Does anyone know of a reputable source/document (or works at a trauma informed facility) that provides practical advice for direct care when working with children short term? Long term, it's possible to work toward implementing some play/limbic system type therapy or TF-CBT if the child is emotionally/developmentally ready or other evidence based therapies, but short term, what are some suggestions for educating staff on preventing escalations and keeping communities safe? This could be in shelters, inpatient psychiatric units, short term residential evalution units, childcares, etc... Are there videos showing "how to escalate a child with trauma" comparing with "how to AVOID escalating a child with trauma"?

For example: 

-Rules that are not required for safety should be re-assessed (what does this look like in practice?)

-Children need limits but also need to feel in control (what does this look like in practice?)

-Yelling or stern reprimand is never ok. (instead, calmly state what should happen or what is expected and ask for help in correcting if it is something that needs cleaning up or fixing OR ??????)

I have a lot of thoughts on how this looks like in practice, but would like to see/hear what others are doing or find information from those with extensive experience, education and a reputation in this field.

Ultimately, one would hope that learning about ACE's and trauma informed care would increase empathy, compassion and kindness, but some people need more practical advice and modeling. 

Thank you in advance!

Original Post

You may consider the Crisis Prevention Institute (CPI). They are very reputable in de-escalation techniques, as well as boundaries and environmental factors.

You could also look at the concept of "radical hospitality" (a faith community term) for mechanisms to create a welcoming environment, since a bulk of "de-escalation" is prevention and how we work with and approach people.

Additionally, Bruce Perry offers up a useful model: The 3 R's.  Regulate; Relate; Reason.  He interplays this with his Brain States Model, which you can find in his book "Born for Love" in the appendix.  The basic premise is that when someone is escalated, we must regulate them first (mindfulness, grounding, give space, etc.), then we can begin to relate (active listening, reflecting, etc.), and only then can we begin to reason (problem solve, accountability, etc.)

Hope this helps!

In our alternative school, we worked with Peter Smyth to have strategies to engage our youth. We have found over the years that these approaches work well with all our students and especially those with high ACE scores.

http://cwrp.ca/sites/default/f...ook2009/Chapter6.pdf

Peter has a textbook that goes more into depth in these approaches called "Working With High-Risk Youth" published in 2017.

Dan Siegel, M.D. has a principle called “Name it to tame it strategy.” He provides a demonstration on YouTube and writes about it in his book The Whole-Brain Child (2011), Thomas Gordon wrote a chapter in his book Parent Effectiveness Training (1970) titled How To Listen So Kids Will Talk to You.

Hi Heather,

We actually have developed a skills workshop (Adversity & Resilience Training), which was piloted last year with undergraduate students from Mississippi State University to inform the development of a region-specific trauma-awareness program. The training was well-received by MSU students from different majors and we adapted the training based on how each training session's outcomes and participant feedback.  Currently, we are working on implementing the training with students who are specifically entering child-serving professions. One of the main goals is raising the trainees’ awareness about core concepts in traumatic stress response, both to improve their effectiveness in their jobs, and also to reduce their risk of frustration and secondary traumatization. The actual training is a 3-hour group workshop that involves applied examples, discussion, and assisting trainees to generate an individual self-care plan. Trainees are also offered a check-in/follow-up 1-2 weeks later, which could be by phone or email survey, to assess to what extent trainees are applying their self-care plan.  Please let me know if any of the work that you do or groups with whom you work would have an interest in this type of free training ( we travel to nearby areas to provide the workshop if there are enough people interested). We would also be happy to meet to discuss the project further. Feel free to email me at lad199@msstate.edu.

Hi there,

I work in a school and am a counselor.  Some of the students that I work with have high ACE scores.  Here are some things that I do.  I am not sure if it will help or not.

1.  I don't consider the ACE scores.  Yes, they may be high but what I have noticed is that these strategies are great for all kids.  So many kids and even adults don't know how to self-regulate.

2.  For safety, all you need to do is give them space if they need it and be available to them.  I will often ask, "What do you need right now."  Even smaller kids usually know.  Sometimes it might be a granola bar or water.  Other times they may need space.  I don't leave the room.  I have fidgets, therapy putty, coloring books, word searches and the like to help them calm down so we can talk.  I also do deep breathing exercises with them if they are struggling to breathe when they calm in.  Breathing is a go-to for me because they do so well by focusing on their breath.

For other ideas on co-regulation and self-regulation, here is the resource that I use and recommend:

https://store.starr.org/Course...otional-regulation-1

3.  Consider quick interventions.  I work with them if and when they are ready.  I listen to their narrative and see if there may be a trauma theme.  Sometimes there is, sometimes there isn't.  Here is a resource for quick interventions; these can be used in the classroom even.

https://store.starr.org/Course...auma-interventions-1

I started out with the above binder but find that I like this one more:

https://store.starr.org/Course...ldren--adolescents-1

4.  As far as training staff, there are several resources and several companies that will come in and train.  I am willing to come in and train; I train clinicians and educators on trauma-informed and resilience strategies.  Let me know.  There may be other places mentioned in the other posts.  You just have to choose the company/person that fits your organization best.

Feel free to email me if you have any questions about the strategies, etc.  I am more than happy to help if I can.  I love what I do!

fryppd@gmail.com

I have attached photos of some of the resources I use.  PS.  I also attached a self-care plan for YOU because you need to take care of yourself to keep doing what you do!  Don't forget how important you are to the process!

 

 

Attachments

Dr. Bukola Ogunkua posted:

Hi Heather,

Dr. Ross Greene has a wonderful model -collaborative Proactive Solution at his website livesinabalance for this subpopulation of children. Its evidence based and has worked in many environments.  Take a look and Good luck.

Dr. B

Thank you so much. Yes, I have the book "Opening Our Arms" which details the process of implementing CPS on an inpatient child/adolescent unit with his guidance. It is tremendously helpful. I was looking for a "cheat sheet" of the policies similar to what they implemented on the unit... I suppose I could make my own.

In my experience, effectiveness of any intervention requires a paradigm shift in the thinking of the provider. The shift is from a compliance model for which there are behavioral consequences to a model that considers safety vs threat. There is a parenting program I like called "Hand in Hand Parenting" and they use a "stay listening" technique that promotes relational safety.  Most of us grew up in a compliance model of parenting. It takes a lot of reflection and practice to make the shift from our automatic response of needing compliance to an automatic response of promoting relationship. And I would say, having an Occupational Therapist who can give you ideas about how to promote regulation in the body is a must!

Christy mcmurren posted:

In my experience, effectiveness of any intervention requires a paradigm shift in the thinking of the provider. The shift is from a compliance model for which there are behavioral consequences to a model that considers safety vs threat. There is a parenting program I like called "Hand in Hand Parenting" and they use a "stay listening" technique that promotes relational safety.  Most of us grew up in a compliance model of parenting. It takes a lot of reflection and practice to make the shift from our automatic response of needing compliance to an automatic response of promoting relationship. And I would say, having an Occupational Therapist who can give you ideas about how to promote regulation in the body is a must!

Thank you Christy. I like to think that if there were policies for staff such as:

"allow the child to have tv on at night - this may be the only thing that gives comfort to this child in this scary, strange place", 

"allow child to take their time with transitions - transitions are difficult for these kids"

that staff would stop causing patient escalations.

BUT, You make a good point in that the paradigm shift ultimately needs to occur because it will be impossible to create policies to address the myriad of scenarios that may present themselves throughout a day (with children interacting with other/new children and staff each day). 

I also was not aware of the "Hand in Hand Parenting"/staylistening. I like what I'm reading .... seems to be similar to the "time-in" and other connection based suggestions recommended for kids with trauma. Thank you so much! 

Lediya Dumessa posted:

Hi Heather,

We actually have developed a skills workshop (Adversity & Resilience Training), which was piloted last year with undergraduate students from Mississippi State University to inform the development of a region-specific trauma-awareness program. The training was well-received by MSU students from different majors and we adapted the training based on how each training session's outcomes and participant feedback.  Currently, we are working on implementing the training with students who are specifically entering child-serving professions. One of the main goals is raising the trainees’ awareness about core concepts in traumatic stress response, both to improve their effectiveness in their jobs, and also to reduce their risk of frustration and secondary traumatization. The actual training is a 3-hour group workshop that involves applied examples, discussion, and assisting trainees to generate an individual self-care plan. Trainees are also offered a check-in/follow-up 1-2 weeks later, which could be by phone or email survey, to assess to what extent trainees are applying their self-care plan.  Please let me know if any of the work that you do or groups with whom you work would have an interest in this type of free training ( we travel to nearby areas to provide the workshop if there are enough people interested). We would also be happy to meet to discuss the project further. Feel free to email me at lad199@msstate.edu.

This sounds fantastic. Unfortunately, I live on the other end of the country (for the moment), but will certainly keep you and this option in mind for my connections in the south. Have you thought of creating an online training or recording one of them?

Heather Mantsch posted:
Lediya Dumessa posted:

Hi Heather,

We actually have developed a skills workshop (Adversity & Resilience Training), which was piloted last year with undergraduate students from Mississippi State University to inform the development of a region-specific trauma-awareness program. The training was well-received by MSU students from different majors and we adapted the training based on how each training session's outcomes and participant feedback.  Currently, we are working on implementing the training with students who are specifically entering child-serving professions. One of the main goals is raising the trainees’ awareness about core concepts in traumatic stress response, both to improve their effectiveness in their jobs, and also to reduce their risk of frustration and secondary traumatization. The actual training is a 3-hour group workshop that involves applied examples, discussion, and assisting trainees to generate an individual self-care plan. Trainees are also offered a check-in/follow-up 1-2 weeks later, which could be by phone or email survey, to assess to what extent trainees are applying their self-care plan.  Please let me know if any of the work that you do or groups with whom you work would have an interest in this type of free training ( we travel to nearby areas to provide the workshop if there are enough people interested). We would also be happy to meet to discuss the project further. Feel free to email me at lad199@msstate.edu.

This sounds fantastic. Unfortunately, I live on the other end of the country (for the moment), but will certainly keep you and this option in mind for my connections in the south. Have you thought of creating an online training or recording one of them?

I have thought about that but I am trying to figure out how to incorporate the interactive aspect of the training in a web platform. Participants are expected to interact in small groups for most of the learning activities. 

Jane Stevens (ACEs Connection staff) posted:

Lediya: Does the training include information about ACEs and resilience science, including having the participants do their own ACEs and resilience questionnaires?

Yes, it does. It becomes especially important when we discuss secondary traumatization and explore risk and protective factors. 

 

PACE as part of DDP.  HERE you will find an interview with Kim Golding and Dan Hughes about using PACE

"Each component has a special contribution but only together will PACE work to its maximum.  

Playfulness = brings the other components to life

Curiosity = the mind: contributing to thinking and understanding.  

Empathy = the heart: focused around feeling.  

Acceptance = the key that allows mind and heart to work together. " Kim Golding (2018)

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