More Staff Training Modules

Here are a few more training modules to use in staff meetings. These are meant to supplement more formal training, not to introduce new concepts. They are designed to be used in existing forums such as staff meetings or treatment teams.

Feelings skills

Adapted from Risking Connection®

Teaching Objectives:

1.    Understand what feeling skills are

2.    Understand that they are learned

3.    Develop strategies to teach them 

Leader:

Children learn feelings skills through attached relationships with care givers. All the thousands of times things go wrong (a child falls and hurts his knee) and the caretaker intervenes (here, I’ll kiss it and make it better) the caretaker is teaching the child something (love heals). Caretakers teach children to use connections, to feel they are worthwhile, and to identify, use and manage emotions. Our children have had inadequate care taking and multiple caretakers. Often their caretakers have been too absorbed in their own pain to help their children. So the children are not taught the skills they need. Since they don’t know how to rely on adults for help; and they don’t feel they are worthwhile; and the don’t have feelings management skills small setbacks send them into deep wells of intolerable feelings. These feelings are fear and hopelessness. In order to escape these feelings they resort to symptom behaviors, which help in the short term but have long term negative consequences. We cannot just order them to stop these symptoms. We have to teach them the skills to not need these behaviors.

Feelings Skills Exercise

Team discussion: 

What do we do now to increase the children’s ability to use their connection to us for comfort? How could we do this better?

What do we do now to increase the children’s sense of self worth? How could we do this better?

What do we do now to increase the children’s ability to identify and manage their feelings? How could we do this better?

Leader: Emphasize:

Feelings management skills are learned.

Our most powerful strategies for change are to teach feelings management skills within the context of attached relationships.

Shame

Teaching Objectives:    

1.    Understand the power of shame and how it influences children’s behavior

2.    Learn how to combat shame 

Leader:       

Shame is a major barrier to relationships. Shame develops because the child blames himself for everything that has happened to him, rather than blame the adults who he loves and upon whom he is dependent. The shame-based child is sure that any one who gets to know his horrible inner core will reject him, and hence relationships will only lead to pain. Shame leads to attack, to move away from others. Taking responsibility for ones actions is not possible when to do so means experiencing ones utter worthlessness.

Shame based children feel it is intolerable to be visible because of the hateful inner core they perceive within them selves. Their anticipation of rejection is so powerful they avoid connection. Any perceived incoming slight is quickly turned around to “kill the messenger” before the powerful shame can be felt. The inner parts of a child that try to protect him refuse contact with others because all contact is painful. He tries to send us away. The impulse of guilt is to reach out and repair…. The impulse of shame is to hide and attack…

The antidote to shame is sharing…To tell the secrets- what is shareable is bearable. These secrets may be specific events, but also may include how sad, confused, hopeless and vulnerable the child feels inside.

Shame Exercise

Team discussion:

What do we do in our programs that adds to shame?

            What can we do to decrease shame?

            How can we talk about problems in non-shaming ways?

            How does shame interfere with “taking responsibility for ones behavior”? 

Leader: Emphasize:

            The power of shame

            The healing power of connection 

Understanding a Client-Symptoms are Adaptations

Adapted from Risking Connection®

Teaching Objectives:

1.    Our interventions should be guided by our understanding of the client, their history and their current functioning

2.    Restorative tasks can be a way for the client to practice new ways of getting their needs met 

Leader:          

We know that all the behaviors we call symptoms or problems are solutions for the client. The client is escaping intolerable feelings by doing a behavior that helps in the moment, even though it has long term negative consequences.

Give examples, and ask for examples from participants, of things we do that help in the moment and have long term negative consequences. Example: smoking, over eating, shopping. Emphasize the point that they really do help, otherwise they would be easy to give up.

It is important to think about how a given behavior helps a client. That will give us many more creative interventions.

Understanding a Client-Symptoms are Adaptations Exercise

Discuss one or both of these scenarios

Jeffrey

Jeffrey is an 11-year-old-boy who has a history of witnessing domestic violence and multiple separations from his grandmother who raised him.  Child protective services finally removed him from his grandmother’s care when they found for the 3^rd time that Jeffrey was left alone at home over night.  He was referred to your facility for his explosive anger and defiant behavior.  Staff has noticed that Jeffrey becomes especially defiant during the evening routine – he often refuses to eat his evening snack, will not get into his pajamas, or brush his teeth.   Battles with Jeffrey that often include him pushing staff, spitting at staff, and restraints will often go on for over an hour.  Even when staff allow him to sleep in his clothes, he finds other ways to engage staff like banging his head in his room or playing his radio so loud it is disruptive to other kids.  Staff worked on a sticker chart to motivate Jeffrey to complete his evening routine. It worked briefly, but soon staff were having long arguments with him over the details of the sticker chart. 

            (Leader emphasizes Jeffrey’s fear of being alone and how actions keep staff engaged; mention how in old system we would give Jeffrey and early bed- how would that help?)

Alexandra

Alexandra is a 14-year-old-girl who has a history of trauma and several foster placements.  She has a history of self-injury and suicidality.  Staff has noted that in the last month she’s been opening up to a few of them in a new way that she has not before.  Last week, it was announced that one of the unit therapists (not hers) was being transferred to work in another program.  This morning staff observed that she was wearing long sleeves even though it was 90 degrees out.  When a staff asked why, she told her to “f__off.”  She eventually revealed that she had been scratching herself with a paperclip.

(Leader emphasizes how staff leaving reactivates Alexandra's distrust and fears, she cannot communicate this directly, she feels vulnerable because she had begun to trust.)

Leader: Emphasize:  

Understanding the meaning and function of the symptoms gives you many more options for intervention.

Please comment as to whether you are finding these helpful so I can decide whether or not to post some more. Thanks!

 

 

 

           

 

 

 

 

 

 

 

Training Exercises to Use in Staff Meetings

In any sort of treatment setting, time is impossible to find. In a congregate care or school setting, someone has to watch the kids. In outpatient, there are those ever present billable hours to accumulate. Therefore, bringing staff together for formal training is often very difficult. And there are many demands on what little training time we have. So I developed these short exercises to teach one concept at a time. They are designed to be used in existing meetings such as treatment teams or staff meetings. They are designed to refresh or reinforce the concepts, not to be the main training vehicle. They provide guidelines for short team discussions of the ideas that support trauma informed care.

I thought I’d share a few here and more over the coming weeks. As you can see, the format is that the Leader introduces the topic, there is an exercise with questions, and then there is a summary. Each exercise should take around 10 minutes or so.

If you use any of these exercises in your staff meetings PLEASE comment or write me to let me know how it works out.

What Helps People to Change?

 Teaching Objectives:

1. Understand the many factors that promote change
2. Appreciate the role of relationships in facilitating change

 Leader:         

Our job is fundamentally to help these children and families to change. Let’s spend some time talking about what we think actually promotes change in people, ourselves included.

Exercise

Ask participants to think of something they have done (or still do) that has negative consequences that they have NOT changed. Examples would be smoking, drinking, over eating, not exercising, etc. Without asking them what the behavior is, ask what are some of the barriers to change?

Ask participants to think of something they wanted to learn and tried to learn and were UNABLE to master (such as tennis, knitting, anything that they tried but could not become good at). Ask for a couple of examples. What does that feel like? How would it affect them if someone offered to reward them for doing it? Or punish them for not doing it? What role does wanting to do it play? If they could ever imagine getting better at this skill, what would it take?

Ask participants to think of a time in their lives that they did successfully make a change- lose weight, quit smoking, etc. Ask for examples. What made it possible? What started their change effort? What factors made it possible to make the change at that time? What helped? Ask about the role of other people and relationships in making the change. Ask about some examples: if you are on a diet does it help to have another person remind you of it? If you go to a restaurant and bread is placed on the table, what is helpful for your companion to do? If you mess up and over eat, what response to you want from another? Note that different people want different kinds of support. What did you feel about having made this change?

How can you relate these insights to the kids making changes?

Leader:

Emphasize:

1. Rewards and consequences are not enough, they only increase/decrease motivation- also need skills and support
2. What part of change is influenced by self-image, hope, feeling a different is possible?
3. The role of relationships in supporting change

 Effective Action

Teaching Objectives:       

1.    Understand how trauma undermines the concept that one can take effective action to resolve problems and achieve one’s goals

2.    Identify opportunities within the program to allow the clients to practice effective action

Leader:

Traumatic and neglectful experiences are characterized by the impossibility of effective action. There is nothing the child can do to change the situation and make it better. The child gives up on the possibility of effective action. The child does not learn how to solve problems, how to assert his or her own wishes, how to make up for wrong doing, or how say no. Therefore, the child resorts to more extreme measures or gives up. When the child does something wrong he feels that all is lost and often insists on leaving the program. He has no hope.      

Exercise:

Team discussion:

1.    What do we do that discourages or prohibits effective action?

2.    What do we do that allow the child to practice effective action? (Student councils, involving the child in treatment planning, peer mediation, etc.)

3.    How can we give the child practice in effective action, to heal relationships, correct mistakes, and accomplish goals?

Leader:

Emphasize:

1.    Why is it important to believe that effective action is possible?

2.    What would be the consequences of encouraging passivity?

3.    How can a child learn to stand up for herself in positive ways?

Sensitized Nervous System

 Teaching Objectives:       

1.    Understand the human danger response

2.    Understand that trauma leaves children stuck in this danger response

3.    Identify strategies to help children calm down in times of dysregulation

 Leader:

The human brain responds instantly to danger. We do not choose to do this, it just happens, because when there is danger, we need to act quickly. We become hyper alert and focused on danger and safety. Our brain withdraws blood from non-essential activities such as digestion, and brings all the body’s resources to the muscles necessary for fighting or fleeing. Our hearts beat fast. One of the functions that is shut down is analytical thinking, because in times of danger we don’t need to think, we need to act.

In the normal course of events the danger ends and the person gradually relaxes. However, when a child is repeatedly faced with unpredictable danger beyond her ability to cope she becomes stuck in the danger response, and is always somewhat activated. This results in the child being overly reactive, concentrating only on danger and safety, and being unable to relax. Both sleep and play are difficult. When new things happen, the child often over-reacts.

A sense of safety is necessary before the person is available for connection.

Exercise

Ask participants to remember a time they were in a near-car accident or otherwise faced sudden danger.

1.    What happened in their bodies?

2.    If they were sleepy, were they still?

3.    If they were admiring the scenery, were they still looking at it? What were they now paying attention to?

4.    If they were chatting with a friend, were they still doing so?

5.    What happened afterwards- how did they return to normal?

6.    How would it feel to be stuck in the danger response?

7.    In what ways do we observe that our children have difficulty with relaxation? 

What are the signals of physical and psychological danger in our treatment programs? What are the signals of safety?

           How can we decrease danger and increase safety?

Leader:

Emphasize:

1.    The human danger response is automatic.

2.    The child experiences more danger than she can handle.

3.    The child gets stuck in the danger response.

4.    The child can learn to recognize this and learn ways to calm herself without help.

The Happiness Project

The Happiness Project

I attended a YWCA Women in Leadership Luncheon on Wed, (I am a past winner). The speaker was

Gretchen Rubin, the author of The Happiness Project  or, Why I Spent a Year Trying to Sing in the Morning, Clean My Closets, Fight Right, Read Aristotle, and Generally Have More Fun (Harper; 1 edition, December, 2009). She was kind enough to give each of us a copy of her new book, Happier at Home: Kiss More, Jump More, Abandon a Project, Read Samuel Johnson, and My Other Experiments in the Practice of Everyday Life ( Harmony;1 edition, September, 2012).

I have been reading it and like it quite a bit. Of course, I was reminded of something I emphasize strongly in my teaching these days: what if our actual job is to help these kids to be happy?

But aren’t we supposed to be making them behave better? Ms, Rubin speaks to that in her discussion of whether it is selfish to pay attention to one’s own happiness:

“I sided with the ancient philosophers and modern scientists who argue that working to be happier is a worthy goal. According to Aristotle, “Happiness is the meaning and purpose of life, the whole aim and end of human existence.” Epicurious wrote: “We must exercise ourselves in the things that bring us happiness, since, if that be present, we have everything, and, if that be absent, all are actions are directed towards obtaining it.” Contemporary research shows that happy people are more altruistic, more productive, more helpful, more likeable, more creative, more resilient, more interested in others, friendlier and healthier. Happy people make better friends, colleagues and citizens. …

I knew it was certainly easier for me to be good when I was happy. I was more patient, more forgiving, more energetic, more lighthearted, and more generous. “(the Happiness Project, Getting Started)

So I guess happiness is a worthwhile goal for our kids as well.

Ms. Rubin has created Eight Splendid Truths about Happiness.  Here are some I find particul;arily relevant to our work:

Second Splendid Truth
One of the best ways to make yourself happy is to make other people happy;

Hence the importance of providing ways for our kids to give to others…

Fifth Splendid Truth
I can build a happy life only on the foundation of my own nature.

Do we try to help our kids be their best selves, or to be someone they are not? What if Leslie is withdrawn and loves to read and is writing a novel- do we insist that participating in group therapy is the only way she can heal?

Sixth Splendid Truth
The only person I can change is myself.

Do we try to impose change on our kids, or do we create an environment in which they feel safe enough to change?

Ms. Rubin has also created her own list of the Secrets of Adulthood. Yes, she loves lists. Here’s some we might consider if or how we teach to our kids: (My comments in parentheses)

• Outer order contributes to inner calm. (Important that we realize how outer order represents inner lack of calm, and  actions can change feelings.)
• The opposite of a great truth is also true. (DBT dialectic)
• You manage what you measure. (Tracking change)
• By doing a little bit each day, you can get a lot accomplished.
• People don’t notice your mistakes and flaws as much as you think.
• Try not to let yourself get too hungry.
• It’s okay to ask for help.
• You can choose what you do; you can’t choose what you LIKE to do.
• Happiness doesn’t always make you feel happy.
• What you do EVERY DAY matters more than what you do ONCE IN A WHILE.
• You don’t have to be good at everything.
• Soap and water removes most stains.
• It’s important to be nice to EVERYONE.
• You know as much as most people.
• Eat better, eat less, exercise more.
• Houseplants and photo albums are a lot of trouble.
• If you’re not failing, you’re not trying hard enough.

Interesting, any thoughts? Has anyone else read these books? If so, any ideas about connecting them with our work or ourselves as treaters?

I have already written about what we might mean by a happier child in a treatment program, I’ll have to go back and relate with this. Stand by for further reflection.

On another topic, I am thinking of the skill of being able to do non-mood related behavior. That is, the ability to do something even when you don’t feel like it, in the service of a greater goal. All of us do this well and less well at different times. How do we learn to do this? How can we teach our kids? Please share any ideas you have.

 

 

What's Happened and What's Happening

I thought I would let you know what we have been doing and what is coming next. This may also help explain why I have skipped some weeks writing in my blog.

I have been doing quite a bit of training in California. In an agency outside of Los Angeles we trained RC Basic, the Restorative Approach, and Train-the-Trainer. We also did a Train-the-Trainer and a Recertification in Santa Rosa.

Steve has been extremely busy working on a research project we are doing in the Yukon Territory in Canada. We are so lucky to have the continuing support of Courtney Baker from Tulane University.

While Steve was in the Yukon he made presentations to several government leaders, hopefully leading to a wider adaptation of RC.

I presented a webinar for NEARI press on the Restorative Approach, the topic of my book which they publish. In fact, we have become webinar pros. We have done several webinars for our trainers, on topics such as shame, supervision and neuro-feed back (coming soon).

Of course we continue to offer RC Basic, Train-the-trainers and Consultation Groups in CT. I am very proud of the Consult Groups, we gather great minds and discuss important topics. Our latest event was about using trauma informed supervision as the back bone of maintaining trauma informed care in agencies. This has resulted in engagements to train agency supervisors in this practice. I also presented this material at the CT NASW Annual Conference with an able partner, Rebecca Desautels LCSW. Let me know if you would like to know more about this.

Steve Brown did a training for the Berkshire School Counselors Organization. Both Steve and I presented at the MASOC conference this year. I did a pre-conference workshop on the Restorative Approach, and Steve presented a very popular workshop on Vicarious Traumatization.

I did an Introduction to Trauma speech for the students and alumni of the St. Joseph’s college MSW program, and spoke to a UConn School of Social Work class on Vulnerable Populations about children in the child welfare system.

I was proud and delighted to become a true Adjunct Faculty member at the UConn School of Social Work this year. I taught a class called Clinical Conditions of Children and Adolescents, and I loved it! I hope to do more,

I’m probably leaving some things out.

So what is happening next? Tuesday we have a recertification for a group of our CT trainers, and we have two more of these scheduled. I am excited to offer our trainers new materials. Next week is the aforementioned webinar on neuro feedback.

I’m doing a Train-the-Trainer for people who want to be trainers of foster parents in early June. I am lucky enough to train with Kay Saakvitne, PhD. There is still time to register for this one, if you have been through the RC basic.

Then in July Steve will be teaching a regular Train the Trainer, and you can also still register for that. The difference is that the first one is for people who want to train foster parents, the second for people who want to train foster parents.

While he is doing that I will be presenting two workshops in Mississippi at the Lookin’ to th Future conference at Natchez, Mississippi. I will also be doing an agency consult on that trip.

Then jumping ahead to a conference I will be doing a major event in October in North Dakota.  I will do an all-day Professional Conference for PATH ND, Inc.  a family and professional agency. Then the next day the 2013 ND Foster and Adoptive Family Conference begins. I will do a keynote and two workshops. They have promised me a microphone so I don’t end up with laryngitis as I did at the Vermont foster care conference.

I am looking forward to both of these events!

I think we may have other things already scheduled but I can’t remember any right now. I do know I am taking a few days off this week to recover my sanity.

 

 

 

Question from a New Therapist

I recently received the following inquiry (posted with permission).

Hi Patricia,

I was just reading your blog on trauma-informed treatment planning for children. I am a fairly new social worker who works part-time in the community with children who have varying degrees of trauma. I am currently working with an 8 yo female who has had multiple traumas (substance abuse, physical, emotional and possibly sexual abuse, removal from home, placement in a crime-plagued inner city neighborhood) I am at a loss as where to even start, problems are so overwhelming…hoping you could share your goals and objectives. I found the info in your blog very helpful and it has assisted me in beginning to prioritize but would appreciate any help you cold give me.

Thanks!

Linda

 

My answer was:

 

Hi Linda,

First of all, do you have any help? Like Supervision from your agency?

Have you taken any training or trauma?

In working with your client, my first thought would be to her current situation. Is her current foster placement safe? Have the foster parents received any training on trauma, or could they? It is important that they understand that current symptoms she may display are not because of them, but because of her history. And that she will not trust them at first and will take a long time to form a relationship with them.

Then the next priority would be any unsafe behaviors she is displaying. Explore what they are and what they do for her- what problem is she trying to solve? How do her behaviors help her? How you work with her in therapy depends on what kind of kid she is. Can she talk about herself? Would it be better to use art or other mediums? If she is not able to be verbal, use rhythmic interactions- like taking a walk, rocking, pushing a big ball back and forth between you. Over time this helps her body become calmer and more regulated.

When/if she is ready try teaching her some regulating techniques, even as simple as taking a deep breath. Have you ever heard of TF-CBT? They have a free training at http://tfcbt.musc.edu/ I DO NOT recommend you do a trauma narrative until she is really safe and solid, which may not be within your time with her. But this training includes some good symptom management techniques.

Don't get drawn into the idea that what you are supposed to do as a therapist is to get her to tell you what happened to her. That is a much later step, one she may not be ready for for years, if ever. Your job is to help her become more regulated and safe.

Most importantly your job is to help her change her basic template about people. You do that through forming a relationship with her. Through your being trustworthy and not hurting her, she learns that some people are good. This may be the most important thing to do. But this, too, may not be easy as she will try to push you away.

There are many resources for you to learn in this area. One book that is a good starting point is Building the Bonds of Attachment by Daniel Hughes. Here are some others:

Allen, Jon. (2001). Traumatic Relationships and Serious Mental Disorders. New York: Wiley and Sons.

Blaustein, M. and Kinniburgh, K (2010) Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience through Attachment, Self-Regulation, and Competency The Guilford Press

Diffenbaugh, Vanessa The Language of Flowers: A Novel Ballantine Books; (2012)

Hughes, Daniel. (1998). Building the bonds of attachment: Awakening love in deeply troubled children. Jason Aronson

Perry, Bruce and Szalavitz, Maia. The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook Child Psychiatrist's Notebook--What Traumatized Children Can Teach Us About Loss, Love, and Healing (2007) Basic Books

Saakvitne, Karen et al.(2000) Risking connection: A training curriculum for working with survivors of childhood abuse. Lutherville, MD: Sidran Press.

Saakvitne, Karen, et. al. (1996) Transforming the pain: A workbook on vicarious traumatization. New York: W.S. Norton

Saxe, Glenn; Ellis, B. Heidi; and Kaplow, Julie B. Collaborative Treatment of Traumatized Children and Teens: The Trauma Systems Therapy Approach (2006) The Guilford Press

 There is a lot of good free information in my blog. I have written recently on changing the template on 11/11 and 11/18. On 8/14 I wrote about changing the brain.

And of course there is my book, Trauma-Informed Treatment, The Restorative Approach available at www.neari.org

 Good luck, Linda, and let me know if I can be of further help.

 Anything else you would have added? Click on "comment" and let me know!

 

A Small Thought About Band-aids

Jason came up to me in the main hall and started talking about a client in our day school, Marvin. Marvin had been diagnosed with autism. It was clear that Jason was very committed to Marvin and wanted what was best for him.  Together they had developed many tools that helped Marvin stay calm as he moved throughout his day. They included such items as a fidget ball which Marvin kept in his pocket and a weighted vest which Marvin could wear when agitated. Marvin reported feeling calmer when he wore the vest.

But Jason was very uneasy about Marvin’s use of these items. He was concerned about what would happen when Marvin returned to public school. When he used these items the other kids would tease him, he would not have any friends, and he would be miserable. Jason was thinking of taking away the items now so that Marvin could learn to do without them.

Later as I helped my husband to apply a Band-Aid to his cut thumb, I reflected on the idea of a band aid. When we apply a bandage to a cut, we do not worry about the person’s reliance on a bandage. Even if it is a big cut and a big bandage. Or a plaster cast. We do not assume they will need this bandage for life and other people will make fun of them. We realize that the body has a powerful innate healing capacity. All we need to do is provide an environment in which the injured part will not receive further jury and thus will heal. We know that as soon as the cut is mended, the broken bone re-connected the person will reject the band aid and the cast on their own.

When you think of it, it is pretty miraculous that skin knits back together; that bones reconnect and are even stronger than previously; that internal organs return to healthy functioning. I have read that a lot of medicine is providing a safe, supportive environment in which the body can heal itself.

So maybe that is a large part of what we do in treatment. We try to avoid hurting our clients further, and we offer safety and support that promotes healing.

Of course in medicine we cannot cure everything. The person may have a scar. Some need prosthetics. Again, we don’t worry about people’s reactions in the future. If the patient needs the aide, medical personnel will teach him how to use it most effectively.

So Jason doesn’t have to worry about taking the supportive tools away from Marvin. When he doesn’t need them, he will drop them himself. The urge to be grown up and normal will prevail. And it he continues to need some help when he goes to school, work with him on how to use it discretely.  

And he may get teased. Most kids do at some point. But maybe we will have taught him tricks not to over react. And the memory of Jason, who cared about him, will give him the strength and hope to keep moving forward.

The Tragedy of Inadequate Resources

All over the country the child welfare system at every level is reinventing itself to provide trauma informed care. At State agencies, at non-profit treatment providers, at the foster care level, in schools, in outpatient therapy, good caring people are working hard to understand behavior through a trauma lens and to offer treatment that is more relationship-based and collaborative, less punitive and inflexible. Much training is being offered, including by us, on viewing symptoms as adaptations; understanding that the child is doing the best they can; and offering youth safe and caring relationships in which to heal. The same principles are being applied to parents, and there is increased awareness of how their early trauma experiences interfere with their parenting. Utilizing the information from the ACEs study we have learned the societal cost of early childhood adverse experiences, and thus the importance of early and skillful intervention.

Yet I am increasingly aware of a central tragedy at the heart of our attempts to reform. For our children who have been damaged at an early age through a combination of neglect, abuse, trauma and attachment disruptions, the best treatment skills in the world are useless if the children have to keep moving around.

Recently I was doing a training in another state at a residential facility and I was asked to consult on a girl they were struggling with. Tabitha is thirteen years old and her placement at this facility is her 29^th. She has been kicked out of day care, foster homes, treatment facilities, and schools. Currently the facility that she is in is considering kicking her out because she keeps attacking the other youth and seriously hurting them. With the resources they have, they are unable to keep the other kids safe while Tabitha is there.

We have done this to Tabitha, we in the child welfare service delivery system. Sure, the damage started when her bio family, overwhelmed with their own trauma, poverty and despair, abused her. But she was removed from them at the age of two. Since then, we have been unable to create a home with enough support and safety that Tabitha could have time to heal. By moving her around we have eventually taught her that people are expendable, that relationships cause pain, and that it is important to be tough so that no one can hurt you.

We know that Tabitha will increasingly cost the taxpayers money, in addition to the considerable amount we have spent on her already. Whether that money be incarceration, drug treatment, medical care for stress-related illness, placement of her children-to-be, etc. etc. it will be spent. And at the same time we will not be reaping the benefit to society that Tabitha could have provided if she had been given time and consistency in one safe place. Furthermore, we lose whatever talents and contributions Tabitha could have added to the world.

Yet all of this money is from different pots authorized by different people counted in different systems. So there is no way to look at this situation and say: spend money now and save it later. It is not that we are choosing not to spend enough money on Tabitha throughout her lifetime. It is that our inability to spend enough money early enough results in our wasting ever increasing amounts of money on short term ineffectual attempts at change.

Tabitha needs love to heal.

She cannot heal if she keeps moving from caretaker to caretaker.

She cannot heal if she keeps getting her worst opinions of herself confirmed by being kicked out of places.

She cannot heal in six week bursts of treatment.

She needs containment and safety to get her through the worst part of learning to manage her feelings, calm her biology, rebuild her brain, develop connections, learn skills to manage feelings, and discover some worth in herself. She needs resources to keep her and others safe until she learns to do it herself.

In order to help Tabitha heal, the adults around her need sufficient resources so that they do not become injured and exhausted. Only if they are well cared for will they be able to see beneath Tabitha’s seeming uncaring aggression to the scared child within. In addition, the adults around Tabitha need training in order to understand why she is acting the ways she does; to understand it is not about them personally; and to give them a road map for healing. This will help them have the stamina to stay engaged with her. And the adults have to understand that it is safety, connection and pleasure that will help Tabitha, not restrictions and punishments.

In the mean time, the agency where Tabitha is currently placed is doing their best. They have been given an additional five hours a week of staffing for her. They are trying to make safety plans. And they are validating her experiences and helping her understand her feelings and learn skills to manage them. Hopefully, they will make some progress.

Or, because of inadequately funding, limited options, and exhausted treaters Tabitha will succeed in once again seriously hurting one of her peers. And the facility will have no choice but to ask the state to remove her. And Tabitha will leave for her 30^th placement, where ever that might be, and the next bunch of people who seem kind but really will not stick by her.

And we will continue to support her ever increasing needs.