me know your thoughts.

Sunday, March 30, 2014

Compassion-Informed Care

One question I get asked a lot when I teach about trauma-informed care is whether this method is appropriate for clients who have not experienced trauma. One reaction I have it that it would be difficult to find anyone, including us, who has not experienced trauma. But putting that aside, I sometimes do regret the term trauma-informed care. Isn't what we are advocating here just good care? Let’s look at the concepts. It is my opinion that they apply to all effective treatment:
  •  A belief that the relationship is the key to healing
  • A conviction that symptoms are adaptive, so that the treater approaches difficult behaviors with respect and looks for how the behavior solves a problem for the client
  • An understanding of the role of the brain and biology and the ways in which development is shaped by experience
  • Empowerment and collaboration
  • Flexibility and individualization
  • A belief that change will come with learning new skills
  • Not relying on punishment and reward as tools of change
  • An understanding that the client is doing the best they can
  • An awareness of the whole body and the importance of non verbal healing activities
  • An understanding that the person will act better when they are safer, happier and more known
  • A deep conviction that the client’s behaviors make sense in view of their experience in the world
So which clients would this approach not be appropriate for? For that matter, wouldn’t it also be the best approach to staff, friends, ourselves?

I wish I could replace the term trauma-informed care with compassion-informed care. After all, compassion is also becoming a buzz word in our world. Would you like to join me in promoting this change? Let’s all begin referring to what we aspire to do as compassion-informed care.

Let me know in comments what you think of this idea.

Sunday, March 16, 2014

Consultation and Training

I am very excited about developing a new division of our training which will offer on line training and consultation. I want this new service to be exactly what you need. To make sure that I understand your struggles and triumphs exactly, would you be willing to take this on line survey? It is called The Joys and Challenges of your job and can be found at:

I would greatly appreciate it. It is short. It is in narrative rather than check boxes because I want to understand you with depth.

I am currently considering a model such as described below. Would you please click on comments and tell me what you think of this- would it be valuable to you? Do you think that you or your agency would purchase it?

An individual or agency subscribes for a specified time period.
During this time, they receive a certain number of training modules.
    Each module consists of a video, transcript, work sheet, and resources
    They are able to download these things and save them
     Topics for modules might include things like:
         How do you know if you are doing trauma informed care?
         A checklist of trauma informed practices
         What can administrators do to promote TIC
         How to formulate and plan treatment
          Maintaining a trauma informed focus in times of stress
          Responding to behaviors that hurt others
During the time period the subscriber has access to once-a week office hours where questions can be discussed.
Furthermore, the subscriber has access to email consultation through which the consultant answers questions and provides additional resources.
For agency subscriptions there are additional elements such as exercises to bring teams together, recognition of accomplishments, notification to administrators when some one completes a module, etc
During this time the subscriber also can join a private FaceBook group consisting of all the subscribers and thus belong to a larger community. This group continues after the time period is over. There is additional less intensive contact and resources after time period is over.   

I am eager to hear your ideas to improve this concept. Thank you for taking the survey and responding to my ideas.

Sunday, March 09, 2014

New Graduates

I am teaching a course at the University of Connecticut School of Social Work. I love it! About two thirds of the members of my class are second year students about to enter the world of job interviewing and jobs. I am interested in preparing them to interview better and enter their jobs with a semi-coherent theoretical framework. In other words, I would like them to be able to demonstrate that they have thought about their work! I often didn't find that when I was interviewing candidates for therapist jobs. When asked about their theoretical framework they all said they were eclectic. So I have developed the following exercise for my students to do to prepare for this question, and then plan to have them practice answering it.

Developing a Theoretical Orientation Statement

Complete these statements:

1.       I believe that people are…
2.       When people experience difficulties it is usually because…
3.       My reading/studying learning of…
has helped me to understand the following about the origins and meaning of problem behaviors:
4.       My reading/studying learning of…
has helped me to understand the following about how to help people change
5.       I believe that the most powerful methods to help people change are:
6.       When doing this work, the helper must:
Compose your answers into a short, coherent statement that summarizes what you believe and know.

What has been your experience with interviewing new graduates? What do you wish they knew or were able to articulate?

You can be sure that the graduates from my class know a lot about trauma, how it affects people, how people can heal, and how the treater needs to care for her or himself to remain alive and hopeful in this work!

Click on comments and let me know your experiences.

Sunday, March 02, 2014

Decreasing Scary Behaviors

Scary days at the Group Home
It is a difficult time in the group home. Sally, a new admission, has been terrorizing the place. She very skillfully causes commotion with all the other girls, making them mad at each other and at her. When they become angry, Sally is astonished and begins to escalate. In her agitation she has left the house in her nightgown and stood in the middle of a busy road, has punched a hole in the wall, hit her favorite staff Tina, cut herself and threatened suicide. The police have already been called three times and she has had one visit to the ER and she has been at the group home less than a month! The other girls are starting to deteriorate, and two of them ran away for a few hours the other night. The staff are very upset. They have begun complaining to each other that the therapist Melissa doesn't seem to know how to handle Sally. Some staff feel the director is being too indulgent with Sally. They say we should impose stricter rules and have stronger consequences for what she does. There is discussion that this is not the right level of care for Sally and the group home should return her to the hospital that she came from.

Sound familiar? What would you and your team do?

Why is Sally acting like this?
Is it because she is unclear about the Group Home expectations? Because she does not know that these kind of behaviors will get her in trouble? Because she does not care about other people? Because she is borderline, manipulative, or bipolar? Because she wants attention?

Sally is acting this way because she is terrified.

She has just moved into this home from a hospital. In many ways she feels more vulnerable. She is right in the town, no campus, no security guards, no gates. She had little control of which group home she moved to, or when, and feels that others are making all the decisions for her. In the past, when adults have made decisions it has not turned out well.

The home reminds her of other homes she has known- both in good and bad ways. She feels much more exposed. She doesn't know these people. She is expected to be more intimate with them than she ever was at the hospital. There is no place to hide. She assumes the girls will hate her and the staff will abuse her and leave her.

When Sally becomes scared, she becomes terrified. She has no one she trusts, so she cannot share her fears with any one. Her already agitated body becomes extremely tense and reactive. She cannot call on any memories of good experiences with relationships to smooth herself. Sally is so sure that she is a horrible person that she knows these new people will not like her and will hurt her. The best defense is a good offense. And Sally does not even recognize what she is feeling, she has no name for it. She does not realize that it is normal to be scared when you move into a new place. She has no ability to calm herself down or use strategies to get through this hard beginning part.

Sally has few skills. She does not know how to make friends. She does not know what to do when her body becomes agitated. She cannot catch herself when she first becomes upset, and she winds up tighter and tighter until she explodes.

When Sally feels hopeless, terrified and overwhelmed she does the best she can to escape these feelings. All the behaviors she displays immediately bring in extra resources and make the situation better. Sally has no idea of any other way to accomplish any relief.

Will consequences and rewards help Sally?
Punishments and rewards effect motivation. Sally wants to to do better. She wants to succeed here and get her own apartment, graduate from college and become a nurse. She just does not know how.

When Sally is emotionally dysregulated, the strength of punishments or rewards is minuscule compared with the mounting pressure of despair and hopelessness. They have no power to influence her behavior.

Punishments and rewards can actually make things worse, by increasing Sally's already strong sense of shame and unworthiness.

If we truly believe that Sally is doing the best she can, why would we punish her?

What will help Sally?
Sally will act better when she feels safer, more noticed and loved, more in control, and when she learns some skills. She will act better when she is happier.

So we can:
Normalize how hard it is to move to a new place
Help her test the safety and security of the Group Home, put her in charge of the locks.
Get to know her.
Do fun things together.
Help her gain control of anything in her life that she can.
Teach her feelings management skills and social skills.
Facilitate relationships with the other girls.

But you say, those are the kind of things we always do. They aren't working fast enough.

These interventions are the fastest and most effective ones there are. Sally won't change quickly. There are no shortcuts.

What can we as a team do to be able to offer the most healing treatment?
Talk to each other. Acknowledge how hard this is. Recognize small progress and special efforts. Plan fun activities together. Talk about vicarious traumatization. Make jokes. Remember other kids who came in snarling and got better. Pay attention when someone gets hurt or has a rough night. Be good to each other. Talk openly about rifts and disagreements that develop. Remind ourselves of Sally's history, and of how hard it has been when we ourselves have tried to change. Have a retreat. Don't work too many hours. Have regular supervision. Take a vacation. Dance together. Have fun with the kids.

There is no magic answer- but there is the possibility of healing
We do not have a system which will immediately result in Sally giving up the strategies that have allowed her to survive her difficult life. However, we have the immense power of love. And again and again we are privileged to create miracles of healing with the young people we serve.

Sunday, February 23, 2014

A New Venture

I am about to start an exciting new venture- plunging into social media. I am taking a couple of courses to help me develop an on-line branch of my consulting business. I envision creating more on-line learning and consulting options. My particular passion is the day-to-day operations in our treatment programs. How can we assure that every moment is as healing as possible? How can we maximize the ability of every treater, whatever their job role, to create a new relationship template in the brains of our trauma survivors? I have experienced how hard our work is and how we constantly operate at the edge of disaster. We don't have enough resources and we manage severe and scary behaviors. We have regulations, scrutiny and extensive reporting requirements. And, we have wonderful, caring skillful staff and a deep commitment to our important mission. The clients we serve have been hurt, not through their own fault. Given these realities, how can we make sure that we deliver effective, powerful treatment? And how can we improve the experiences of our employees so they stay energized and hopeful in the work?

I have been devoted to these goals through my training, teaching, presenting, consulting, this blog and my book. Now I would like to extend my reach through cyberspace. Would you like to be part of this? I would love to develop an advisory group to help me figure out I can be of most use. If you are interested let me know by clicking "comment" below.

Meanwhile, wish me well and you will be hearing more in the future.

Sunday, February 16, 2014

Signs that Trauma Informed Care is Eroding- and What to Do about It

This post is part of my new focus on how to sustain trauma informed care. It describes indicators that a trauma informed approach to treatment may be eroding in a team, factors that may be contributing to that erosion, and actions to take to restore compassionate and effective treatment.

Signs that trauma informed care is eroding:
·         Grounding are more frequent and longer
·         Restorative tasks begin to look like punishments
·         People start talking about clients “getting away with” things
·         Behaviors are described as deliberate and attempts to get at staff
·         Team members are not trying to understand behavior or figure out how it is adaptive for the client. Instead they focus on how to change it. 
·         Divisions start between team members, there is more blaming of each other
·         Team members start asking for more rules to govern their interactions
·         Staff stay in offices and interact less with clients
·         The words “consistency” and “structure” are used more than usual
·         Activities begin to have to be earned, and clients are not allowed to attend fun events or arts or recreation activities due to recent problem behaviors
·         Clients are described in pejorative terms such as “manipulative” and “borderline
·         People say things like "she wants to be that way"
·         People make hopeless and cynical statements
·         Less laughter and fun
·         People are talking about returning to points and levels or adding more severe consequences

What to look for as contributing factors:
·       Client turnover
·         Staff vacancies and over work of remaining staff
·         A new, more severe type of client
·         Administration being less available
·         Any particular staff having severe problems
·         Personal issues and losses
·         New reporting or oversight demands
·         Difficult incidents and/or bad discharges

What to do:
·         Talk about it
·         Acknowledge changes and stressors
·         Make a plan to solve particular issues ( I.e. Hiring) with deadlines and responsible people and stick to it
·         Discuss vicarious traumatization (VT), do VT exercises, acknowledge difficulty of work
·         Provide opportunities to reflect on successes
·         Arrange team building retreats and fun events
·         Increase staff recognition
·         Emphasize the mission and the importance of the work
·         Increase administrative presence
·         Remember past successful clients, and how they started
·         Do not get sucked into making more rules for clients or staff- look beneath to the meaning     

 Let me know your thoughts- have you had any experiences with observing the erosion of trauma-informed thinking in your teams? What has been helpful?

Monday, January 27, 2014

American Health Care Paradox

I attended an interesting seminar on Friday. It was entitled Mobilizing a Multi-sector Approach to a Healthier America: Resolving the “spend more/achieve less” paradox. It was sponsored by the Connecticut Council for Philanthropy, the Donaghue Foundation and the Connecticut Association of Nonprofits. The main speakers were Dr. Elizabeth Bradley, professor of public health at Yale, faculty director of its Global Health Leadership Institute and author, will share comments about the complicated question "why is our society less healthy than other industrialized countries when the U.S. spends so much more on health care? and co-author, Lauren Taylor, MPH., Dr. Bradley offered insights from extensive research and discussed how our current health care system provides limited outcomes while expending excessive resources. They are the authors of a new book "The American Health Care Paradox." 

The authors began by showing us that the US spends more per capita in health care costs than any other member of the Organization for Economic Co-operation and Development (a group of 34 industrialized countries), and achieves dismal outcomes. They shared statistics which demonstrated that America ranks very low among the 34 industrialized countries, ranking 25th in maternal mortality, 26th in life expectancy, 28th in low birth weight, and 31st in infant mortality, for example. 

However, the picture becomes more interesting when you add the spending that these countries do per capita on social support. That includes such things as food stamps, housing help, early infant care, every other type of social welfare. When the two types of spending are added together, the US spends an average amount, in the middle of the per capita spending. The US spends a very large percentage of the total on health care, where as other countries spend a larger percentage of the total on social support. In the US, for $1 spent on health care, about $0.55 is spent on social services. In the OECD on average, for $1 spent on health care, about $2.00 is spent on social services. In other words, we spend more of our social help dollar on healing illness; other countries spend more on supporting better living conditions for the population. The authors did extensive analysis that proved that with or without including the US in the mix, the higher the percentage spent on social support, the better the health outcomes. 

In other words- when you spend more of your total health and quality of life dollar on social services, you get better outcomes. 

The authors described an interesting difference in values that contributes to the decision making around allocation of money. One area of difference that stood out to me was our sense of who social supports are for. We would all agree in America that we all use health care. But in America we think that social supports are for the “other”: the poor, the minority, those who are different from us. In other countries, such as the Scandinavian countries, supports are considered to be necessary for all. In America, if you have a baby, you get an in home visitor if you meet certain risk criteria. In European countries, every new mother with a baby gets in home visitation. 

Bradley and Taylor described some programs which have combined social service and medical spending to achieve notably good results (let me know if you want the citations). They and other speakers promoted that the Affordable Health Care Act offered opportunities for such programs. 

I felt that their argument is greatly bolstered by the ACEs study. The ACEs study is proof that social conditions leading to child abuse and maltreatment cost our society many millions in health care costs. Once again, our money would be spent more effectively by addressing social stressors which lead to child abuse and maltreatment than it is presently by treating the resultant severe medical disorders. 

I won a copy of the book so I will post again after I read it. Please click on comment to share your thoughts on this important topic.