The Rush to Change

We are in the change business. So when a child comes to us because of difficult behaviors our first thought is what can we do to change him or her? Jeffrey assaults people when he doesn’t get his way. Latasha cuts herself so badly she sometimes needs to go to the ER. How can we stop these things? That’s why people pay us the big bucks after all.

And there is plenty of external pressure for change- at every review someone is asking why that child hasn’t changed yet. Her parents, too, have suffered enough and want to see something different soon.

Then there is the internal pressure. Our lives would be a lot easier if these kids would stop doing these crazy things. And we judge ourselves- do we really know what we are doing? When Jeffrey hit his teacher yesterday is it because I am not a good enough therapist? I feel guilty about the pain the teacher suffered. We can start to blame each other- isn’t it the therapists’ job to take an angry child to her office and bring her back calm and happy?

And when we feel compassion for the child, we start to feel even more urgent about change. Jeffrey’s life would be so much easier if he could control his anger. He is in danger of being kicked out of this place, as he has been out of his last six places. It is so painful to see the blood stream down Latasha’s arm.

In this urgency for change we ourselves feel powerless, vulnerable and incompetent. We feel much like the kids we serve. So like them, we turn to something that we think will give us more power and control. We often think first about punishment. Surely if we restrict Jeffrey long enough he will learn that his life goes better if he does not hit people. Or, being more enlightened, we think about rewards. Maybe if we promise Latasha that we will take her out to lunch if she can go a week without cutting…

It would be actually astonishing if Jeffrey didn’t already know that his life would go better if he controls his anger. Look at all the bad things that have happened to him already- he is on probation, he has been kicked out of six placements, and he is in residential- just to name a few.

When Latasha is calm she fervently wants to stop cutting, and she hates her scars. She does not need more motivation. She needs more skills.

I would suggest that this very urgency we feel to change the kids gets in the way of effective treatment. It makes it harder for us to stop and think about what is going on. How do we understand this behavior? What is actually happening when Jeffrey hits someone? What leads up to Latasha’s cutting? What problem are they trying to solve? How does this behavior help them in the moment?

We need to take time to explore, observe, think and consider. We need time to help the child feel safe enough to share their experience with us. They will be able to do this when they form strong relationships. In collaboration with the child we will discover the meaning and function of the behavior.

Then, we must consider what skills the child would need in order to choose a different behavior, a new way to meet his needs. It will take time for the child to learn these skills.

Jeffrey formed a close relationship with his teammate (primary child care worker). After a while Jeffrey shared how scared he was that he is such a bad kid that no one will ever take care of him or meet his needs. He said has learned that force is the only way you get anything you want. Staff started looking for the first signs that Jeffrey was agitated and asking if he needed anything. In small steps Jeffrey learned to trust them enough to ask for help. It was important that at the same time Jeffrey discovered a skill at cooking, and became the star chef of the school café. He got a lot of praise and recognition for this and was generally feeling better and calmer.

Latasha connected with her therapist slowly. They began looking at the patterns that led up to cutting. After a while, several factors were identified: not getting enough sleep, fighting among the girls on the unit, and not hearing from her mother. They worked out many strategies, including a crisis kit. Medication helped with her disturbed sleep. Latasha found soothing music, a piece of fur to rub, and a honey candy soothing. This did not always work and she continued to cut for a long time, but the self harm decreased in frequency and severity. She started telling staff when she felt vulnerable.

Note that these children did not change quickly. They did not change because of punishment. But with time, safety and relationships they did change.

And then the staff felt the true power of changing the life of a child.

Healing the Generations Conference

I want to highly recommend the second annual Healing the Generations conference at Foxwoods on March 25 and 26th. Last year’s conference was wonderful and this year looks to be even better. I am presenting on Trauma Informed Foster Care, Helping Survivor Parents and What We Know about the Brain and What We Should Do. My colleague Steve Brown is presenting on teaching Healthy Sexuality to High Risk Kids, and on our statewide initiative to use Risking Connection to train the staff of Extended Day Programs. This presentation, in conjunction with Marilyn Cloud from DCF, will include exciting new research demonstrating the effectiveness of the training. I hope to see you at the conference, and be sure and come up and say hello!


The Clifford W. Beers Guidance Clinic, Inc. Presents

Healing the Generations:

Second Annual Family Violence and Child Trauma Conference

Keynote Speaker: Dr. Alicia F. Lieberman, PhD

Dr. Lieberman has spent her career trying to prevent and undo the emotional damage inflicted on people at very young ages. "Young children, even babies, remember traumatic events in their bodies with increases in stress hormones such as cortisol--the event makes a distinct impression on them." Investments made in the first three years of life have the best predictive role in creating positive change in a person's life, so the infancy years are crucial in shaping not only individuals, but society as a whole.
Dr. Lieberman's keynote and workshop will describe the impact of chronic adversity on parents' attitudes and child-rearing practices, illustrating the transmission of emotional difficulties and relational conflicts from one generation to the next. It will also describe how parents can surmount difficult child experiences to transmit a message of love and hope to their children.

Spotlight on Workshop Presenter:

Michael Mack

Haunted by memories of childhood clergy sexual abuse, Michael Mack wondered for decades if one day he might meet his abuser for a conversation. In 2008 he had that chance. Although Mack had anticipated countless scenarios, what happened was beyond anything he had ever imagined. He will deliver a theatrical monologue about the healing power of personal storytelling. He uses monologue "because when we can talk to ourselves consciously, we can experience healing more deeply."

Michael Mack is a poet, playwright, and solo performer best known for his one-man verse play "Hearing Voices (Speaking in Tongues)" about his mother's life with schizophrenia. Mack has performed Off-Off-Broadway, at the US Library of Congress, at Yale University, and for faculty and students of the Harvard Medical School.

For full conference agenda visit:

www.cliffordbeers.org

Up to 12 CEUs will be available through the Women's Consortium for MFT, LPC, LCSW, NASW and CCB.

Contact Info:

Jane Hendrickson at (203) 772-1270 ext 246 or jhendrickson@cliffordbeers.org

Legacy of Caring Conference a Resounding Success

On February 9, 2010 Devereux Mass and Klingberg Family Centers co-sponsored a conference entitled "The Nuts and Bolts of Trauma Informed Care". The conference was attended by over 300 people, from CT. MA, Florida, Kentucky, NY, Missouri and several other states.

The conference began with a welcome by Steve Yerdon, CEO of Devereux. After Dr. Bob Davis set the frame of the day, Dr. Steve Brown asked the audience questions to determine who was attending. Some participants rated their agencies at the beginning of trauma informed care; others had considerable experience. Disciplines such as direct care, therapists, administrators, nurses and teachers were all represented; and settings included residential, schools, hospitals, out patient and foster care.

Dr. Davis led the presentations with a history of the trauma informed care movement, which related to the restraint reduction initiatives. Then Dr. Brown and Dr. Davis described the Risking Connection® foundational trauma training. Dr. Brown included a clip from Star Trek in which the character Data, who has no feelings, wonders whether it is actually advisable to form connections- much as our children do.

Patricia Wilcox, LCSW and Dr. David then described a vision of a trauma informed agency, using a formulation created by Roger Fallot. Ms. Wilcox described how an agency can incorporate safety, trustworthiness, collaboration, choice and empowerment. Dr. Davis followed with sharing agency practices that embody administrative commitment to change, universal screening, staff training and education, hiring practices, and supporting policies/procedures.

At lunch the Legacy of Caring Award was bestowed on Lynn Sanford, LCSW. Lynn made an inspiration and humorous acceptance speech.

After a delicious lunch (the cheesecake got especially good reviews) participants attended workshops on trauma informed care on the units, in education and in clinical practice. The role of administration in creating and sustaining trauma informed care was the subject of one workshop, one covered sensory interventions, and the Restorative Approach was another.

Participant comments included:

"It was relevant to what we are trying to do. The presenters were knowledgeable and helpful."
"I appreciated the honesty about the challenges."
"Different agency perspectives were helpful in comparing/contrasting real life processes and challenges."

Trevor and his Restorative Experience

What we heard on the grapevine Monday morning- a kid trashed Susan’s office! He even broke her computer! Can you believe it?

Trevor worries about everything. He loves his mother, and his worrying may have started very early in life when he observed her being beaten by his biological father. His anxiety continued to mount as his mom’s mental health problems have caused her to have extreme, fluctuating moods, at times feel suicidal and need hospitalization, and often need a lot of help from others. Trevor blames himself whenever his mom is unhappy or having trouble. His stepfather tries to take care of Trevor, but his rigid standards result in him using discipline such as tying Trevor to the bed and stuffing socks in his mouth. Trevor worried when one of his brothers died and worried when another was placed out of the home. Trevor knows this is all just because he is a bad kid.

Trevor wants to be good. He tries to please everyone. Yet he gets so anxious so fast, and at age 14 he becomes completely overwhelmed by sudden changes, uncertainty, unpredictability, and things going wrong. The pressure in his mind is so intense that he resorts to behaviors such as head-banging, self-cutting, screaming and physical agitation.

So when another kid, Marvin, broke off the antenna of Trevor’s new remote control car, the one his mother gave him on her last visit, it was more than Trevor could bear. Aside from being angry that the car wouldn’t work and sure that it could never be fixed, Trevor believed that his mother would blame him for not taking better care of this expensive present. It was her hard earned money and already it was broken! One more example of how he could never do anything right.

Trevor could not stand how horrible he felt, and so he started screaming-- and the staff were just making it worse by talking to him. So Trevor ran off the unit and outside. As he was storming around the yard he noticed an office window that was open right over a porch roof. A refuge! He easily climbed up and got in the window, closed and locked it, and found himself in the secretary’s office-- but staff saw him! They couldn’t get through the now closed window, but they were knocking on the door and trying to unlock it.

Trevor knew that if they got in all sorts of horrible things would happen, people would yell at him, he’d be kicked out, he’d have to go to jail, and he’d never see his family again…so he decided to barricade the door. He began moving furniture frantically towards the door. As he pushed the desk, the computer monitor fell off and broke. A whole lot of plants toppled over. The fax machine fell and shattered. When he moved the bookcase, lots of papers scattered around. But he kept pushing furniture towards the door- he had to make himself safe.

The staff became worried. They could not get the door open. The banging continued. And the sounds Trevor was making made them wonder if he was hurting himself. So, they called the police for help. The staff were able to disable the door, and with the police present opened the door, and Trevor moved some of the furniture so they could get in. The staff and police decided Trevor needed to go to the ER. The policeman told staff that he would call later about whether or not Klingberg wanted to press charges.

So- a kid did major- in fact VERY major- property damage, and destroyed the office of someone we all love. What should we do?

Susan was surprised when her boss, the Vice President of Treatment Programs, met her at the door on Monday when she came in. He wanted to warn her before she opened her office door. And when she did, she was horrified. Who could have done this to her? And why? She was always nice to the kids and in fact she had had some pleasant conversations with THIS kid. Why would he target her? And all the work she was going to have to do to clean this up and restore order!

Susan was a little apprehensive when the team suggested that Trevor would need to work with her when he returned from the hospital. Would she even be safe with someone who could do all this? What on earth could she have him do? What should she say to him? Should she talk about what happened and her reactions, or not? And besides- she was quite angry that he had caused all this devastation and she wasn’t at all sure she wanted to be around him.

Susan talked all this over with the team. They validated her feelings and encouraged her to talk to Trevor about her reactions and listen to his experience of what had happened. She agreed to participate in the restorative process.

Meanwhile, the team discussed whether it would be helpful to have Trevor arrested for the property damages he caused. For some kids, being arrested could provide a deterrent next time. Yet when the team talked it over, this did not seem to be the case for Trevor. His main problem was that he worried too much, and gets over whelmed by anxiety about all the ways he has disappointed everyone and all the bad things he knows will happen. Being on probation would probably make that worse, cause him more panic and make it more necessary for him to do something to escape his horrible feelings. So the team decided not to press charges.

While Trevor was in the hospital he did not really want to come back to Klingberg. He was so ashamed of what he had done, and he did not want to see people who knew about it. He assumed they all hated him now; in fact he was surprised he was even allowed to come back. He was especially worried about seeing Susan and said "I thought she would yell at me."

Trevor was scared when he started working for Susan. She had him carry some heavy boxes of files to the downstairs storage area. He was proud of how much he could carry! He was afraid he would do it wrong but soon saw that he was actually helping her. The next day they started to re-pot all her plants. During this process they talked a little about what had happened. Susan told Trevor how upset she had been walking into that mess. He apologized and said he had just been so scared.

Susan says that the experience of working with Trevor made a difference in how she thinks about this event. "I realized he was not attacking me. I could see he was just so scared. And it meant a lot to see how genuinely sorry he was. He even brought me back pictures from a trip he went on. I am not left with anger or fear. I don’t feel like I am working with a bunch of dangerous kids. I feel sad about how scared Trevor is and I hope we can help him feel better."

Trevor says that he liked working for Susan. In fact, he kept doing things for her and making her things long after the restorative tasks were over. When asked if he thought the fact that he liked doing the tasks would encourage him do something wrong again in order to be assigned new pleasurable tasks, he looked puzzled and couldn’t get that concept. “Maybe it would work that way for some kids” he said "but not for me. Not for me." (Clearly, he’s never taken a course in behavior therapy!) When he imagined just being grounded instead of doing the restorative work, Trevor said "then I would still be worried and nervous and I’d still be feeling so bad about what I did. Now I am friends with Susan."

Trevor is leaving Klingberg soon and going to a therapeutic foster home. When asked if he thinks he has changed, Trevor says, "Oh yes, now I can use some coping skills." What are those? "Art- I really like art. And music. I have a guitar now. And drama- did you see me in the last school play? And I am going to be Jack in the next one." What helped him most were "the staff- not the kids so much-although some kids helped me." He thinks that the kind of staff that help kids are the kind that "listen and don’t get an attitude," although he does feel they should be "strict." And Trevor says that it has helped him that staff have been his friends- especially Susan.