Connecting with Blog 4Nonprofits

As part of my participating in the Non Profit Blog Exchange Virtual Event (http://nonprofitblogexchange.blogspot.com/) I have been asked to review the blog: 4Nonprofits - A Blog From the Pace Wilson Center for Social Entrepreneurship. (http://4nonprofits.org/) This is a quote from the description of this blog:
4Nonprofits features news and commentary presented by Rob Johnston, executive director of the Helene & Grant Wilson Center for Social Entrepreneurship [1] at Pace University in New York. It aims to support the efforts of nonprofit leaders seeking to strengthen the management and entrepreneurial approaches of their organizations.

The Wilson Center for Social Entrepreneurship has as it mission "to promote social change through entrepreneurship." For nonprofit organizations, the Wilson Center will provide scholarly research, short training courses, advisory services, and roundtable discussions. For Pace undergraduate and graduate students, the Center will add additional nonprofit subject matter and courses to the University's current entrepreneurship offerings. For retirees and business people seeking to make a transition to the nonprofit sector, the Center will provide executive education.

I was excited to discover this extremely useful and informative blog. I was particularly interested in the active creation of connections between non profits and the business community, with the goal of enhancing both. I am interested in the blog post: Nonprofit Boards and the 'Duty of Imagination'. (http://4nonprofits.org/Boards-Korngold) This suggests a more exciting role for board members, that of envisioning the possibilities in the non-profit. In my experience with the Board of my own non-profit, the Board members have many differing skills and talents, and can often inspire us to open our thinking and take more risks. They are used to the kind of thinking necessary to move a business forward into the future. Also, in this post and throughout this blog Robj emphasizes how participation in on profit governance can enhance the skills, careers and lives of business members who become involved.

I look forward to continued reading of this interesting blog.

Understanding Problem Behavior

As we think more about the Restorative Approach, we realize that it is built on a new understanding of problem behavior.

The old points and levels, reward and punishment systems seem (in retrospect) to be based on a model of a rational person choosing thoughtfully between alternatives. For example, the child is seen as deciding whether or not to run away by considering- what will happen if I do run away? What will I get out of it? What bad consequences might there be? What fun might there be?

The model does include a role for past experience- that the child may have learned inappropriate behaviors as the only way to get their needs met, or to accomplish some goals. Therefore, they mostly had to unlearn them. And our job was to weigh the choices more heavily- make it worse to run away (add consequences) and make it better to stay (add rewards). If we did this long enough, and consistently enough, the child would change.

I realize that I do not think this way any more.

Instead, I think that an event happens which results in the child feeling a loss of control, in danger, confused, panicked- she feels intolerable emotions. The cause for these emotions may be only 10% in the present, and 90% in the past. But they are unbearable. And the child has no idea how to change the emotions or how to get through them. Her chemical system is out of balance, and the body’s natural calming and relaxing mechanisms are dysfunctional. She has not been taught to self-sooth. She has no experience of help from adults; in fact turning to adults has often made things worse. The pressure builds and she CANNOT STAND IT ONE MORE SECOND. So, she explodes, and does an impulsive act to escape- an act that makes the situation worse.

So- with that formulation how can we help?

Weighing options plays little to no part the scenario. So we don’t help by explaining that if you do that, certain consequences will follow.

Instead we:
Help the child learn how to recognize her patterns.
Help her differentiate past from present.
Teach her active calming skills, and do them with her again and again.
Stay calm ourselves so we demonstrate how it is done.
Express our compassion for her pain.
Contain her if necessary, as much as possible prevent her from doing too much damage which she will regret later.
Help her think over events afterwards, recognize vulnerability factors and consider less harmful ways to escape pain.
Help her understand how she got this way and that she can heal.
Teach her self-capacities of hope, self-worth, and the ability to hold love in her heart.
Stick with her, keep understanding what is happening within her, and keep the faith that there is a better way and she will get there.

And celebrate as she gradually becomes safer and stronger, and can laugh, sleep and love.

©2006 The Restorative Approach is a servicemark of the Klingberg Family Centers, Inc.

Biological Changes from Trauma

One challenge in trauma informed treatment is the recognition of the biological changes that accompany trauma. Children who have experienced early, repeated and multiple abuse are left with disturbed biological regulation systems. Their abilities to relax, calm down, sooth themselves, and rest are all compromised. At times these changes are superimposed on biological systems already impacted by maternal drug use in utero, and by family pre-disposition to mental health disorders.

What does this mean to us day to day?

When LaShanna’s mother doesn’t come for a visit- or when LaShanna even thinks about that happening- she becomes agitated. She experiences an intolerable emotional state. She feels a painful pressure. It is not that she is thinking through her situation and considering her options. In fact, she cannot think at all. She is feeling jagged, irritable, disconnected. So far, what she knows to do to relieve that feeling is break windows and destroy furniture. It helps. It provides a release.

We must try to remember times when we have felt this way, even to a mild degree- when we have felt so agitated by something that we could not sit, could not relax, and could not concentrate. Then multiply that feeling, and take away any coping skills and supports we may have. Have those been the moments when we wanted to talk about our issues and engage in problem solving?

It doesn’t help LaShanna if we respond to her furniture-breaking by confining her to her room. In fact, it is unbearable for her, and she does something else to escape the prison of her room, and of her mind.

But what can we do? We have to provide her with methods to change the intensity of her pain and hyper-arousal without hurting herself or others (or even the furniture). These would be things like going for a walk, moving around, accomplishing something active but not very difficult, engaging in an activity that provided a distraction (such as cooking). We have to take her by the hand and do these things with her. We have to be active to engage her and almost drag her into another space. Hopefully, we get better at noticing the early signs of her distress and intervening then. Eventually, we hope that LaShanna will notice her own signs of distress and use her own interventions. But we are a long way from that place.

None of this is about punishment and reward. That will not help. It is about recognizing biological distress and teaching by example how to moderate it.

LaShanna will feel understood and safe. The compassion of the people around her will strengthen their relationships. Her motivation to change, to learn to master her own body, will grow when she thinks that is possible to do so, and when she feels that people she cares about want her to have a better life.

Where is the Hope?

Miguel’s mother is addicted to drugs, and so his early life contained serious abuse and neglect. His grandmother took him in for a while, but health problems got in the way of her being able to raise him. He came to Connecticut to get treatment for his increasingly aggressive and risky behavior, and to live with his aunt and uncle afterwards. But he has continued to disobey their rules, and they just told him they will not be able to take him. Several other uncles are in jail, and there are no other family members willing to be resources for Miguel. Now he has no plan, and even his uncle’s visits with him are becoming rare. He ran away this weekend, and engaged in very risky behavior.

So what do we do, what do we say? How can Miguel begin to feel that there is any possibility of creating a better life?

It is clear that contrary to our impulses, we need to keep him nearer than ever to adults. If we isolate him as punishment, his despair and estrangement will be more complete. We can try to create responses to his run-away which give him some sense of connection and achievement- for example, community service that involves helping the younger kids program. We can work on getting him a mentor.

Yet I am still left wondering- for Miguel, where is the hope?

Shame and the Restorative Approach

Why is it important to use restorative tasks when a child has hurt others? Why assign a task that offers the child the chance to learn, and the chance to reconnect with others, to make amends for the harm he has caused? An abused child is shame based. He is sure that the abuse he suffered was some how his fault. When the people a child depends on to survive are abusing him, it is life saving for the child to believe that the abuse is caused by something he has done. This is a better choice than believing that the people you need are crazy. If it is your fault, maybe you can somehow figure out how to change and stop it. It is better to believe that you are a devil living in a world of angels than to believe that you are an angel living in a world of devils.

After an explosive episode the child struggles with feelings of shame- an increase of the sense that he is a useless, worthless person. Traditional punishments, such as isolation in a room away from adults, increase this sense of shame, and thus increase the likelihood of more aggressive behavior. People who are feeling deep shame feel they have nothing to lose. They distrust relationships, and believe “if you really knew me you would hate me”. They act to say: “let’s get this over with now- I’ll show you how bad I am, and you will leave or hurt me like everyone else”.

Restorative tasks that offer a way to reconnect and make amends teach a valuable skill that we all need: what do you do when you have messed up? It is possible to do something wrong and set it right. It is possible to have a problem in a relationship and then to fix it. This is not something these children have previously experienced.

When a child makes a meal for the unit he has disrupted, when he does a chore for the staff he has harmed, when he teaches a computer game to the child he has attacked, he is left feeling a little better, a little stronger. He is connected to others. He has given something valuable, from his own efforts and talents. He feels he may be worth something after all. He has a reason to try to act safely next time. He has a tiny ray of hope.

©2006 The Restorative Approach is a servicemark of the Klingberg Family Centers, Inc.

Jonathan

Jonathan is a 14 year old boy who was admitted to Klingberg about six months ago. He is small in stature and has a history of severe trauma. He came in snarling- he was vicious to staff and to other kids, and talked a lot about how tough he was, his gang friends, and made many threats to stab and otherwise harm everyone. He would not say hello or smile, much less talk about himself. He thought this whole treatment thing was so stupid. Yet, there were moments. Even the second day he was there he said: “You aren’t helping me!”- our first glimpse that he felt the need for help.

In he old system Jonathan would never have emerged from punishments. Staff would have confronted his every behavior head-on. Now, people kept their focus on the small, hurt, scared, confused boy who was desperately protecting himself with a wall made of hostile actions. Staff smiled, approached him, and said “life doesn’t have to be this hard, Jon.” He even said: why are you guys punishing me more? That would have fit with his self concept. We kept a log of “Hopeful Moments with Jonathan” to help us keep up our stamina.

Gradually Jon started to relax a little, connect a little. He began to say hi, and ask for things he wanted. One time that he was mean to a younger peer he and that boy made brownies together for the unit, and Jon taught the boy how to play a computer game. He began to participate in family therapy, and shared with his therapist how angry he feels about how badly he was beaten. He even started to look at his relationship with the mother who is only intermittent in is life.

Unfortunately Jon was hospitalized this week. He began to cry a lot, stayed in bed, and would not go to school. But this is all part of the process, and he will return to continue his treatment. If he is able to change, it will not be to earn privileges or to avoid punishments. It will be because compassionate people made him feel safe enough that he could finally share how scared he is, and finally begin to rely on some help from caring adults.

Sandra Left This Week

Sandra was discharged this week to a group home. At her discharge party Sandra said: “I never thought I’d see this day. I was sure I would end up in jail.”

The thing that helped Sandra the most was probably just sticking with her. Sticking with her despite all the staff she assaulted, all the windows she broke, all the furniture she destroyed.

But what helped us stick with her? It was the emphasis on relationships, the staff who could say, “we love Sandra. She is such a special girl” despite all the outbursts and difficulty. Staff was able to see the goodness in her because they understand trauma, and know that her agitation was a symptom, her disregulated emotions were a result of Post Traumatic Stress Disorder, that she was not defiant or bad and that she was doing the best she could. They saw that the center of her distress was relationships, her need for closeness and her fear of closeness, her struggles within her connection to her mother and her family.

It helped Sandra when we took seriously that she could not stand to be in her room alone for “Quiet Hour”- she was not “being manipulative” or “just looking for attention” she was actually experiencing flashbacks.

It helped Sandra when we converted our unit to a Dialectical Behavioral Therapy unit (www.behavioraltech.com) and began to teach her specific skills of mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. She began actively learning and practicing these skills.

It helped Sandra when as a result of converting to DBT we learned and began practicing distress tolerance skills, so we could get through a crisis, remain calm, stay mindful, and not make it worse.

And as we watch this courageous young lady hug the people she has come to trust, cry and say goodbye, and head out to create new connections and a new future, we know that it has all been more than worthwhile.

Time

One concern we often hear expressed when we train on this method is: I don’t have enough time! We don’t have time to think up all these individualized responses, much less do them. How can we spend time with an individual child doing restorative work? Who will be watching the rest of the kids?

It does not take more time, or more staff, to do this method. Restraints take time. Restraints use a lot of staff. This method cuts down on restraints, cuts down on staff holding doors shut to keep kids in rooms. This method cuts down on power struggles and arguments over the loss of points that result in escalation and angry outbursts.

Restorations do not necessarily take a long time. They do not have to take as long as the former restriction would have taken. They can be as straightforward as a conversation.

Restorations can be done in groups, and at staff convenience.

Quite a bit of time is freed by not having to fill out, tally and record points.

The relaxed, flexible atmosphere results in staff having more time, and in heir using their time in more meaningful ways- in forming true relationships with the children.

Consistency

We do a lot of training about the Restorative Approach. This approach suggests that the staff response to each child’s actions be individualized. One child bites a staff, and she is required to do a chore with that staff before returning to fun, special treat activities. Another child hurts a staff. He makes a poster showing a thermometer which represents his anger, and he draws pictures of the feelings in his body when his anger is at each level from mild to out of control. Different responses for essentially the same behaviors. People often ask: what happens to consistency? Isn’t it essential that we respond the same way every time a child does a similar thing? Won’t the children feel that these individualized responses are unfair?

First of all, the administration of points-and-levels systems is not consistent among staff- ask any child and they will tell you which staff are more lenient about it. Secondly, doing the SAME thing is not doing the FAIR thing- as the children differ in intellectual and emotional capability. We should respond confidently to the children: everything is individualized here. We do what is right for each individual.

Still, the adult should be able to explain why she chose a given restoration for a given symptom- the choice should be based on the formulation of the child’s treatment, their treatment themes, their abilities and skills, and the severity and frequency of their actions. The team atmosphere should value challenging each other about being too strict or too lenient with a given child.

Our consistency is found in our individualization, our understanding of each child, and our compassionate approach to their symptoms. Our consistency is not sameness, it is thoughtfulness, and it is giving each child a chance to learn and to make amends, to feel less shame, to be stronger and better connected after a difficult situation.

©2006 The Restorative Approach is a servicemark of the Klingberg Family Centers, Inc.

Principles of Trauma- Informed Treatment

These are the principles that inform our thinking about treatment, and that have led to our creation of the Restorative Approach:
· Children and families are doing the best they can
· It is our responsibility to teach them to do better
· Our most powerful tool is our relationships with them
· They have developed their symptoms for a reason, and the symptoms have been life saving in the past
· When afraid and stressed people seek to control
· Abused children are shame based
· Traumatized people often re-enact their trauma shifting between the roles of victim, abuser and ineffective bystander.
· Compassion and empathy are the cornerstone's of our approach
· The families are central to the children's growth
· Children learn to regulate emotions in the presence of regulated adults
· All behavioral problems are and expression of unmet needs and that our job is to help the child/family meet these needs
· When children are having difficulty they need to be closer to reliable adults
· Staff team work is the essential foundation for all our work, which includes trust, responsibility, honesty and self awareness
· If a child or family is not getting better we need to re-assess what we are doing

Sam's Difficult Day

Today Sam had a melt down. He broke several windows in our beautiful new school, and he trashed the library. Throughout the agency people were asking: what's upsetting Sam? He hasn't done anything like this for many months. What is hurting him? Sam used to lash out regularly, seriously assaulting people. We were not sure we could keep him and others safe. But he has gradually begun to connect, to talk, to explore his complex self. He hasn't had any behavioral problems for a long time, and he even says hello and asks others how they are doing now. When his therapist and staff asked him about today, he started out by complaining about various adult decisions. But gradually he started to talk about his mom. She has steadfastly stated he can never come home and live with her. But now she is opening the door a little, saying maybe she will consider having him home. Sam said he is scared- scared he will let her down. He said: "I don't want to go there if she doesn't really want me". After some more discussion he said "so tomorrow I will fix the library, and what can I do to earn money to pay for the windows? I will have to apologize to some of the teachers". Staff added that he would have to do something restorative to make amends to the other students he scared, and that he would be on a hold (loss of extra fun privileges) until this work was done. Also, they wanted to keep him near them (no off-grounds trips) while he was struggling with these big issues in his life. He accepted this readily.

This is the Restorative Approach in action.

©2006 The Restorative Approach is a servicemark of the Klingberg Family Centers, Inc.

Training and Thinking

Yesterday we did a training for fifteen people from the Andrus Center in Yonkers, New York (http://www.andruschildren.org/). It was great to meet this group of intelligent, receptive people. Included in the training on the Restorative Approach was a presentation by our adolescent Boys' Unit, a meeting with school staff, and a discussion of the DBT adolescent Girls' Unit- and lunch, of course! There were so many questions and so much discussion it was hard to keep the day moving along.

As I do these trainings, it becomes clearer that we are suggesting a new way of looking at the kids and their symptoms- not just a new method of behavioral control. People often start out wanting to simply substitute restorative consequences for restrictive consequences. But the difference in approach became clear in a couple of examples. In the school, a teacher spoke of a boy who refused to go into his classroom. She tried to figure out how she could help him- what was wrong? What was bothering him? and arranged for him to spend the day in another class, with a plan to work towards returning to his own. It wasn't about compliance- you must get into your classroom because that is where you are supposed to be. It was about understanding- how can we help you? The Boys' Unit staff demonstrated a similar approach to a child who was escalating around refusing to take a shower. Their reactions were completely informed by an understanding of the relationship of trauma, low self esteem, and hygiene problems.

Every time we do a training I come to understand the Restorative Approach more deeply.

©2006 The Restorative Approach is a servicemark of the Klingberg Family Centers, Inc.

How Should We Respond to Harmful Actions?

If we are not using time-based restrictions, isolation, and loss of privileges when the child acts out, what should we do?

When children do something that hurts others, the adult response is two-fold: the tasks given to the child as “consequences” should provide an opportunity to make amends, and they should provide teaching of skills that will help the child avoid similar problems in the future.

How can a child who has assaulted a staff and damaged property make amends? There are many possibilities. He can do something for that staff: write an apology, talk over what was going on, make him a picture, write and sing him a song, pick him a bouquet of flowers. He can make popcorn for all the kids on the unit to pay back for the disruption he caused. He can help fix the property he damaged.

How can a child who has had a fight with a peer learn skills to avoid future fights? She can be assigned practice in getting along, like playing a game positively for half an hour. She can role-play a relationship problem with a staff. She can interview three people and find out how they handle it when a friend lets them down.

The theme here is that instead of “doing time” the child is learning skills and reconnecting with people.

What's Wrong with Points and Levels?

Almost all group treatment programs for children use points and level systems. These systems started as a good thing, an attempt to make concrete for the kids the concept that if you do better you get more profiled and responsibility. (This is sometimes, but not always, true in life.) However, the systems grow, multiply and become more complex. They actually interfere with relationships between children and adults. For one thing, the point system becomes the language people use to speak to each other- asking "how many points did you earn today" instead of "how are you?" Adults react to things children say and do with threats of the potential consequences, rather than with curiosity and empathy. Adults spend a lot of time filling out point cards when they could be interacting with kids. One advantage claimed for such systems is that they are consistent across staff, but any child in a program can tell you that isn't true, and tell you which staff is more lenient or generous with points. And they are often inaccurate as busy staff try to fill out cards hours after the time period has passed. Many restraints start over a power struggle that begins with a child losing (or not earning) one point, and then feeling that their entire day, and in fact the entire self, is ruined and useless. So, what started as an admirable attempt to organize rewards and punishments has grown to interfere with relationships, change and growth.

Use of Self

The use of self is central to a relationship based approach. Staff and therapists speak from their hearts. Instead of saying "If you run away you will be restricted for a week and lose your privileges" staff will say "if you run away I will be scared, I will worry about your safety. I will have to keep you closer to me because our trust will be broken". Staff is encouraged to evaluate their work by what they do, not by what the kids do. We utilize The Attitude, described by Daniel Hughes in Building the Bonds of Attachment (http://danielahughes.homestead.com/). The elements of The Attitude are: Playful, Loving, Accepting, Curious and Empathetic. PLACE. Staff explore what these elements mean to them, which are easier, which harder. Any day in which staff have approached the children with the Attitude is a successful day. It is up to the adults to structure an environment around the children which maximizes their chance for success: organized, predictable, reliable, calm.
Developing related teams is essential every effort is made to nurture teams in which people can talk freely about their own reactions to the children, and can challenge each other. If one team member seems caught in a power struggle or stressed out, another team member will tag them out and take over for a while. It is considered a strength for a team member to say they know they have lost their sense of what to do and ask for help. This type of team work is enhanced through meetings, retreats, parties, recognition events, staff recognition boxes which are read out weekly, and individual and group supervision.
We can only relate to the kids as well as we relate to each other. Or, to quote a phrase I heard at a training once: if you don't feed the caretakers they will eat the children.

Theory of Change

In creating this new approach to treatment, we had to consider our theory of change. Why do people change? What helps us to change when we notice something in our lives that we wish to improve? What inspires us to achieve, to do well at our jobs, to further our education, to live as responsible members of society? Motivations are many and complex, and include fear of punishment, monetary and other material rewards, etc. However, the basic tenet of this approach is that relationships provide the strongest motivation to people.

Relationships include wanting to please some one, not wanting to not let someone down, feeling warmed by another person’s caring, looking forward to bringing an achievement to the attention of another ("Watch this, mom!").

The restorative approach concentrates on the relationship effects of behavior. What behaviors bring you closer to another; earn you the respect of your community? What behaviors hurt and alienate others and distance you from your community? When you have hurt others, how can you make amends?

If we believe that relationships are our strongest tool in creating change, then everything we do should be informed by our understanding of what will strengthen relationships.

©2006 The Restorative Approach is a servicemark of the Klingberg Family Centers, Inc.

Restorative Approach (sm)

I am a social worker who is currently a Vice President of a large child welfare agency in New Britain, CT. Klingberg Family Centers (http://www.klingberg.org/). We are pioneering a newly developed, trauma informed approach to congregate care of children with serious emotional disorders. Many of the children we treat have suffered early trauma- physical and sexual abuse, domestic violence, multiple moves- within their biological families. Then when they enter the child welfare system they often suffer more abuse, and experience many more moves. They present to us with serious problems of aggression, suicidality, self harm, property destruction, and unsafe choices. We are a highly clinical program, and we treat the children in our state with the most serious difficulties. We used to use a traditional points-and-levels approach in our congregate care programs (residential, acute residential, extended day after school treatment, special ed therapeutic school). But we found that these approaches were not working, and also were not transferable to a home setting.
We have learned a lot about trauma and about attachment, and have been influenced by the work of Daniel Hughes (especially Building the Bonds of Attachment, a wonderful book), Jon G. Allen and Judith Herman.
We have been trained using the Risking Connection trauma based training curriculum (http://www.riskingconnection.com/) and are now involved in delivering this training.
So, we have invented and are using the Restorative Approach.

What is the restorative approach to treatment? The basic tenet of this approach is that relationships provide the strongest motivation to people. The restorative approach concentrates on the relationship effects of behavior.

This approach emphasizes the importance of shame. Most of our children have been seriously abused, which they have felt is their own fault. Therefore they are shame based: completely sure in their hearts that they are no good worthless people. Any set back reaffirms this basic belief. Punishment that includes isolation and public humiliation further reinforces this internal certainty.Therefore, the first step in the restorative approach is to understand that it is our job to form a relationship with every child and family we treat. It is our responsibility to reach out to them to find the good in them, to learn about them.

Then, when they do something that hurts others, the approach of the consequences is two-fold: the consequences should provide an opportunity to make amends, and they should provide teaching of skills that will help the child avoid similar problems in the future.

The theme here is that instead of "doing time" the child is learning skills and reconnecting with people.

If a child has injured or had difficulty with a particular staff, that staff should be central in establishing and working through the restorative work.

Because the restorative approach requires more flexibility and creativity of the part of the staff, it also demands a high degree of self-awareness, and the ability of a team to talk honestly with each other. Each child does NOT have to receive the same response for the same action. We should not hold consistency (in the sense of sameness) as our goal. Instead, we should be consistent in our values and our purpose. The response to each child and each instance of misbehavior will consistently be personalized, related to their goals and what they need to learn.

In addition it is important for staff to recognize and discuss with others their own thoughts and feelings about the child, how these get triggered in many ways, their own concept of justice (related to their early parenting) etc.

A restorative approach offers hope for a more healing environment, and a more meaningful experience for both staff and children. It is also more transferable to the outside world, where levels and points do not exist. A restorative approach restores our focus to the most important and powerful aspects of our work with the children and each other, which are our mutual and respectful caring relationships.

I hope to write more about this approach, our use of it and our thinking about it in this blog.

©2006 The Restorative Approach is a servicemark of the Klingberg Family Centers, Inc.