Attached is the Saxe et al text there is a quote that begins with “Clinicians are witnesses.” Read that entire quote and share your thoughts and reactions LABEL QUESTIONS TO ANSWERS Also, post your response to the following questions on your private journal. In what ways have you been affected by bearing witness to the horrors experienced by your clients? How do you balance the statement “…If this clinical work does not have a profound personal effect on a clinician, that is something that clinician should pay attention to” with the need for self-care to prevent secondary traumatic stress? ” What questions does this week’s material raise for you? How might you address them? Be sure to Expand more on your thoughts and ideas, and how they might relate to your field work/practice. Ex- Why were these ideas the most impactful on your learning this week? Do you have any clients in field now that you can relate these concepts to- if so, how? http://ct.counseling.org/2010/11/the-power-of-play/ OVERVIEW OF WEEK: Objective: The two lessons for this week set the stage for thinking about intervention with children and families impacted by trauma. In the first lesson students are introduced to basic principles for trauma informed treatment and are given information about the range of evidence informed interventions to trauma treatment that currently exist. Students are asked to investigate one of these interventions in greater depth and to identify how the basic principles for trauma informed treatment are incorporated. In the second lesson, students focus on specific developmentally appropriate techniques for working with children and adolescents as well as with adults. Assignment 2 is introduced and discussed. The week concludes with an individual private blog submission.Course Objectives o Develop specific skills for working with children adolescents and/or adults including specific interview and expressive techniques. o Develop the ability to use specific interventions including psycho-education, strengthening the caregiving system, distress reduction and affect regulation, cognitive reprocessing, and strengthening relational skills. o Recognize how interventions with trauma-exposed children adolescents and/or adults impact the practitioner and develop self-care skills to prevent vicarious trauma.Learning Objectives By the end of this week, you will be able to: o Examine core principles of trauma treatment and determine the opportunities and barrier that exist in their agencies and communities to implementing them. o Compare, contrast and analyze three evidence informed approaches to trauma treatment http://www.nctsn.org/resources/topics/treatments-that-work/promising-practices Current Psychiatry Reports, Volume 15, issue 1 (January 2013), p. 1 – 9. ISSN: 1523-3812 DOI: 10.1007/s11920-012-0332-5 Current Science Inc., New York Evidence-Based Treatments for Traumatized Children and Adolescents 1. Briere & Scott, Chapter 4 Central issues in trauma treatment. 2. Saxe, et al Chapter 6 Ten treatment principles: The principles that guide TST. Lecture: Approaches to Trauma Treatment Overview While it is beyond the scope of this course for students to become proficient in specific evidence based interventions for trauma treatment, this lecture will focus on principles of trauma informed treatment that form the foundation for many of these approaches. In chapter 4 of the Briere and Scott textbook, they begin by suggesting that ” effective – therapy-irrespective of underlying theory – can be broken down into a number of broad components, the exact combination of which varies according to the client’s specific clinical needs” (p. 77). This does not mean that we should overlook the theoretical underpinnings of trauma informed treatment. Indeed having a strong theory base is crucial to the development of treatment approaches. Later when you will be asked to review various evidence based interventions, you will need to think about their theoretical bases and use them to help you further understand the origins and conceptualizations of the approach. The above quote contains another crucial idea – that being that we must tailor our approach to each client’s specific needs. This requires a thorough assessment and case conceptualization which will be covered in the next week’s material. Increasingly, there is recognition of the value of identifying core components of treatment rather than emphasizing a specific “one size fits all” manualized approach although there are others who argue strongly against this perspective. (Blaustein & Kinnisburgh , 2010) For the purposes of our course, we will focus on the following: 1. Provide and ensure safety. Because trauma is about vulnerability to danger, safety is a critical issue for trauma survivors. This includes both physical and psychological safety. Not only must the client BE safe but he or she must also FEEL safe. Because of prior experiences, trauma survivors have developed survival mechanisms such as hypervigilence and cognitive distortions that result in them misperceiving a safe therapeutic environment as unsafe. Two important implications for treatment are first, that whenever an issue of safety arises, regardless of the “stage” of treatment or the goal that was expected to be accomplished in a particular session, all other efforts must be stopped and the safety concern addressed. The second implication that arises from the first is that treatment may take considerably longer and call upon more caring and patience from the therapist than might be called for in more traditional therapies. 2. Fix a broken system. Remembering that a trauma system consists of a child or adolescent who cannot regulate his or her emotional state AND a social environment/system of care that is not sufficiently able to help the child regulate these emotional states, treatment must focus on the child or adolescent and his or her social environment and caregiving system. It is always important to think systemically about interventions. 3. Provide and ensure stability. “Stability refers to an ongoing psychological and physical state where one is not overwhelmed by disruptive internal and external stimuli. It also implies some degree of capacity to resist the effects of such stimuli in the near future” (Briere & Scott 2013, p. 87). Your textbook further specifies that the child or adolescent must have both life stability and emotional stability. Ensuring life stability may entail strengthening or changing the caregiving system and /or social environment. Emotional stability refers to the fact that a child or adolescent who is displaying acute symptoms may not be ready to engage in trauma related work unless and until those symptoms can be diminished. 4. Maintain a positive and consistent therapeutic relationship. Research consistently shows that a good working relationship between the trauma survivor and the therapist is crucial in order for healing or growth to occur. With children and adolescents this requires that we again visit the concepts of attachment and build strong attachments between the child and therapist but also strengthen the attachment between the child or adolescent and a healthy caregiving system. 5. Tailor the therapy to the client. A thorough understanding of the client and his/her situation must be obtained first before deciding on specific interventions. While manualized treatments may be able to provide a strong evidence base, they do not duplicate the realities of the real world in which our clients live. And these realities cannot be ignored. Any interventions must take them into account and may require a deviation from a specific manualized approach to a more practical one that is more likely to succeed. The corollary to this comes from the Saxe text that talks about putting scarce resources where they will work. Saxe et al point out that the complexity of traumatic situations with which we are working has developed over the course of many years (or generations) so we cannot expect that our interventions will ever be able to “fix” everything. Because mental health and other resources are limited, we must make strategic decisions about which ones to employ that have the greater likelihood of successful outcomes. Finally Saxe and colleagues remind us to create clear, focused plans that are based on facts…….. of each case and to beware of offering a particular type of treatment to a child or family because that is the only one that is available. 6. Take gender and sociocultural issues into account. Earlier in this course we examined some of the ways in which the meaning that one makes of a situation may be culturally influenced or determined. Briere reminds us that we need to be aware of the ways that gender and social status impact who experiences different types of trauma, and that “people with lesser social status are more likely than others to be victimized” as well ( p.94). This means that service providers should be more in tune with the possibility of different types of trauma exposure among various groups, using the “trauma lens” as one way of seeking to understand the individual’s experience. Trauma focused treatments must pass through a cultural lens as well with the practitioner and agency being constantly on the lookout for potential biases and misunderstandings that would interfere with effective treatment. 7. Practice ethically and within the standard of care. Briere and Scott make the point that while the same ethical principles that apply to any client apply to trauma survivors, there are some special issues involved in this kind of work that make the situation even more challenging. With an emphasis on relational connection as needed for effective trauma treatment, the social worker must be ware to not let issues of counteractivation interfere with a professional approach. The client’s vulnerability makes it especially important that the social worker be careful not to violate the client’s boundaries either by becoming overly caring or by becoming overly directive and authoritarian. It is imperative that social workers working with this population adhere most strictly to the social work code of ethics. They must be constantly monitoring their actions, addressing counteractivation issues when they arise and remain firmly grounded in the reality of what is possible to assure that all aspects of the Code of Ethics are followed. 8. Take care of yourself and your team. Briere and Scott refer to this as monitoring and controlling counteractivation…..This is a consistent theme throughout this course. The social worker and the agency experience high levels of stress when working with children and families impacted by trauma. Unless the caregivers are supported, they quickly will be drained of the resources necessary to give needed care. These principles will undergird the various treatment approaches that we will be studying throughout the remainder of the course….. DISCUSSION #1 AND LABEL This discussion will allow you to reflect upon the principles of Trauma Focused Assessment. Answer the following questions o Given the principles outlined, which one(s) do you think will be most challenging for you to put into place in your agency/community? Why? o What strategies might you use to deal with the challenges? o In reviewing the posts of your colleagues, address; o To what extent do you experience similar challenges? o What additional strategies might you recommend? Lecture 02: Core Components of Trauma Interventions Overview This lecture will highlight core components of interventions designed to address trauma. The National Child Traumatic Stress Network and SAMSHA’s National Registry of Evidence – based programs and practices provide information on a number of different evidence based interventions but first let us discuss core components. Many existing trauma-focused interventions overlap in their content and approaches. These areas of overlap are termed “core components.” Providers are encouraged to consider (1) whether and how specific interventions include desired intervention components, (2) how, if included, these components are carried out (e.g., specific skills-acquisition activities, homework, role-play, games), and (3) how well these components “fit” with the specific needs and preferences of the population the agency serves. For example, does the intervention emphasize acquiring the appropriate coping skills? If so, are the activities in which skills are acquired appropriate for the developmental level, cultural background, and geography of the population served? Interventions that do not include needed core components may be inappropriate for the population, or may at least require substantial adaptation in order to be considered appropriate. Examples of core components might include: o Screening and triage o Systematic assessment, case conceptualization, and treatment planning o Psycho-education o Addressing adults, children and families’ traumatic stress reactions and experiences o Trauma narration and organization o Enhancing emotional regulation and anxiety management skills o Facilitating adaptive coping and maintaining adaptive routines o Parenting skills and behavior management o Promoting adaptive developmental progression o Addressing grief and loss o Promoting safety skills o Relapse prevention o Evaluation of treatment response and effectiveness o Engagement/addressing barriers to service-seeking This discussion will allow you to explore and discuss the types of evidence based interventions, as well as various treatment approaches. Introduction This course will go into more depth on many of these components in the remaining weeks but first it is important to understand the types of evidence based interventions that exist, the populations for which they are most suited and the level of evidence that supports their efficacy. Go to the National Child Trauma Stress website or if you interest is in working with adults, go to SAMSHA’s National Registry of Evidence – based programs and practices. Review the Fact Sheets and/or information for at least three different treatment approaches that you believe might be useful in your practice setting. Answer and label the following questions DISCUSSION #2 o Name the three approaches you have chosen to review. o What do you see as the advantages and disadvantages of each approach in your practice setting? o What core components do they share? o What if any are unique components of treatment in each one? o If you would be asked to select one of these approaches to learn and use within your practice setting, which one would you choose and why? o To what extent did you choose similar approaches? How well did your colleague justify his/her selection? This discussion will allow you to explore and discuss the types of evidence based interventions, as well as various treatment approaches. Introduction This course will go into more depth on many of these components in the remaining weeks but first it is important to understand the types of evidence based interventions that exist, the populations for which they are most suited and the level of evidence that supports their efficacy. Go to the National Child Trauma Stress website or if you interest is in working with adults, go to SAMSHA’s National Registry of Evidence – based programs and practices http://www.nrepp.samhsa.gov/SearchResultsNew.aspx?s=b&q=trauma . Review the Fact Sheets and/or information for at least three different treatment approaches that you believe might be useful in your practice setting. After your review, answer the following questions by posting on the discussion board: Name the three approaches you have chosen to review. What do you see as the advantages and disadvantages of each approach in your practice setting? What core components do they share? What if any are unique components of treatment in each one? If you would be asked to select one of these approaches to learn and use within your practice setting, which one would you choose and why? In your response to your colleague, focus on the following question: To what extent did you choose similar approaches? How well did your colleague justify his/her selection? EXAMPLE: Name the three approaches you have chosen to review. 1. Group Treatment for Children Affected by Domestic Violence (DV) 2. ARC: Attachment, Self-Regulation, and Competency: A Comprehensive Framework for Intervention with CULTURE-SPECIFIC INFORMATION Complexly Traumatized Youths 3. Trauma Systems Therapy What do you see as the advantages and disadvantages of each approach in your practice setting? Group Treatment for Children Affected by Domestic Violence (DV) Advantages; Group so more than one child will benefit. Disadvantages; Forty-four week group: Offering it in a school setting might be hard we are not in school for 44 weeks. ARC: Attachment, Self-Regulation, and Competency: A Comprehensive Framework for Intervention with CULTURE-SPECIFIC INFORMATION Complexly Traumatized Youth Advantages; adaptable treatment framework and ARC has been used with a range of populations Disadvantages; None found Trauma Systems Therapy Advantages; TST is not limited to one specific trauma type. Disadvantages; multidisciplinary team What core components do they share? They can all be with a range of populations What if any are unique components of treatment in each one? 1. Group Treatment for Children Affected by Domestic Violence (DV); Delivered in group format 2. ARC: Attachment, Self-Regulation, and Competency: A Comprehensive Framework for Intervention with CULTURE-SPECIFIC INFORMATION Complexly Traumatized Youths; increasing access to trauma informed services in the array of settings that trauma-exposed populations access and engage. 3. Trauma Systems Therapy; includes a module ‘Ready set go’ that specifically addresses treatment barriers. If you would be asked to select one of these approaches to learn and use within your practice setting, which one would you choose and why? ARC: Attachment, Self-Regulation, and Competency: A Comprehensive Framework for Intervention with CULTURE-SPECIFIC INFORMATION Complexly Traumatized Youths because it identifies 10 core targets of intervention within three broad domains, and provides guidelines and examples of intervention. It can also be used across settings and across populations. The Lima City Schools has a wide range of populations of children and family that are served. Self –Regulation is a huge goal in my work in a school system. Most children do not know how to self-regulate.
