The Boy who was Raised as a Dog by Bruce Perry

I highly recommend the book The Boy Who was Raised as a Dog by Bruce Perry (Basic Books, New York, 2006). (http://www.amazon.com/Boy-Who-Was-Raised-Psychiatrists/dp/0465056520/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1195999799&sr=1-1)

Dr. Perry also has a very helpful web site at: http://www.childtrauma.org/default.asp which contains other articles he has written.

Dr. Perry uses the stories of many abused and neglected children to illustrate and develop his points about the effects of trauma. This book is an excellent way of sharing this knowledge as it is quite readable and fascinating.

Here are some notes I took about points I found important. If you want more information or don’t understand a note- read the book! Or, click “comments” and ask questions.

Brain sets down a “template”- how life is supposed to be and go- and reacts particularly to any thing out side that template, anything new

Thus our early experiences contribute the template: our definition of “normal”

Could also contribute to under-reaction to danger: since brain is particularly paying attention to what is new, what doesn’t fit the pattern- danger is not new

Brain changes through repetitive, patterned activity:
Use dependent development of brain

To change muscle (exercise) must have moderate, repeated, patterned extra stress- brain decides, oh, we are going to be doing this now, better develop some new muscle cells
Same with brain cells
Stress is signal to cortex- something new going on here
Moderate stress is good for brain and body, develops ability to handle stress

However, imagine going to gym and trying to lift 200 pounds- would not build muscle or teach body anything
Would hurt yourself
This is similar to stress children receive from trauma

Brain constantly processing info from senses
Becomes habituated to the familiar
Reacts to the new

Critical to survival to remember those things that led to negative experiences
Often must remember after ONE bad experience
Negative emotions burn events in to memory

Lower brain compares in-coming data with laid down patterns- one question- does this data suggest danger?
Makes immediate response while sending to higher brain for further refinement
Become more alert, look for more information

What the brain does in danger:
1. focused alertness
2. shut down cortex chatter
3. more vigilant and more concrete
4. heart rate increase- blood to limbs
5. focus on social cues- is help available?
6. muscle tone increases
7. hunger/digestion disregarded

Dissociation- freeze- response when you cannot flee or fight
1. curl up
2. make yourself as small as possible
3. prepare for injury:
4. blood shunted away from limbs
5. heart rate slows to reduce blood loss from wounds
6. body flooded with opioids to protect against pain
7. produces feeling of calm and a sense of distance from what is happening
8. some times can help with functioning

Both hyper arousal and dissociation help people survive trauma.
Both can be harmful if prolonged and habituated.

Stress without control is most harmful
Rat experiment- some rats were shocked when they pressed a lever (had control); some were shocked when the other rat pressed a lever (no control): animals who do have control develop strengths, those who do not develop ulcers, lose weight, compromised immune systems, become more sensitized to shock, can’t recover

Stress with control leads to habituation (developing new skills and coping mechanisms)
Stress with lack of control leads to sensitization (disorganized intensifying response, immobility)

Flash backs, re-enactments- an attempt to have small doses of trauma within one’s control to develop habituation or tolerance
If trauma is too much cannot be mastered this way

Brain develops sequentially- certain tasks at certain ages
So traumas at different ages have differing effects depending on what the brain was working on at the time

Terror early in life can shift person to a less thoughtful, more impulsive, more aggressive way of responding to the world- thinking has been shut down too much just when it was time for it to develop

Humans develop through relationships
Relationships necessary for survival
Humans are also our most dangerous predators

Stress responses very closely tied to systems that read and respond to social cues
We are very sensitive to moods, expressions, gestures of others

We have mirror cells in our brains that fire when OTHERS express emotions, creating similar emotions in us
Mother-baby
Basis of empathy
Human society built on this interactivity

Infants born dependent
Parenting is pleasureful
Infant associates touch with pleasure- needs met, relief from distress, calming anxiety
Sensory patterns of human interaction associated with pleasure
Template established
Brain develops in use-dependent manner
If sensitive period is missed, may be hard/impossible to do later- if a kitten’s eye is kept closed during a certain period of sight development, may never develop sight even if opened later
Need repetitive, patterned interactions

If touch has not been associated with pleasure this needs to be addressed in systematic, careful way, starting with less scary touch
Touch own hands
Chair massage
Using heart rate monitor to monitor fear

Importance of rhythms
Rhythm is very important to human functioning
Sleep/wake, when to eat, heart rate, cycles
Use music, movement, dance, drumming to re-train

Using psycho-ed with kids, enables them to help each other

Let me know if you read or have read this book and what your reactions are!

Our Presentation at ISTSS

I was extremely proud to be part of a pre-meeting institute at the recently completed Annual Conference of The International Society for Traumatic Stress Studies. Our presentation was entitled:
Preventing Trauma by Applying Theory to Change the World
The premise was that theory based on science provides a road map to guide practice, and theory-based practice leads to effective and lasting change in the world.

The first presenter was Laurie Pearlman, PhD, who discussed the creation of her trauma theory, Constructivist Self Development Theory. (For more information see: McCann, I.L., & Pearlman, L.A. (1990). Psychological trauma & the adult survivor: Theory, therapy, and transformation. New York: Brunner/Mazel and Pearlman, L.A., & Saakvitne, K.W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: W.W. Norton.) Laurie described the need for this theory, the context at the time it was developed, and how it was developed using the Boulder model (theory-research-application). The assumptions of CSDT are Constructivist: trauma effects individuals differently; Developmental: trauma effects the development of self; Relational: relationships are the context for trauma and recovery; and that symptoms are adaptations. CSDT articulates that trauma affects: self capacities (ability to manage the inner world); ego resources (ability to manage the interpersonal world); and psychological needs and cognitive schemas: safety, trust, esteem, intimacy, and control; as well as the frame of reference (big picture) including identity, world view, spirituality; and the body and brain.

Kay Saakvitne, PhD. then spoke of the process of converting this theory into a teaching manual, Risking Connection®. Risking Connection® arose out of a grass roots movement in Maine in which survivors sued the state claiming that mental health services were making them worse. They won, and Risking Connection® was developed to train all mental health workers about trauma. Kay covered the basic outline of Risking Connection® and the collaborative process necessary to make the theory into a teachable curriculum for people at all levels of experience. (Risking Connection: A Training Curriculum for Working With Survivors of Childhood Abuse by Karen W. Saakvitne, Sarah Gamble, Laurie Anne Pearlman, Beth Tabor Lev Sidran Press; Spiral edition January 2000)

Steve Brown, PsyD and I then discussed our work using Risking Connection® to train child serving agencies. We reviewed the reasons agencies feel a need to change from traditional points and levels and rule oriented systems, and how hard that change can be. We described our dual approach of Risking Connection® trauma training combined with the Restorative Approach™ "how-to-do-it" method. Agencies that make these changes are experiencing a drop in restraints and seclusions, better outcomes and better staff job satisfaction.

Esther Giller, MA, described a fascinating project in which Risking Connection® was used to unite faith based and treatment agencies in Baltimore. Risking Connection® training was used to develop a common language and understanding to break through barriers and connect diverse service organizations. Esther described a slow process of forming relationships, developing common terms, and training people separately that was needed before the groups could be brought together. The RICH framework from Risking Connection® provided a structure for respecting each other, sharing information, forming connections and developing trust and hope. The project was evaluated and give high marks for collaboration and sustainability, and remains active today. (DeHart, D. (2006). Collaborative Response to Crime Victims in Urban Areas: Final Evaluation Report. Columbia, SC: Center for Child & Family Studies, University of South Carolina.
Giller, E., Day, J., &Vermilyea, E., (2007). Congregational Clergy Responding to the Spiritual Needs of Trauma Survivors: Risking Connection in Faith Communities. In press, Haworth Press, Journal of Trauma Practice, vol.6.
Full report of findings available at: http://www.sc.edu/ccfs/research/FaithReport.pdf)

Ervin Staub, PhD, then presented his theories of Prevention and reconciliation in mass violence: The theoretical bases for intervention; and the origins and prevention of violence between groups. His theories demonstrate how difficult life conditions and frustration of the fulfillment of basic needs can create a climate in which hatred between groups can grow. He described continuums of conditions which push towards violent or more peaceful solutions of problems (such as devaluation of other vs. humanizing the other; destructive, exclusive ideology vs. Constructive, Inclusive Ideology; Unhealed Wounds vs. Healing of Past Wounds; uncritical respect for authority vs. moderate respect for authority; monolithic society vs. pluralism; unjust societal arrangements vs. just social arrangements; and passive bystanders vs. active bystanders. He described conditions which promote the healing of past wounds. Ervin has also been studying altruism born of suffering: what makes some people who have been hurt turn to helping, instead of hurting, others? Also, what promotes active bystanders who have the courage to object to evil? (Staub, E., Pearlman, L.A., Gubin, A., & Hagengimana, A. (2005). Healing, reconciliation, forgiving, and the prevention of violence after genocide or mass killing: An intervention and its experimental evaluation in Rwanda. Journal of Social and Clinical Psychology, 24(3), 297-334.
Staub, E. (1989). The roots of evil: The origins of genocide and other group violence. New York: Cambridge University Press
Staub, E. (2003). The psychology of good and evil: Why children, adults and groups help and harm others. New York: Cambridge University Press
Staub, E. (2006). Reconciliation after genocide, mass killing or intractable conflict: understanding the roots of violence, psychological recovery and steps toward a general theory. Political Psychology, 27,(6), 867-895.)

Finally, Ervin Staub PhD and Laurie Pearlman PhD presented how Ervin’s theories are combined with CSDT and Risking Connection® to intervene in genocide torn Rwanda to promote reconciliation and healing. They have used the RICH messages to inform a radio drama show which teaches about trauma and healing. Their work has special emphasis on preventing those who have been victimized from vicitimizing others.(For an overview of Staub and Pearlman’s work in Rwanda, see
Staub, E., & Pearlman, L.A. (2006). Advancing healing and reconciliation. In Barbanel, L. & Sternberg, R. (Eds), Psychological interventions in times of crisis. New York: Springer-Verlag.)

For me the most exciting part of this presentation was the connections between the various projects. For example, there were similarities between the careful processes necessary in Baltimore to those needed in Rwanda. And Ervin Staub’s work on promoting healing, and promoting those who have been hurt from hurting others, there lies the blue print for the work we are doing in child serving agencies.

It was an honor to be part of such a distinguished panel; and I think that all such theory-based work in its turn informs and transforms the theory.

Note: descriptions of theories and projects were taken from the words of the authors.

The International Society for Traumatic Stress Studies Presentation

Note: I will be presenting as part of a pre-meeting institute at The International Society for Traumatic Stress Studies’ 23rd Annual Meeting which will be held in Baltimore, Maryland on November 15-17, 2007, with pre-meeting institutes on November 14.Wednesday, November 14.

Half Day
8:30 a.m. – noon
Trauma Prevention as Social Change: From Trauma
Theory to Real Life Practice (Abstract #178942)
Pre-Meeting Institute (commun)
Technical Level: Intermediate
Pearlman, Laurie Anne, PhD1; Saakvitne, Karen, PhD2; Wilcox, Patricia, MSW3; Brown, Steven, PsyD3; Staub, Ervin, PhD4; Giller, Esther, MA5
1Trauma Research and Education Institute, Inc., Holyoke, Massachusetts, USA
2Private Practice, Northampton, Massachusetts, USA
3Klingberg Family Centers, New Britain, Connecticut, USA
4University of Massachusetts Amherst, Amherst, Massachusetts, USA
5Sidran Institute for Traumatic Stress Education and Advocacy, Baltimore, Maryland, USA

In this institute, we present three theory-based initiatives in trauma prevention and treatment. We describe two central theories and three initiatives based on them, highlighting the process, challenges, and benefits of attempts to put theory into actual practice. The theories are constructivist self development theory (McCann, Pearlman, 1990; Pearlman, Saakvitne, 1995), a relational trauma theory which provides a framework for understanding the psychological impact of traumatic life experiences, and Staub´s model for understanding the origins and prevention of group violence (1989, 2003). The three projects all emphasize the importance of theoretical frameworks, the healing powers of RICH relationships (that include respect, nformation, connection, and hope; Saakvitne, 2000), and the ethical imperative to address the experience and needs of the healer in trauma work. Saakvitne will describe the translation of psychological theory into a training curriculum, Risking Connection. Esther Giller will present Baltimore´s Spirituality and Victim Services Initiative using the CSDT-based Risking Connection (Saakvitne 2000) and Risking Connection in Faith Communities (Day 2006) curricula as training and collaboration-building tools to bring together multidisciplinary
community resources to trauma survivors. Wilcox and Brown will describe efforts to create trauma-informed care systems for young adults, adolescents, and children in mental health systems. This initiative has taken place largely in congregate care settings. It combines training and consultation using Risking Connection, and the restorative approach (Wilcox, 2006), a treatment approach emphasizing relational rather than behavioral management techniques. Pearlman and Staub describe a project that combines CSDT with Staub´s Origins and Prevention model to promote healing in Rwanda. Staub´s work identifies the psychological,
social, economic, and historic forces that set the stage for group violence. It emphasizes understanding the sources of violence and the necessary components of reconciliation after mass violence. A controlled evaluation of their approach found decreased trauma symptoms and more positive orientation toward the other group. The approach has been used with groups from community members to national leaders, and is the basis of radio-based public education
in Rwanda, Democratic Republic of Congo and Burundi. Each presentation will discuss research, challenges, and successes.

If you are going to be at ISTSS, stop by and say hello!

Increasing Readiness for Trauma Informed Care

If you work for a treatment agency that is just beginning to think about trauma informed care, there is an important step you can take to increase your readiness to make this change.

This step is: increase the likelihood that staff will consider what is behind a behavior that a kid is displaying before taking action to respond to that behavior.

A key concept of trauma informed care is that symptoms are adaptations: that people do things for a reason. The behaviors the kids do that are problems for us, are solutions for them. Behaviors such as aggression, self harm, destroying property, bullying, screaming, running away, throwing chairs- they all serve an immediate purpose for the child, and what’s more, they work. The purpose is usually to escape some sort of intolerable feeling. Because the child has no reliable attachments to help her calm down, her emotions over whelm her. Because she has a changed biology and a sensitized nervous system, a small problem feels like a catastrophe. And because he doesn’t know any feelings management skills, he does not know how to identify or handle the feelings, does not believe any one cares, and does not think he is worth the trouble any way.

So instead of staying with over whelming feelings of fear and hopelessness, the child does something. And the problem is temporarily solved- even though there are long term negative consequences.

Every behavior is adaptive. And if we understand the benefits a child is getting from a behavior, we open up many more ways to help the child. This is much more powerful than just trying to punish the behavior away.

How can an agency develop a culture in which the adaptive function of a behavior is routinely considered and discussed?

I believe the clinicians should take the lead here. Shortly after a child is admitted (like 2-3 weeks) the team should hold a meeting in which members of all disciplines (teachers, child care workers, nursing, etc) are present. The therapist should convey a beginning formulation of the case- a theory of what happened to the child and why they are acting the way they do. This formulation could be summarized in a treatment theme such as "learning to trust adults" or "learning to manage feelings" that highlights the most important thing the team will work on. The child should also be part of determining the treatment theme when appropriate.

Then for every behavior that occurs the therapist should lead the questions: why is she doing this? Why now? What problem is she trying to solve? What has happened recently? How do we understand this?

After a while this kind of thinking can become so pervasive in the program that everyone thinks this way, and child care workers, teachers, everyone starts asking the same questions.

So if a boy often has a tantrum before bed time, we are wondering what it is about bed time that is hard for him, and thinking more of night lights, staff presence outside his room, soft music- and less of punishing the tantrum.

Start thinking about what meetings, what occasions, what communication channels can be used to communicate ideas about the meaning of behavior.

After a while it will be automatic to ask these questions and use your theories to determine your responses. Then you can start the next steps in implementing trauma informed care.

As always, comments are strongly desired- it’s easy! Just click on the word “comment” below.

Call for Response and the Restorative Approach™ and DBT

First, I would like any one who is reading this to read the previous guest post from Devereaux and respond to the thought-provoking questions they pose through clicking on the "comment" button below.

Last week I attended the first week of intensive training in Dialectical Behavior Therapy (DBT). The State of Connecticut Department of Children and Families is providing this training for 18 agencies chosen through an RFP process. The trainers are from Behavioral Tech, the official training group of Marcia Linehan, who authored DBT. (http://www.behavioraltech.com/)

Several people asked the trainers how DBT fits with a relational model. The trainers stated, and I completely agree, that DBT is a relational model, and pays a lot of attention to the quality of the relationship between the treater and the client. DBT states that the relationship is our main source of power and reward, and our main vehicle for changing behavior.

Many aspects of DBT promote a relationship approach. First of all, the DBT assumption that the client is doing the best they can, and that we must adopt a stance of radical empathy and search for a non-prejorative, phenomenological empathetic interpretation of the clients makes a relationship possible. We are more able to form a relationship with the client if we are not blaming him for his behavior. Secondly, DBT promotes radical genuineness on the part of the therapist. It is okay (inevitable in fact) for the therapist to have personal limits, to be affected by the clients' behavior and to have reactions. These can be shared with the client in a real way. The emphasis on transparency, on teaching the client everything you are doing, on respect for the client's ability to learn and understand, also promotes a strong relationship. The therapists’ ability to respect her own limits decreases her becoming angry with the client.

A critical component of DBT is the consultation team, which supports the treater. The Consultation Team assumptions of fallibility and non-defensiveness, as well as the dialectical method of problem solving, create a strong and healthy team. Therefore, relationships with other providers enable the treater to have strong relationships with the client.

DBT pays very close and careful attention to what the treater does within the relationship. DBT speaks about positive and negative consequences for behavior, and emphasizes contingency management. But most often they are not referring g to 10 minutes more Nintendo time. They are asking us to closely notice what we do within the relationship. When do we spend time with the child? When do we smile, talk in a warm voice, pull back, frown, be closer, be more distant? All of these can reward or punish behaviors. And we need to use these contingencies carefully and planfuly, lest we inadvertently reinforce the very behaviors we are trying to change.

DBT even has a concept of restoring relationships after there has been a problem, and of over correction- doing more than you strictly need to to make sure the breach is healed.

Although there were some parts of the training I need to think more about to integrate with our current approach, over all I think that DBT and the Restorative Approach™ compliment each other.

Questions from Guest Bloggers

I am delighted to feature this guest response from the staff of Devereaux, Mass. Please all readers: post your answers to the thoughtful questions they raise by clicking on "comments".

Pat,

On behalf of countless readers to this blog, we’d first like to extend our sincere appreciation to you for your willingness to speak to the needs of some of society’s most vulnerable children as well as for your consistently compelling and thought-provoking challenges to the status quo in residential treatment. As mental health professionals who have been immersed in attempting to facilitate culture change toward a trauma-informed model of care at our place of employment, we’ve been truly grateful for the leadership you’ve provided your fellow administrators and clinicians who struggle to match contemporary trauma and attachment theory to the pragmatic challenges of healing traumatized youth in congregate care settings.

Not unlike many of your blog entries, your latest spoke directly to our experience in residential treatment. The scenario you described was very similar to events that take place at our campus school from time to time, including the ‘ripple effects’ among staff following an aggressive incident and the difficulty of providing an administrative response that honors the client’s therapeutic needs while not dismissing the staff’s charged emotions.

Upon discussion we agreed that our preferred response to the scenario in your blog would include: a) an emphasis on maintaining the safety of both client and staff, b) a thorough assessment of the situation which should identify any critical yet underdeveloped skills and capacities that played a role in the client’s response, as well as any other setting events and/or environmental circumstances (including staff behavior) that may have played a role in the incident, and c) based on the results of the assessment, a creative intervention that combines teaching the needed skills while also attempting to heal the relational breach between the client and staff member. In short, we did not view as necessary the need to institute any consequences that would serve purposes other than those listed: safety, skill-building and relationship-enhancement.

To be completely honest, what compelled us to write to your blog was not to endorse Klingberg’s Restorative model of treatment and/or the Risking Connection curriculum. As both residential administrators and treatment team leaders, we’d really be interested in hearing from others who not only believe in these approaches to treatment but also are attempting to implement them. As such, we’d like to broaden the questions you’ve posed in the above scenario in an effort to invite fellow providers to respond from a more systemic perspective.

In the aftermath of a significant aggressive outburst toward a staff member such as the one you describe between Aaron and Charles, our experience has been that staff seem less inclined to embrace a trauma-based framework and, instead, drift toward adopting more punitive, response-cost methods of facilitating change if: Aaron is physically large and imposing, Aaron has no documented trauma history, he appears to have had a "good day" and was quite calm leading up to the moment of aggression, Charles and other staff members appeared to have avoided any actions that could have been misconstrued as a posture of intimidation towards Aaron (e.g., inadvertently surrounding the client), Aaron boasts after the incident (often viewed by staff as a ‘lack of remorse’ and seemingly inviting ‘power-over’ responses from staff), Aaron was heard making threats toward Charles earlier in the day/week (suggesting planfulness rather than merely becoming overwhelmed in the moment by intolerable feelings), Aaron is gang-involved, or if Aaron assaulted an equal-sized or physically smaller female staff.

We’d like to hear how other providers increase the likelihood that their staff (i.e., clinical, residential, educational, medical, and administrative) collectively hold to a trauma-informed model of care when these type of countertransference-heightening factors are present. How do other providers temper the contagion of staff fear, anger and/or silent wishes for retribution? What efficient mechanisms do others use to regularly remind their staff of the role of shame in driving many incidents of disruptive behavior? Do other providers use ‘crisis staff’ (as Pat referred to them) in their schools? How do you define their roles and does your funding allow you to maintain sufficient numbers of these staff so that they have time to engage in restorative work rather than merely reactively running about putting out fires? How do you avoid becoming complicit in over-relying on physically large, male crisis staff who typically become, over time, the primary repository for vicarious traumatization at residential centers?

In addition, do other providers anticipate there are limits to a restorative approach or its effectiveness with certain populations (e.g., clients diagnosed with autism spectrum disorders)? We recognize that neither the restorative model nor the Risking Connection curriculum have, as yet, been subjected to randomized controlled studies and we are interested in the experience and thoughts of other providers.

Lastly, the success of facilitating this type of culture change also seems dependent on a host of other culture-congruent circumstances. In Massachusetts, for example, many providers are witnessing fewer residential referrals with a concomitant decrease in overall census. As a result, providers are often forced to limit expenses for many activities that do not involve direct work with clients, namely trainings, staff meetings, supervision, correspondence with interdisciplinary team members, keeping shift supervisors free to supervise rather than be assigned clients, etc. In addition, staff turnover, while improved in our setting since introducing the Risking Connection curriculum, still requires further stretching of resources. While we’re certainly proponents of adopting restorative approaches and providing Risking Connection training to staff, without the necessary structures to reinforce these concepts and practices on a day-to-day basis, culture change becomes an even greater uphill battle. Since most models of trauma-informed care rely heavily upon staff members’ own ‘relational skill set’, it comes as no surprise to us that some staff working in fiscally strained environments tend to drift toward utilizing generic, predetermined and punitive responses to client aggression and disruptive behavior.

(Note: We were pleased to recently learn of the American Psychological Association’s strong support for the effectiveness of a related model of intervention, i.e., ‘restorative justice’ approaches, over ‘zero tolerance’ approaches to reducing violence in schools. We viewed the report as providing additional support for utilizing a restorative model of care in residential treatment, even for treatment of youth without documented histories of trauma or attachment disruptions.)

Thanks, again, Pat for being a national leader in trauma-informed care. Your work has been a catalyst for change in our setting. We also look forward to hearing about the experiences, positive or negative, of other treaters who are evolving toward trauma-informed approaches.


Bob Davis, Psy.D., Director of Clinical Services
Jennifer Bergeron, Psy.D., Program Director
Mike Healey, M.A., Clinician
Devereux Massachusetts

Would More Severe Punishment Have Helped?

Everyone is talking about it- staff and kids. Yesterday at school Aaron punched Charles, and Charles has a black eye. The kids are agitated, worried, and making fun of Charles. Aaron is bragging: "yeah I really showed him". The staff are furious. Charles is feeling helpless and humiliated.

It was during math class, and Aaron was being his usual loud, obstructive, insulting self. The teacher tried many times to redirect him. Finally, she called the crisis staff and asked that Aaron be removed from her classroom. Charles came and talked with Aaron, and he seemed to calm down a bit. He walked out with Charles- did not require any physical intervention. But ten minutes later in the intervention room Aaron became agitated again, and hit Charles in the eye.

The worst part is, the staff is saying, that Aaron did the same thing two weeks ago- he hit another staff, a friend of Charles’.

Some of the talk is:
Did Aaron get off too lightly the first time? If he had been punished more severely, would he have been less likely to hit again?
He seemed calm and he walked out of the classroom on his own. Doesn’t that mean that this attack was planned and thought out, not an emotional reaction?
What is Charles supposed to do when the other kids make fun of him? He is feeling low and stupid, like he has been made a fool of or like Aaron has gotten the better of him. If only the administration hadn’t been on this trauma-informed-treatment kick Aaron would have been punished more the first time and so would have known not to do this again. Doesn’t the administration even care what staff goes through?
What should happen to Aaron now?

So- what do we think about this?

If Aaron had been more severely punished the first time, would that have resulted in his not hitting Charles this time? It is possible that if Aaron had a threat of jail, or parole, or had been some how more severely consequenced, he would have been able to keep that in his mind during this incident and use that to help himself control his impulses. It is also possible that severe punishment would have left him more angry, more shameful, less connected, more hopeless and less able to feel any reason not to hit. What do you think?

What about the fact that he seemed to calm down for ten minutes or so after his agitated behavior prior to this hitting incident? Does that mean this was not an emotional reaction and trauma-related? Does that distinction even make any difference? Should the fact that he appeared calm lead to him being held responsible for this incident in some way? If the incident was emotion and trauma based does it mean he should not be held accountable?

What about Charles? He is feeling pretty lousy now. Is he right to blame the administration for not punishing Aaron more the first time? How should he handle the kids’ teasing? How can he use what he is going through to understand Aaron better?

What about Aaron? If we had control of what happens next, what should it be? Should he leave the program? What interventions would actually contribute to his being less likely to hit again?

Please contribute your thoughts on these questions by clicking on "comments" and leaving a comment. We will thus continue this discussion.

Presentation at Alliance Conference

I will be presenting at the National Conference of the Alliance for Children and Families next week. If any one reading this plans to be there, please stop by and say hello.

The conference:

Alliance National Conference: Join the best peer national network of nonprofit human service leaders at the Alliance’s premiere event in Anaheim, CA at the Anaheim Marriot Hotel. This conference promises to expand your national peer connections and equip you, your senior management team, and your board with knowledgeable solutions to the many timely issues and opportunities facing the nonprofit human services sector. Learn more at the conference Web site.

My workshop:

Session C: Thursday, October 18 - 10:30 a.m. to Noon

C6The Creation, Enhancement, and Maintenance of a Trauma-Informed Treatment AgencyThis presentation explores the transformation of a large behavioral health, child welfare agency into a trauma-informed, relationship-based treatment program. It explains how unique approaches were used to establish trauma-informed treatmentintegrated with Dialectical Behavioral Therapy, implementing it in group homes, a school, and various community-based treatment programs. The workshop further explores the enhancement of trauma-informed treatment through client-generatedindividual crisis management plans, psycho-education on trauma for children and parents, and integration of sensory interventions. These approaches reduce the use of restraints and seclusions, increase staff job satisfaction, and reduce staff turnover. The agency enhances its ability to effectively treat severely damaged children and their families with successful outcomes.
Presenter: Patricia D. Wilcox, vice president, strategic development, Klingberg Family Centers, Inc.

Are Restorative Tasks Punishments in Disguise?

When programs first begin to use the Restorative Approach™, staff often think of restorative tasks as punishments by another name. This leads them to attempt to create tasks that take as long as their traditional punishments did. Staff are still thinking that the power of the tasks lies in their deterrent value; in other words, that the kid will stop doing the behavior because the tasks will be so hard and they will not want to have to do them. In other words, that the tasks are punishment. This leads to the piling up of tasks, and continuing hopelessness on the part of both the child and the staff.

Instead, let’s go back to our theory of what is wrong, and what do we actually think will promote change.

Why are the children hitting people and throwing chairs and running away and cutting themselves? Is it because they lack motivation to change- that the previous punishments they have received for doing so have been inadequate?

No, it is because they are doing the best they can to solve current intolerable problems.

They do not have safe, strong trustworthy attachments in which they can relax and learn new skills, and they never have. They do not know how to resolve problems that arise within relationships. Trauma has changed their biology, sensitized their nervous systems, and left them hyper-reactive. They have not been taught the basic human feelings skills: how to hold onto the belief that someone loves you; believing that you are worth the air you breathe; and what we do when we experience strong emotions.

Because of this, they over-react to current setbacks, do not believe that anyone can or will help them, and have no way to manage their emotions. So they act out.

Will punishment help all this? No. The children have already been punished. If that would solve these problems they would be over them by now.

The Restorative Approach™ is designed to provide what will help:
Attachment- safe, regulated relationships in which people speak from their heart and are honest about the relationship effects of behaviors, and are Respectful, Informative, Connected and Hopeful.
Containment of hyper-reactivity: an environment structured for success with available regulated adults helping children become regulated.
Teaching of feelings management skills: Opportunities to develop relationships. Active effort towards creating inner representations of those relationships. Many different methods to experience competence, help others, examine shame, surface what is shameful, and to see delight in another’s eyes when they look at you. And feelings management: active teaching of noticing, naming, soothing, distracting, and utilizing feelings.
Teaching of relationship repair skills: when something goes wrong between me and another, there is something I can do about it.

The power of change happens in these areas. The restorative tasks should be designed to take a small step in one of these tasks- it could be in any area. Often, the learning piece is in the area of feelings management: what was I feeling? What happened? Or, it could be feeling worthy of life: make a list of my skills and good points.
The amends piece works in the area of attachment, relationship skills, and also contributes to self worth.

So the idea is not to make up a task for every thing the child does wrong. The idea is to figure out what we think is going on in a given event, what skills is the child lacking, and assign a task that will help develop these skills. It does not have to be aversive. It has to be our best guess at something that will work- help the child learn a little something new, and be a little more connected with the people around him.

It is not fear of punishment that will change the child. It is developing the relationships and skills that will allow her to weather current set backs without having to resort to such desperate behavior.

Excuses

"I guess I can understand how his trauma history can be an excuse for his behavior yesterday" Sarah, a child care worker, said to me in training. "But today, he was feeling fine and I don’t see how his past is an excuse today."

The fact is that a child’s trauma history is never an excuse. It is always a reason. The child’s daily life, emotions, and thoughts are always affected by their past. The child’s biologically different, hyper-responsive nervous system does not change from day to day. His distrust of others is always present. His fear of being weak or vulnerable remains a part of his choices. His lack of emotion management skills, his sense that he is not worth while, that he is to blame for everything bad that happens, his inability to maintain a connection with others, stay present in every day life.

However, this does not mean that the child cannot change. He can begin to feel safe and to relax. He can slowly learn to trust a few people. Through experiences of success and approval from others, he can discover positive parts of himself. He can learn feeling management skills.

If a child had diabetes, we would not refer to his diabetes as an "excuse" for his reaction to sugary foods. We would not speak of his diabetes as an "excuse" to avoid eating certain foods. We would hope that the child would gradually increase in his competence in managing his diabetes, and would use the skills and technology available from others, and would lead a largely normal life. And, the diabetes would be always present as a reason for some actions and choices.

Even if a child had a broken leg, we would not call his broken leg an "excuse" to avoid a hike. If we were taking the child some where, we would make adaptations to promote the child’s success on the trip. We might bring a wheel chair for long distances. We would plan frequent stops to rest. We would teach him how to use crutches and bring them along with us. We would not be blaming the child for needing these adaptations.

At the same time, we would expect the child to get better. We might enroll him in physical therapy and encourage him to work hard at the exercises. We would gradually do less and less for him as he healed. His whole leg cast would be reduces to a smaller cast and then to a bandage. There would be a constant balance between understanding his pain and incapacity, and supporting his efforts to heal.

How we speak about kids can strongly influence how we feel about them and thus how we act towards them. When we speak of their trauma histories as an excuse, we imply that kids should have no responsibility and that what will help them is to simultaneously blame them for their incapacity and to have low expectations. This is, in fact, the opposite of what will help. If instead we understand the child’s trauma history as a reason, a fact, a condition they have been given, we will both not blame them, and we will have hope for their potential to heal and to achieve greatness.

Thinking Blogger Award

I was tagged for a Thinking Blogger Award!

Congratulations, you won a Thinking Blogger Award! The participation rules are simple:
If, and only if, you get tagged, write a post with links to 5 blogs that make you think,
Link to this post so that people can easily find the exact origin of the meme,That was that! Please, remember to tag blogs with real merits, i.e. relative content, and above all - blogs that really get you thinking!

This all started at:
http://www.thethinkingblog.com/2007/02/thinking-blogger-awards_11.html

The blog that tagged me is:

http://theyreourchildren.blogspot.com/
And I was very interested to discover this blog and add it to my reading list.

This is the link to the entry in which I was tagged:
http://theyreourchildren.blogspot.com/2007/09/thinking-blogger-award.htm

I was also fascinated by another blog that was tagged, Sunshine Girl On A Rainy Day. She's a former foster child who now writes about foster care issues and how kids in foster care could be better served. Very interesting!

So now I have to tag 5 blogs that make me think. I have not been able to find many blogs in the therapy world, so if any one knows good ones please post in comments. I read a lot of blogs about promoting change, and non profit management.

One of them is: Change This
http://blog.changethis.com/changethis_newsletter/
"ChangeThis is creating a new kind of media. A form of media that uses existing tools (like PDFs, blogs and the web) to challenge the way ideas are created and spread. We're on a mission to spread important ideas and change minds." Since I am working on changing how treatment is provided to children, this blog often gives me good ideas.

World of Psychology
Dr. John Grohol's daily update on all things in psychology and mental health. Since 1999.
http://www.psychcentral.com/blog/
This blog is part of Psych Central, "the Internet's largest and oldest mental health social network created and run by mental health professionals to guarantee reliable, trusted information and support communities to you, for over 12 years." It contains updates of the latest news and information in the mental health field, which can be very helpful.

The Trouble With Spikol
http://trouble.philadelphiaweekly.com/
is a blog by Liz Spikol, "managing editor of Philadelphia Weekly. She writes the award-winning column which began as a chronicle of her struggle with mental illness, and has since expanded into humorous musings on everything from graphic novels to how to use a mop. This blog is about mental illness- policy, news, personal journeys and more." I like the combination of personal experience and news updates.

Net Squared
http://www.netsquared.org/blog
New Squared is a central site for the non-profit community which introduces us to Web 2.0. They state that: "Our mission is to spur responsible adoption of social web tools by social benefit organizations. There's a whole new generation of online tools available - tools that make it easier than ever before to collaborate, share information and mobilize support. These tools include blogs, wikis, RSS feeds, podcasting, and more. Some people describe them as "Web 2.0"; we call them the social web, because their power comes from the relationships they enable." I have gained much useful information here.

Nonprofit Communications
http://www.writing911.com/blog/

Descibes its content as: "Tips and ideas on nonprofit communications, publications, marketing and PR. As a nonprofit consultant, I love helping organizations communicate more effectively with their members, donors, volunteers and other supporters, so they can make the world a better place." I like the fact that each entry is a "carnival"; a compilation of many articles on a certain subject. It is a wealth of information.

Then here is a bonus blog. I love Mind Mapping and use Mind Manager for all my planning, writing and thinking. Therefore I also love the official Mind Jet blog:
http://blog.mindjet.com/

"This is the blog of the Mindjet Corporation, the makers of MindManager® software. Mindjet Corporation is the leading provider of productivity software for visualizing and managing information, allowing individuals and teams to more effectively think, plan, and collaborate. The Mindjet® MindManager® enables users to visually connect and synthesize ideas and information to improve decision making, shorten business planning processes, and harness the intellectual capital in their organizations."
I get many ideas as to how people are using Mind Manager in new and creative ways.

I hope this post leads you to some interesting reading. Please add your own favorite blogs in our field in the comments. Thanks!

The Children are Running the Program

"Help us Pat!" the call comes in.
"We need you. Ever since we moved away from points and levels, the children don’t care what they do. They are getting worse and worse, rude, defiant, acting out. Since they don’t lose points they have no deterrents to bad behavior. A two-minute apology letter means nothing to them. We need to put back some more consequences."

What are the assumptions behind this plea for help? That the main reason that the kids ever acted politely was because they would lose points if they didn’t. And that the only response we have to address problem behavior is consequences.

Do we really believe this? I don’t.

What about the relationships?I think what happens is that when the behavior management system of a program is changed, if we are not careful a staff paralysis sets in. If I cannot take away points or drop levels, what can I do? So I do nothing, and sit by helplessly, another sort of neglect.

In fact, points, levels and consequences are a small part of our arsenal of tools to impact the kids’ behaviors.

Here are some other tools:
· Talk about it. Say you don’t like it. Describe how the behavior affects you and the other community members. Express hopes that change will happen.
· Work hard and constantly to form caring relationships with the kids so they care what you think.
· Validate the feelings behind the behavior.
· Express an understanding that this is the best the kid knows at the time- and the hope and confidence they will learn better.
· Develop in the child the basic feelings management skills of maintaining an inner connection to others, feeling worthy of life, and feelings management.
· Teach specific feelings management skills to do things differently.
· Use feelings management skills your self and label out loud that you are doing so.
· Have group meetings about what kind of place we want here.
· Have group meetings about bad things that happened and how everyone felt and how we can support each other to do better.
· As a team, discuss how we understand this behavior. What is our formulation about what is going on here? What problem is this behavior solving for this child? How can we teach her to solve that problem a better way?
· With the kid, develop a treatment theme- what is the basic thing this kid is working on? Examples would be: feeling emotion without acting to make the situation worse. Learning to trust. Growing up. Then relate all behavior to that theme.
· As a team support each other in the long, difficult process of doing this work.
· Work on developing self worth.
· Address shame.
· Use (possibly as restorative tasks) exercises that help the child understand and manage his behavior, such as mood charts, emotion thermometers, collages of how they are feeling and/or things they can do differently, interviewing others about how they handle emotions, etc.
· In treatment team develop restorative ideas for each child that are significant, require thought, and are related to their treatment.
· Don’t take the kid on trips when they have just hurt you- and explain why you don’t want to.
· Make sure you have enough fun and interesting things going on so that kids who can’t participate because they are working or restorative tasks will be missing something they want to do.
· Make sure your structure and planning supports success.
· And- TALK ABOUT IT. Address every problem. Take the kids on. Tell them what kind of behavior you expect. Tell them how different actions make you feel.
· And tell them, and show them, over and over again, all the good things you see in them and how delighted you are by everything positive (and even neutral) that happens.

Points and levels are so insignificant when compared with these (and other) more powerful tools. Changing to a trauma focused approach does NOT mean paralysis in the face of destructive behavior. It means active, complete and relationship based engagement. And then both the staff and the kids will be co-running a programs that supports growth and change in all.

Attention

Many times when we start discussing what is going on with a particular child I hear staff say: "she is just doing it for attention". We say this dismissively, as this invalidates the behavior and means we don’t have to take it seriously.
If you go to a play ground where children are playing and adults are near by, what do you hear constantly from the children: "Look, Mommy!" "Daddy, watch this!" "See how high I can go!" The children are clamoring for attention.
In fact, as adults we also demand attention. When you receive a compliment or an honor, do you call someone to tell them about it? Do you get upset if you try to tell your partner something and they are not paying attention?Attention is the food of the soul, the building material of the brain. It is necessary for growth and change. It is through the attuned attention of another that our brain develops and we form a sense of who we are, what the world is like, and what we can expect.
Attention is one crucial part of what was missing in the development of traumatized children. They were not central. Their needs were not put first. Often there was no one to listen to their stories and to take their disappointments seriously. Their needs were problems to be dismissed, not legitimate. Their cries were not answered. They have an attention deficit- not just that they cannot concentrate, but that they have empty spaces that have not been filled through the loving attention of another. No one was watching.
And now they are in treatment programs in groups of 12, 14, 17. Adult attention is in short supply, and is often monopolized by extreme behaviors. It some times seems the only way of being heard is to scream.
Paying attention is the greatest gift you can give another person. So next time you hear the words "he was just doing it for attention" stop. Pay attention. Listen. Express delight. Remember. Comment. Watch. Look, and describe what you see.
Attention is the nourishment you can give that will enable others to grow.

Change Your Conversations, Change Your World

You can further your change towards a trauma informed treatment program by changing the conversations you have as a staff.

Lisa is a sixteen year old girl who has been at this therapeutic group home for almost a year. During that time she has been known to sneak off and be where she is not supposed to be, and to lie to staff. However, recently she has been doing really well and everyone is quite proud of her. Lisa is scheduled to be transferred to a lower level of care shortly- a graduation which makes her staff very proud.

The other night Lisa sat with her favorite staff and said she had some thing to tell her. She then proceeded to confess a series of occasions when she had lied that no one knew about- such as saying she was at her job when she was really with her boyfriend, and sneaking out of the house at night. These things happened weeks and months ago.

What is the FIRST thing that you talk about at a staff meeting?

Is it what is the correct consequence- should she be grounded even though these things happened a while ago? Do staff take sides on yes, ground her, she needs to learn; no don’t ground her after all she told us voluntarily?

If this is your conversation, the fact that you decide not to ground her does NOT prove that you are using a Risking Connection® / Restorative Approach™ approach.

Instead, your first conversation, and ultimately the only interesting one is: what is going on here? Why is Lisa telling us these things? What was happening with her when she was doing them and what is happening now? Of course, her telling this is probably related to her impending discharge. She is probably saying: Look you guys I’m not so sure I am ready for less help. I know you are proud of me and all but I am scared to death. Plus I don’t want to leave you just as I am finally getting used to you. Look what I am capable of- I should stay right here.
And that conversation leads us to lots of possibilities. Is there more we can do to help her get to know the people at her new place? What conversations can we have with Lisa about her fears of going, the difficulties of saying good bye, and what she needs? We do not need to lecture her on the dangers of running away, or how she will never keep a job if she is not reliable. Instead we can talk about what it all feels like to her, the job, the boyfriend, this group home, the place she is going.

And with these interesting conversations going on we never even need to get back to boring subjects like whether or not she should be grounded.

If you want to change your program, after every event ask: what is going on here? What does this behavior mean? How is this action an adaptation for the kid, what problem is it solving for her? How can we help her to meet her needs another way?

These thoughtful conversations among staff and with the kids will strengthen relationships, teach feelings management skills, help the child (and staff) feel sane and worthwhile, and offer the greatest possible power for healing.

Cereal on the Counter

Scenario number one:

It’s a school day and Dahlia is sluggish and half awake. She scatters cereal all over the counter and leaves the milk out when she goes over to the table to eat. "Dahlia!" Mary, a staff member says. "Clean up this mess you made! Put away the milk!"
"No" replies Dahlia. "You do it".
"Dahlia, I have given you a directive. Please get over here and put away this milk and clean up this mess!" Mary insists.
"F you" replies Dahlia.
Eventually Dahlia leaves for school, counter unclean, milk untouched. Mary cleans it up.
Mary is fuming. "These girls" she says to a co worker. "They are so lazy and they have no respect for me or for this house. They are hopeless. How will they ever be able to live on their own?"


Scenario number two:

It’s a school day and Dahlia is sluggish and half awake. She scatters cereal all over the counter and leaves the milk out when she goes over to the table to eat. Mary looks at the counter and says: "Hey, Dahlia, what a mess. How about I’ll put away the milk- will you get the counter after you are done eating?"
"Okay I guess" says Dahlia.
After she is done with her cereal Dahlia cleans off the counter in a half-hearted way, leaving some cereal. Then she goes off to school.
Mary finishes up the cleaning.
"Ahhh, teen agers" she thinks to herself as she goes on with her tasks.

Which was your morning like?

We have all had both types.

Notice the power of how a request is made: a "staff directive" or a request and a mutual effort.

But even more important notice the power of how an event is defined. Is this an obstinate child defying a Staff Directive, a sign of disrespect and a hopeless future? Is it clear evidence that the child has no caring for Mary or for the house? Does it demonstrate beyond doubt that Dahlia will never manage her own life well?

Or is it a teen ager in the morning?

The Real World

I have not written anything in this blog for a while because I have been working on a SAMHSA grant application that has demanded every bit of free time and writing energy I could dredge up.

However, in a Risking Connection® training we were doing recently, a participant made the familiar objection: "we are not preparing these kids for the Real World". I’ve heard this a lot. The idea is that if we do not punish the kids for their behaviors they will never learn that these behaviors are not tolerated in the Real World- we are coddling them, spoiling them, and giving them an unrealistic view of life.

Consider the following analogy:
My 8 year old friend Ryan is in Instructional Little League this year. In this league the kids get five strikes, some times more if the coaches decide that the ball throwing machine isn’t working right. Everyone always says encouraging things to them: "good swing Cameron" (Ryan's team has three kids named Cameron, two girls and a boy) for a strike; "nice try" for a throw to a completely unpredicted part of the field. And the coaches constantly teach the kids skills: move your foot up a little. Keep your eye on the ball. Move your body to catch the ball, don’t just stretch. Every thing the kids do that is even remotely in the direction of what they are supposed to do is highly praised. They can only run two bases (otherwise everyone would get a home run every time, as no one ever catches the ball) and the innings are over when a team gets 5 runs. Obviously, the idea here is to begin teaching the kids the skills, and to limit the humiliation/ disappointment/ frustration they feel so they will want to play again. The game is set up to encourage success and limit damage.

And no one ever says: "we aren’t preparing these kids for the Real World if we give them special treatment like this".

Maybe we can consider our treatment centers to be instructional real life.

In the actual Real World ideas of Restorative Justice are gaining ground, and many more court systems are using them.

I would also hope, however, that the Real World that our kids live in will contain (as mine does) people willing to negotiate, and flexibility, and understanding. I hope that they will not in fact be punished for everything they do wrong (luckily, I am not). When they hurt someone, I hope they will have a chance to make up for it and heal the relationship. I hope that their Real Worlds will not be characterized by unremitting harshness.

In the mean time, maybe we can continue with the Instructional level and teach them skills, encourage them, and limit the damage so they will want to continue to play.

Just Ask What’s the Matter

I want to remind you that there is a major way you can implement trauma informed care without needing any committees, any program change, and without eliminating your points and levels system.

When a kid is upset, ask them what is the matter.

Don’t talk about consequences. Don’t talk about better ways they could be handling it. Don’t try to get them to take responsibility for their actions.

When you ask, be prepared that their response will be about something that someone has done wrong at your "stupid place" (that’s if they are putting it mildly). Don’t argue. Don’t tell them why the person was right to do what they did- even though you know they were.

Paraphrase what the kid said: so you are very angry about being sent up from school? It doesn’t seem fair to you? You can add an element of the possibility of change by introducing such phrases as: "Right now" as in: "right now you don’t like any thing about this place?" or "at the moment it seems impossible that you will ever have any friends?"

Emphasize any feelings they impart, especially any besides anger: you are discouraged, you are sad, you are frustrated, you were hurt.

Ask what else is upsetting them?

Stay for as long as you possibly can at the exploring and paraphrasing stage. No suggestions of how they could have handled it better, no mention of consequences that will happen, no taking responsibility for their action, just explore what are they upset about.

During all this keep your breathing slow, your voice calm, yourself regulated.

And this takes patience. You may have to keep doing this for a long time.

And then when (and only when) you notice some de-escalation on their part, some slowing of breath, and reduction of yelling, willingness to talk, then start considering: so where can we go from here? The kid is upset and wants this, the adults think this is necessary, how can we go forward? Where ever you can compromise, be creative, use unique solutions, do so.

At this point also slip in some discussion of other, non-problem related things: how the room floor is hard, how its cold in here, how you remember they had their basketball game yesterday, how did it go- chit chat. If the child is really much calmer, some humor can often help.

Once the child has regained some sort of regulation, you will often be surprised how easily the next steps can be figured out.

Try this today.

Recent Conference Presentations

I have just returned from presenting at the Black Administrators in Child Welfare Conference in Baltimore and at the Child Welfare League of America Conference in Washington, DC.

At BACW I was struck by the power of inspirational stories and of invoking past heroes and heroines to create courage for the current struggle. Presenters repeatedly told their own and others’ stories of triumph after trauma, prejudice and adversity. Heroes such as Rose Parks, Sojourner Truth, and Martin Luther King were called forth to bring energy to current problems. How can we use these methods more in our own agencies, and in our own change efforts? All of us in this field know inspirational stories of kids and families who have changed, programs that have been transformed, and treatment that has been effective. Many agencies have their own founding heroes and heroines. While we do turn to these rich legacies for help, I felt after attending this conference that we could do so more and with greater emphasis. Also, in this conference I experienced more acknowledgment of the struggle of this work, and the need to comfort and care for each other.

In my presentation I referred to the kids we treat as "damaged". Joanne V. Rhone, Ph.D., Professor at Clark Atlanta University suggested I would be better served by referring to them as "wounded" because as we know, wounds can heal. Damage, she stated, sounds more permanent and unchangeable. I thought this was an excellent point and will adapt my language in the future.

I attended a workshop on "Working Between Circles & Lines: Using the Restorative Circles Process to Create Effective Collaborative-An African Centered Construct for Organizational Prosperity". This workshop includes an introduction to Restorative Justice as a best practice in Child Welfare and how to use it to create paradigm shifts in organizational culture and practice. Restorative Justice is a set of values that guide decisions on policy, programs and practice. The Circles process restores the collaborative effort of agencies working together for the greater good. It was led by Saleem Hylton, CEO, President; K. Ivy Hylton, MSW, LICSW, Youth & Families in Crisis, LLC, Washington, DC They described and demonstrated the power of a Circle to bring people together and hold meaningful discussion. They gave examples of the use of this circle in creating agency collaborations, as well as in offender/victim encounters. I hope to utilize this technique further.

I also purchased two useful small books: The Little Book of Restorative Justice (Little Books of Justice & Peacebuilding Series) by Howard Zehr and The Little Book of Restorative Discipline for Schools: Teaching Responsibility; Creating Caring Climates (Little Books of Justice and Peacebuilding) by Lorraine Stutzman Amstutz and Judy H. Mullet. Both have clear explanations and many practical implementation ideas.

At my presentation at CWLA I had participants from all over the country, and it was very interesting to experience this national change in treatment approach. Many agencies are starting to implement trauma informed treatment and to move away from point and level systems. One agency expressed concern about whether such a change led to longer lengths of stay. Others talked about child care workers indoctrinating each other to "be tough" and not show feelings. It was clearly helpful to connect with others doing this work, and reinforced my hope to start more email net works and communication mechanisms.

Altogether it was a very interesting and inspiring trip.

Upcoming Conference Presentations

Is any one attending either the Black Administrators in Child Welfare (in Baltimore) or the Child Welfare of America (in Washington D.C.) conferences next week? I am presenting at both and would love to see you there. If you read this blog, please introduce yourself to me at the conferences.

My workshops are:

BACW
Friday afternoon
C-4 Creating a Culture of Connection in Residential Treatment

This workshop explores the transformation of a Residential Treatment Center into a trauma-informed, relationship-based treatment program. It explains the Restorative
Approach theory of change, new language used, specific treatment techniques and response to acting-out behaviors. The Risking Connection Curriculum-trauma framework, therapeutic relationships, counter-transference and vicarious
traumatization-will be introduced.
Moderator: Dr. Sharlyn Bobo, Washington, DC
Presenters: Patricia D. Wilcox, Vice President of Strategic Development; T’Kai Howard, Coordinator, Nia Sage House, Klingberg Family Centers, New Britain, CT


CWLA
Tuesday morning
C11 Creating a Culture of Connection in Residential Treatment
This presentation explores the transformation of a residential treatment center into a trauma-informed, relationship-based treatment program. It explains the restorative approach theory of change, the new language used, specific treatment techniques, and the response to acting-out behaviors and it introduces the Risking Connection Curriculum. Presenter: Patricia Wilcox, Vice President of Strategic Development, Klingberg Family Centers, New Britain, CT

Hope to meet you there!

A Wonderful Example of a RICH Interaction

I am in the midst of a Risking Connection training with two co-trainers, Michele May LCSW and Richard Nicastro, Ph.D. Michele is the Clinical Director of Natchaug Hospital’s Journey House Program. Richard is a therapist specializing in trauma with offices in Glastonbury, CT. He is also a life coach, and his blog can be found at http://www.relationshiptuneup.typepad.com/

Richard gave a wonderful example of how even a brief interaction can be RICH.

A few years ago Richard was running an anger management group for boys at a local community center. He noticed that one boy was standing near by imitating his movements and mocking him. After the group, Richard went up to the boy and say: "You know, I am looking for some new members for this group, so if you or any one you know would like to join I’d welcome new people. But you know what, I am looking for someone who is a real wise-ass, because we need some humor in this group. Even though we deal with some serious topics we need some comic relief and I’d like someone like that in the group. So, if you know any one..."

The boy did not join the group, and in fact Richard didn’t see him again for over a year. He learned from others that the boy had been in a lot of trouble and a lot of programs, and that since he was young he had been living with his father’s serious illness and constant near death.

Much later someone called Richard with a referral of an adolescent boy whose father had just died. Richard accepted the referral and was astonished to find the same boy in his waiting room. It seems that when the boy needed to go to therapy he remembered Richard’s name and asked if he could see him.

Think how completely Richard displayed a RICH relationship in those few minutes. He demonstrated Respect for the boy in his approach, and in his assumption that a sense of humor could be an asset. He gave Information: the group is available, you could join, and you could help others. He established Connection (more than he realized) by appreciating the boy and his skills. And he conveyed to the boy the Hope that there is some one out there who wouldn’t judge or dismiss him, who might see the good in him and who maybe could really help.

And look at the power that one moment of RICH interaction can have in someone’s life.

Many thanks to Richard for this excellent example.

Asking Directly for What We Want

Asking directly for what we want is very difficult.

First of all you have to know what you want. That is not always easy. It involves noticing your own distress or need, and correctly diagnosing a possible solution. Many times we feel vaguely unhappy or sad and have no idea what would help.

Then, you have to have in your heart the concept of needs being met, the possibility of improvement. You have to have some experience of feeling bad, then feeling better. When you need help, some times people help you.

And which people would that be? You have to have people you can trust around to receive your requests. You have to experience them being willing, pleasant, and regularly saying yes to you. Your experience must also be that they are gracious and generous about helping you, and do not extract a high price.

Also, to ask for help you have to feel enough okay about your self that you can handle not being perfect. I need help, I cannot manage everything myself, but I am a good enough person over all. I actually deserve help. I help others.

That deserving is a big thing. You have to think there is some reason that some one would actually be willing to do something for you.

Asking for help directly makes you vulnerable. The other person could say no. They could make fun of you. By telling them what you need you are showing how they could hurt you.

I know a lot of very competent people (especially women) who cannot ask for help. I know many professionals that have trouble delegating and work from an "I-can-do-everything-myself" stance. I know women who take on every responsibility in their family, and men who can’t share worries about work. I know a man who overwhelms his friends by doing things for them until they become annoyed, because he can’t imagine they would like him unless he "bought" their friendship. I myself often have difficulty asking for and accepting help.

When we work with treatment systems we try to teach staff willingness to step back from an interaction with a kid and accept help from a peer when you are stuck. People say that this is hard. Harder still is identifying the kid you are struggling with and asking the team members to help you figure out what is going on for you and thus do better treatment with that kid.

So...

When we focus with our kids on "asking appropriately" we are demanding a very high level of functioning, maybe more than we ourselves can do. How many times have I heard a staff saying "you didn’t ask appropriately" or "she is only doing that for attention". Manipulation, as we have seen, is the essence of asking indirectly and dishonestly for what one needs.

If we believe that symptoms are adaptations and solve a problem, we cannot wait until our kids can "ask appropriately" to meet their needs. None of the above conditions have been true in their lives. Instead, we have to guess and use observation and trial and error to figure out what their needs are. Then we have to meet them. We have to volunteer help, give graciously and generously to them as best we can. Then, maybe, after much time, they can relax, trust, and feel safe enough to ask for what they need.

Maybe even appropriately.

And maybe if we also create environments in which we can relax, trust and feel safe, we can also learn to ask for and accept help from each other.

Non Profit Blog Exchange

I am writing as part of the Non-Profit Blog Exchange, a method of connecting the non-profit blogging world and further spreading our work. The blog I am reviewing is Marion Conways’ Consultant to Non Profits Blog, at http://marionconwaynonprofitconsultant.blogspot.com/. This blog covers many aspects of non-profit leadership, including fundraising, finding volunteers, on line donations, promoting your web site, and Board responsibilities. I recommend it because it contains information that is helpful across many types of non-profits. It is very interesting to learn skills from say, museums, and apply them to behavioral health. It helps us identify the commonalities in our struggles. Marion offers very useful help for non-profits of all kinds.

Who Are These Kids?

If I walked up to the first child care worker I saw at your place and asked, "Who are the kids who come here? What are they like?" what response do you think I would receive? Would the person say: "They are kids who have experienced severe difficulties in their lives, who are hurt, who haven’t developed the skills they need to have lives worth living. But they are really great kids"? Or would the response be more like: "they are very difficult, aggressive kids. They have committed crimes or done other bad things. They are wild and out of control. They can’t be trusted, they will hurt you, you need to watch them, you can’t let them get away with a thing"?

Of course the response would vary with the day, with the minute. It might be different from program to program. And most likely the response would contain parts from both responses above.

But who we think the kids really are determines what we think they need. In the first scenario (again, keeping in mind that these are extremes on a continuum) those kids need to heal, to learn to manage their pain and emotions, and they need skills. In the second scenario, those kids need control, punishment, vigilance, to be watched, a tough staff who holds them accountable and doesn’t let them get away with a thing.

And that leads us to who we have to be. Who we think the kids are leads us to our ideal for child care staff. What is the actual ideal that is operating in your culture? Are new child care staff socialized by experienced workers that they should be kind, calm, soothing, and should gently teach the kids new skills? Are they taught and shown that liking, enjoying and appreciating the kids is essential to what we do here? Or are they scared by violent war stories, shamed for being innocent and trusting, or weak, and taught you have to be tough and firm and not let the kids get away with anything? Do staff brag about their moments of connection? Or are they proud of the battles they have endured, the injuries they have received without flinching or showing any response? Is the staff ideal closer to a person or to a rock?

Again, the reality is undoubtedly somewhere in the middle. But let’s have these discussions out loud. Ask staff what they learned from experienced staff when they first came to work here. Talk about what we want the ideal to be and how we can put that into practice. Remember, how we see the kids is undoubtedly how they will act.

Manipulation Part Three- Us

I may seem to be obsessed with the concept of manipulation, as this is my third blog post about it. This concept, for me, represents how hard it is to create an entire world-view change in the treaters who work with our damaged kids. So often we teach the section in Risking Connection on manipulation, only to hear as I did the very next day a child care worked in the training say with indignation something like: "and I couldn’t believe that child was trying to manipulate me to get what he wanted, what did he think I was, an idiot? And by going to that other staff he did get exactly what he wanted!"

First of all, it actually isn’t a crime for a child to get what he wants. And if we would like to encourage direct communication of needs, we have to be prepared to say yes when ever possible.

Secondly, the question of what may have prevented this boy from asking directly for what he wanted was missing. And more and more I become aware that our systems prevent a child from asking directly- for more phone time, for an extra snack, for a later bed- because we are so wedded to our structure that we automatically say no. "He knows the rules. Who does he think he is?"

Yet we ourselves often ask for and get extra, against the rules- an extra cookie from the cafeteria staff, the ability to leave early just because we are tired from our supervisor, some extra telephone time (when we are being paid to be working) because our child is sick.

I have begun wondering why we get so angry about this. We feel angrier than we do for more severe behaviors, such as aggression, at times. One aspect, I think, is that manipulative behavior appears deliberate and calculating, within the child’s control, as opposed to an angry out burst which is clearly emotionally based. We lose sight of the factors beneath the child’s inability to meet his or her needs directly.

What do we feel when we have been tricked or manipulated? When we are vigilant to spot and stop all manipulation what are we guarding so heavily against?Staff comments give us clues: Does he think I am stupid? I felt like a fool. The rest of the staff will not respect me. He thinks he can get over on me. I looked bad in front of every one. I felt like an idiot because I believed him.

So, being tricked makes us feel foolish and stupid. It taps into our fears that we may be incompetent. We feel unsafe, exposed, laughed at. We imagine we look bad in the eyes of our peers and they are judging us as naïve, gullible. In short, we feel a type of shame. We strengthen our resolve never to feel this way again, and become more guarded and distrustful with the kids. We determine to be trickier than they are.

Can we use this experience to develop a new depth of empathy for our kids? After all, they feel this way most of the time. They have been tricked, used, and made to feel foolish. They have trusted and then discovered lies. They have been counting on someone and been left. They, too, have felt unsafe, exposed, judged, laughed at. And just as we do, they develop the protection of being hardened, guarded and distrustful- and indirect.

Humans, adults and kids, are vulnerable. We don’t like to be exposed. We don’t like to be rejected. We don’t like to be taken advantage of, tricked or lied to. If this happens a lot, we close down, form a protective barrier, hide our true hearts, and interact defensively. We try to get what we can through indirect, covert ways. When we feel safe and trusting, we are most likely to ask directly for what we need and want.

When we hear ourselves use the word manipulation, and we feel that familiar indignation, let’s look deeper into our selves. Let’s use what we feel to help us understand in a new way what our kids feel. Let’s use this understanding as a platform to create meaningful, caring discussion about the possibility and benefits of honesty between people.