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I think this is the point we are all up to in many countries...the 'what next?' who to refer to and what the best course of action for each child is.  

There is no standardised approach to dealing with high ACEs scores as each individual will have individual experiences that may combine and compound in different ways, and affect them differently.  

I am intrigued about what I am starting to examine more of as a professional Youth Worker with specialist skills. I have indeed referred to myself and staff recently as Resilience Therapists. 

In our profession (Youth Work) what we essentially do is offer the relationship of unconditional positive regard...and oh wow! my latest project is showing just how important that is to young people affected by ACEs...more so / or even more powerfully when in compound with use of specialist techniques to help a young person regulate.  

I'd be super grateful to learn from others what they think a Resilience Therapist looks like.

Best wishes

 

 

 

I'll also add here in the UK we have insufficient funding and resources for all the different therapeutic needs of young people and adults (and parents / families).  This again affects who and where to signpost people to for support...there really isn't many/anyone!

Hi all, What a terrific question! As a psychologist who works with trauma AND someone who has created a curriculum on resilience interventions for primary care, I want to emphasize there are lots of things you can do in your clinic to bridge the gap and begin to build resilience. Will there still be a need to refer to outpatient therapy or trauma informed specialists? Perhaps. But there are actually many things that you can do in an office visit that only take a couple of minutes to boost resilience. Here’s a link to my website if you’d like to check out more, including an upcoming two day intensive specifically for pediatricians around how to learn resilience building activities. www.doctoramyllc.com/2dayintensive

I’ve trained hundreds of physicians now and we have amazing outcomes data including decreased burnout for docs!

 

No - A Resilience Therapist per say, doesn’t exist.  

I’ve never seen any such thing.  There are just concepts... generally formed by those far away from the real world creating edicts from an academic center somewhere .... the resilience therapist, maybe that can be the pediatrics doctors who can ask patients to reflect on the protective factors in their environment; can ask parents who are hanging on by their fingernails to look for and focus on the things they can be grateful for, all while the doctor is simultaneously waiting 2 hours for the PA to go through for the spinal MRI the neurosurgeon requested, while having the front desk staff call around for 1/2 a day to see what specialist will accept this kid’s Medicaid and cast her broken arm, and sending in 6 different PA attempts for a stimulant med and antipsychotic that the kid was sent home on from the inpatient stay...Why do they always discharge these kids with samples of meds that insurance won’t cover and that are over 1000 dollars a month?  The family is really angry and I have to try to explain to them why I can’t get this med for them and I’ve got to find something else that he hasn’t taken before that will work. I hate being put in this position...... or an acne med or whatever med because there’s a different approval for each one and it all depends on the patient’s insurance and then spend 8 hours in the evening typing up the day’s notes into an unwieldy EHR while contemplating where I can get more free infant formula (our society has made formula the way too many vulnerable parents have to go when poor parents have to go back to work when the baby is 7 days old because there is no AFDC safety net anymore), and how to get a car seat, “Who can I call?  Who did I call last time?” and who can help this homeless mother or throwaway teen? 

What we do now is tell patients to go to community mental health... or call your insurance company to ask the company who you can see if you don’t qualify for CMH (and that process of making those calls is almost impossible for a chaotic family; I’ve tried it and I find it impossible for me to comprehend and not get overwhelmed).    Many patients have been to Community mental health as kids or have family members who have been there and they feel that the services provided there have harmed them and they don’t want to go back so they might go back or most of the time, they don’t.  That’s it for this kid with 6 ACEs.  Almost all of the kids who do go, especially if there is a complaint from school about acting out or hyperactivity are quickly diagnosed with ADHD and well - the kids are put on a trajectory to polypharmacy beginning with Ritalin or whatever medicaid will cover.  The kid gets a little depressed on the stimulant, has an SSRI added, then a manic attack, gets diagnoses with Bipolar and gets put on an antipsychotic and the kid is 7.  It all happens in 12-18 months, you had a kid exposed to environmental chaos and “toxic stress” who is now on 3-4 psyche meds and now has a diagnosis of Pediatric Bipolar, and is set up to go on SSI and disability as a career.  In most places and for most patients and especially for the patients who are struggling most.... there isn’t anyone equipped to take care of these generationally traumatized kids in these generational families where ACEs and disorganized attachments and personality disorders are being transmitted through epigenetics and learning for generations and are the norm. 

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