Saturday, January 30, 2010

The Devil is in You

I met a gentleman named Ernie this week who was talking about his life. He is French Canadian, and grew up speaking French in his home. He attended Catholic school. When ever he answered a question in French, the nun would hit him with a ruler. He was not taught to read English, but was punished for not being able to do so. The nuns told him that his problem was that he had the Devil in him, and that their job was to drive the Devil out- mostly through punishment.

Ernie dropped out of school before graduating, and got a job working hard as a carpenter- skills he learned from family members who were also carpenters. He never learned to read or write.

I think we would all disagree with this form of education and we would not be surprised that it was not successful.

Yet, how different is this (except in degree) from our traditional ways? We see what the child has learned from their family. We do not like it, and we try to drive it out with punishment. Luckily, there is not so much hitting with rulers- more confinement to small rooms.

In various ways we convey to the kid that he has the Devil in him, and we are trying to drive that Devil out with our strictness.

And often the kid drops out of treatment, and remains emotionally illiterate. They can sometimes till be successful as Ernie is, if they find people to teach and mentor them. But they are left with a bad feeling of being a Devil-person.

There must be a better way.

Sunday, January 24, 2010

From Strategy to Reality: The ‘Nuts and Bolts’ of Implementing Trauma-Informed Care in Child and Adolescent Settings

I want to make sure that you all know about our conference in Worchester MA on Feb. 9. We are delighted that both people we have worked with and people who may want to work with us are coming in from other states for the conference. We hope to see you there!

Devereux presents:

The 2010 Legacy of Caring Conference
(in conjunction with Klingberg Family Centers)

From Strategy to Reality: The Nuts and Bolts of Implementing Trauma-Informed Care in Child and Adolescent Settings

Date: February 9, 2010
Time: 9:00 am - 4:30 pm
Location: Crowne Plaza Hotel
10 Lincoln Square
Worcester, MA 01606

Overview:

Successful restraint and seclusion reduction happens within a trauma-informed setting. But, implementing trauma-informed care (TIC) requires system-wide culture change - - no easy task, especially with ever-more challenging clients and settings that historically have placed a premium on controlling children’s behavior. Centered on the Risking Connection® treatment philosophy, this nuts and bolts conference will help your school or agency translate broad stroke strategies about trauma-informed care to real life solutions.

Conference Objectives:

• Participants will be able to describe the daily operations and practice of a trauma informed agency and relate these to restraint reduction.
• Participants will identify training strategies that promote trauma-informed care,
Including Risking Connection®, an established curriculum for working with traumatized youth.
• Participants will learn trauma-informed behavior management, administration, milieu and classroom treatment techniques, which can be integrated into existing evidence-based models of treatment.
• Participants will learn ways to anticipate and overcome many of the institutional challenges of implementing trauma-informed treatment.

Schedule:
8:00-9:00 AM Registration and Check-In
9:00-9:30 AM Welcome and Introductions
9:30-9:45 AM Trauma-Informed Care: Its History and Relationship to Restraint Reduction
9:45-10:45 AM Risking Connection®: An Integrative Pathway Toward Trauma-Informed Care

10:45-11:00 AM BREAK

11:00 AM-12:00 A Vision of a Trauma-Informed Agency

12:00-1:00 PM LUNCH (provided)
Presentation of the Annual Legacy of Caring Award

1:00-2:30 PM Workshop One (please choose one of the following)
A. If You Don’t Feed the Staff, They’ll Eat the Children: Leadership’s Role in Trauma-Informed Change
B. Relationships, Structure & Individualized Care: All This and Paperwork Too? Running a Trauma-Informed Care Unit
C. From Chill Rooms to Calm Down Kits: Sensory Interventions to Prevent Crisis
D. Healing the Heart of the Helper: Helping Staff Manage Vicarious Trauma

2:30-2:45 PM BREAK

2:45-4:15 PM Workshop Two (please choose one of the following)
A. Relationships, Structure & Individualized Care: All This and Paperwork Too? Running a Trauma-Informed Care Unit (Workshop 1 repeated)
B. The Restorative Approach: A Relationship-Based Alternative to Points and Level Systems
C. How Can I Be Trauma-Informed and Still Get Through My Lesson Plan? Trauma-Informed Care in Educational Settings
D. Why Are These Kids Doing These Crazy Things? The Role of the Clinician and Clinical Supervision

You may register on line: http://events.devereuxma.org

Or call 508-886-4746, ext. 314. Fax 508-886-4473

See you Feb. 9th!

Monday, January 18, 2010

A Warning Sign

"It’s the tasks" your program manager says to you. "We just cannot seem to think of enough tasks to assign to the kids in my unit. And those we can think of they don’t take seriously, they are done quickly, and I just don’t think they are significant enough to deter the behavior."

What would be your response to this plea? Would you start researching tasks that the unit could use?

I think this is a sign that more training is needed. In my experience, this focus shows that staff are still considering the tasks as punishments, and thinking that their power for change is found in their deterrent function. That is, the kids won’t want to do the tasks so they will avoid that behavior. If you are thinking that way, you start to wonder if the tasks are hard enough, significant enough for the bad behaviors. You become concerned if the kids seem to enjoy the tasks. You hear statements like "they did ... and THAT is all they have to do?"

Let’s step back a few steps. Our basic premise is that symptoms are adaptations- that the kids are doing the best they can, and they are doing these behaviors because they do not know any other way to handle their intolerable feelings. Therefore, in the Restorative Approach we respond to behavioral problems with tasks that are designed to help the child learn new skills and to repair damaged relationships.

So- Kayla has a difficult call with her mother. (A small (or large) set back happens in the present.) Kayla does not trust relationships and cannot ask for help. She is already over activated and is now completely lost in her stress response. She has no sense that there is any one who loves her and will care how this turns out. She feels pretty worthless anyway, and knows that this latest event is just one more sign of what a lousy person she is and how her mother gave her up because she is such an awful girl. And she does not know how to notice, identify or sooth her feelings. So, Kayla is plunged into the depths of fear and hopelessness. Who wants to feel that way? So she does something, anything, to escape these feelings. She cuts herself. She throws a chair. She runs away. She hits a staff.


So what Kayla needs to be able to handle a setback in a better way is:

Relationships she can trust
A calmer body
A sense that people care about her, and the ability to remember them when they are not present
The knowledge that she is worth the air she breathes
and
Skills to identify and soothe her feelings

And hopefully we know Kayla. We know the neglect, sexual abuse, and multiple placements she has experienced. We know her strengths in drama and her ability to teach younger children, and we know how mornings are hardest for her. And we have a formulation, a theory about what is going on with her and that our primary theme in working with her is learning to trust others and ask for help.

So this is where the tasks come in. The tasks are a chance to practice some part of what she needs. To put one building block in her wall of creating a competent self.

Kayla will act better when she feels better. After her blow up she is feeling worse, more shame, more self hatred. And that can send her into another acting out episode.

So- the tasks.
Making amends helps strengthen relationships and teaches how to fix problems in relationships.
Doing a task with a staff member is practicing trust and accepting help.
It is also practicing effective action- when something goes wrong, Kayla can do something about it. She does not have to freeze.
Practicing what to do when upset (a feelings chart, a poster to illustrate what Kayla was feeling or six steps I can take when she is angry, interviewing others, making a plan for her next contact with her mother, etc) help to develop feeling skills, and include methods to create a calmer body.
Doing something to make things better (chores, create a bulletin board, make brownies, helping a younger child with her homework) increase self worth.

The idea is to use the opportunity that an episode provides to help give Kayla what she needs to handle life better.

Kayla doesn’t have to hate the tasks. She has to take them seriously and do them well. Then its over, and we go on, hopefully just that little bit closer to what she needs.

This is where I would focus with the unit that needs more tasks.

Sunday, January 10, 2010

New Resources

My Australian friend Laurel Downey has created a wonderful new resource: From Isolation To Connection: A Guide To Understanding And Working With Traumatized Children And Young People. It is available at: http://www.ocsc.vic.gov.au/
Published by the Child Safety Commissioner, Melbourne, Victoria, Australia, November 2009


© Copyright State of Victoria, Child Safety Commissioner, 2009
This resource was commissioned by the Child Safety Commissioner and written by Laurel Downey, previously Manager of Practice Development and Training for Take Two, Berry Street Victoria. Laurel is currently consultant to the learning and development strategy for non-government child protection placement services for Far Northern and Northern Queensland and based at James Cook University, Cairns.
(laurel.downey@jcu.edu.au)

At the same site is her previous work: Calmer Classrooms: A Guide To Working With Traumatized Children
This resource was commissioned by the Child Safety Commissioner. It was written by Laurel Downey, Manager, Practice Development and Training, Take Two, Berry Street Victoria. Laurel would like to acknowledge her Take Two colleagues, Annette Jackson and Lisa McClung for their contribution to her work. Published by the Child Safety Commissioner, Melbourne, Victoria, Australia June 2007 © Copyright State of Victoria, Child Safety Commissioner, 2007


Please check these out and let me know what you think!

I just finished an interesting new book: Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others (Paperback) by Laura Van Dernoot Lipsky, Connie Burk, Berrett-Koehler Publishers (May 1, 2009) which is available at:
http://www.amazon.com/Trauma-Stewardship-Everyday-Caring-Others/dp/157675944X/ref=sr_1_1?ie=UTF8&s=books&qid=1263142968&sr=1-1

It is interesting that Van Dernoot Lipsky extends her audience to include those who work caring for animals and in ecological preservation. Witnessing the harm done to animals or to our world can also have profound effects on the helper. This book explains in detail sixteen common components of what she calls a "trauma exposure response" The author then adapts a Native American custom to explore five directions to maintain ones self within this work. A daily centering practice is essential to her approach.

The cartoons added a nice touch!

Another book I am reading is Pain, Normality and the Struggle for Congruence: Reinterpreting Residential Care for Children and Youth James P Anglin Routledge; 1 edition (August 22, 2003).
It can be found at: http://www.amazon.com/Pain-Normality-Struggle-Congruence-Reinterpreting/dp/0789021404/ref=sr_1_1?ie=UTF8&s=books&qid=1263144143&sr=1-1#noop
This book was recommended to me by Martha Holden, the Director of the Cornell CARE Project. It is an important influence on their work. This author studied many group homes in Canada in an attempt to discover what makes a good group home for children. It is very interesting. He is clear about the tensions between best practices and the many pressures and constraints on programs. He gives specific ideas for creating a healing environment, all of which fit completely our work and message.

All comments are welcome.

Sunday, January 03, 2010

Happy New Year- New at TSI for 2010

Happy New Year to all readers! Let’s make 2010 a banner year in changing the world- in making sure that the children and families we serve get the best, most effective, caring and meaningful treatment possible.

Here at the Traumatic Stress Institute we have been doing some planning and thinking as to how we can become even more effective in spreading the word about trauma informed treatment for children and adolescents.




We have been working with consultants to develop a new logo and a new look- soon you will be seeing our butterfly on all our materials. Along with that we hope to expand out use of social media. We already have a Facebook page (http://www.facebook.com/home.php?#/pages/Traumatic-Stress-Institute-of-Klingberg-Family-Centers/178395157455 ), but want to learn how to use this and other avenues to better stay in touch with all of you who are also doing this hard work.

To that end we plan to begin a newsletter. Send us your email if you want access to news of what we are doing, information and articles about developments in our field, and other updates. Send your email to megana@klingberg.com with a note that you would like to be on our mailing list.

An exciting change is that we will be occupying a new space in Hartford. Klingberg Family Centers is moving its Hartford office, and as part of that move the Traumatic Stress Institute will have a new space. It will be located at the Rudder Building at 157 Charter Oak Avenue. This is near the new Convention Center and Science Center. Stay tuned for details on our Ribbon Cutting event early this year.

We have been working on a project for Trauma Informed Foster Care that we will have ready this year. It will include Trauma Informed Behavior Management Guidelines for Foster Parents and a six session training manual entitled: Trauma Informed Foster Care- Why are These Kids Doing These Crazy Things and How Can I Help Them while Preserving My Sanity?. Let us know if you would like to find out more.

Our Director of Training, Steve Brown PsyD. has been working hard putting together research that we and other agencies we have trained have conducted on this method. We hope to have those results available soon.

Of course you will not want to miss our conference in Worchester MA. The title is: From Strategy to Reality: The ‘Nuts and Bolts’ of Implementing Trauma-Informed Care in Child and Adolescent Settings. The date is February 9, 2010 from 9:00 am to 4:30 pm. We are co-sponsoring this conference with Devereux, MA. You may also register on line: http://events.devereuxma.org or call 508-886-4746, ext. 314.

We are working on several Risking Connection® trainings. Our next open training is on January 27-29 at Klingberg. (To register contact megana@klingberg.com 860-832-5514.) Steve Brown continues to teach on Healthy Sexuality for High Risk Kids. He will be traveling to the Yukon Territory, Canada to do this training in the spring.

We will continue to support our excellent Associate Trainers though consultation groups, the Day of Learning and Sharing, and other activities. One upcoming event for Associate Trainers is a half-day training by Kathy MacAfee, America’s Marketing Motivator, entitled: Telling Stories and Other Strategies for Presentation Success. This should be a valuable resource for our trainers.

We will present at the MASOC/MATSA conference from Wednesday April 7 through Friday April 9, 2010.conference on He Just Refuses To Take Responsibility!!! -- Implications Of Trauma Theory On Th Issue Of Taking Responsibility. Look for the conference brochure in early January or visit one of our websites in early January at www.mascoc.net and www.matsa.org. And if you have any questions please don't hesitate to contact Diane Langelier at (413) 540-0712 x14.

These are just a few of the exciting events we expect in 2010. We look forward to joining with you in changing the world through improving treatment for children and adolescents.