Transitions, Change and Loss

chaos and change

This time last year I’d not long arrived in Kansas and it’s been a long time since my last blog, I just want you all to know that this blog site is far from finished as there are many more reflections, topics and visits I want to share with you all.  Obviously I’m home now and have been on Australian soil for some time.  The title of this blog which was already next in line for publication is also true and reflective of why it’s been so long between posts… transitions, change and loss, but more about that later on…

Visiting Mount Saint Vincent Home I spent time reflecting on the impact of change, loss and transition.  On my first day with them, the Clinical Director Kirk Ward, advised me that they were facing all sorts of changes, transitions and loss.  It was coming up to the end of the school year and children were graduating out of the school, out of the program or going off on summer break for the day treatment clients, there had been some staff turnover resulting in a lot of retraining of new staff and to top it off the County had started to refer a slightly different demographic of child.

As a result of all of this, staff and clients were struggling.  Emotions were running higher, people more reactive and that week staff and I often reflected on the struggle they faced given old strategies were not working as successfully as they had been.  When we are faced with challenges as such it’s not surprising that we think it’s time to try something new or change things up.  We can find ourselves feeling stressed and anxious about the seemingly little impact we are making.  We know from my prior blogs and the work of Dr Perry and Dr Siegel that the more stressed we become the more reactive we become.  The more reactive we become the less we are able to really think creatively and reflectively about a situation.  This is a universal human phenomenon, not only does it happen to our troubled and traumatised clients, but it happens for every one of us.

When we are stressed and reactive, the danger in changing it up or trying something new is further increasing the uncertainty, predictability and routine and in turn further exacerbating stress levels and reactivity of all involved.  I’m not saying that we should always soldier on and hold firm to our way of operating, not in the least as it could very well be the way we are doing things is problematic or part of the issue.  What I am saying though is that we need to take space, calm ourselves so to really be able to think more reflectively and creatively about what we are doing, and how we move forward in making a difference in the lives of others.

My time with Mount Saint Vincent home highlighted again the absolute importance of staff being emotionally regulated and emotionally safe within themselves.  The ability to take time as a staffing group, reflect and seek supervision and manage ourselves is paramount in the treatment, care and healing of trauma. I was impressed with the clinical, residential and educational team at Mount Saint Vincent and their ability to support children and young people at times of emotional and behavioural escalation.  Staff would come away from these situations and interactions concerned and worried for the wellbeing of the children, the success of their interventions, in turn requiring regulation and support from each other and their management.   However when engaged and interacting with the young people in their program and the emotional and behavioural distress these kids demonstrated, the Mount Saint Vincent staff were focussed, centred, and on the whole all about co regulating these kids.  I witnessed clever use of movement, music, and sensory input to keep young people regulated and/or regulate them.

The challenges facing Mount Saint Vincent during my visit could easily have derailed them, left them focussing on new and different strategies. I’m not saying as a program emotions weren’t running high and the staffing group were certainly concerned, but I watched them rally together and co regulate each other so as to not to let the transitions, chaos and loss their program was experiencing result in organisational reactivity, but instead continue in the provision of safe, predictable and thoughtful care to their clients.

Advertisements

Mount Saint Vincent Home

IMG_7207

Mount Saint Vincent Home

In stunning Denver Colorado, surrounded by snow capped mountain ranges, I spent the week of 2nd to 6th June 2014, at Mount Saint Vincent Home. This was my second visit to Mount Saint Vincent in as many years and approaching the gateway on my first day, for the first time in weeks, I felt a sense of familiarity and connection.

Mount Saint Vincent Home is located  just a short bus ride from downtown Denver and is situated on a 16 acre property, offering a running track, football field, multiple playgrounds and a swimming pool.  Founded by the Sisters of Charity Leavenworth Kansas in 1883, Mount Saint Vincent had it’s origins as an orphanage.  With social change and the move away from orphanage based care to out of home foster care and residential treatment, Mount Saint Vincent moved with the times and now prides itself on being a treatment center for children ages 3 – 13 years.

IMG_7209              IMG_7211

Mount Saint Vincent specializes in treatment of children who have suffered abuse, neglect, trauma and/or mental illness, offering services with a child-focused but family centered approach acknowledging the importance of the family in a child’s healing and recovery.  Referrals to Mount Saint Vincent Home come largely from the County Human Services Department of Child Protection, School districts and other mental health services.

 Mount Saint Vincent offers a variety of services to clients including:

  • A 36 bed residential treatment program consisting of 3 cottages each housing 12 children
  • Individualised day treatment programs for up to 55 children
  • In home treatment and follow up services
  • K – 8 School program that affords children developmentally matched education rather than chronological determined education.
  • An early learning child care program

All of the services offered by Mount Saint Vincent operate under their treatment philosophy that focuses on the regulation of a child rather than compliance; that care is developmentally appropriate and matched and that they afford a child an environment of safety that allows children to ‘try on’ and develop positive relationships.

Mount Saint Vincent has some very innovative service elements including:

  • Creative Arts Therapy team who provide music therapy, dance/movement therapy and art therapy;
  • An animal assisted therapy program onsite using dogs and guinea pigs and offsite using horses
  • An onsite volunteer tactile therapy program offering clothed massage, yoga, meditation/mindfulness, bach flower remedies and reiki for example.
  • Individual Therapy
  • EMDR
  • Swimming
  • Bike Riding
  • Gym
  • Group Therapy Programs including Lego Group and Psychodrama
  • Sensory tool boxes for each child and program
  • The school program has a dedicated mental health clinician to support the inclusion of developmentally matched regulatory activities for the students so to assist in maintaining a state of regulation, coupled with an intervention team able to take students in the moment and provide co-regulation for children to assist them back into classroom learning activities.msv swimming pool

Like everywhere else I had visited up to this point, the staff at Mount Saint Vincent Home are dedicated, passionate and committed to making a difference in the lives of children.  I watched and listened to staff talk openly about their love of the work, the challenges it brings and most importantly the changes they feel privileged to be part of in the journey of these children.  Like all services operating with the public health system there were clearly challenges that the programs were having to manage and deal with, but that aside the Mount Saint Vincent team not unlike Sandhill, Cal Farley’s, Sumner Mental Health and Alexander Youth Network were thoughtful, authentic and so very respectful in their work with children and families.

In 2013 Mount Saint Vincent Home’s Creative Arts Therapy team published an awesome resource called, “Doodles, Dances and Ditties: A Somatosensory Handbook”.  This book is a collection of creative, sensory and movement based activities you can use to regulate children.   You can get it on their website http://www.msvhome.org or via amazon – where I see it now comes in a Kindle version.

somatosensory-handbook

Greater and Less Than – Lessons in learning Through Movement

Somatosensory activities and education, this is a topic close to my heart.

GREATER THAN

For a little over two years now I have been consultant and then project manager of a pilot project in Australia looking at the inclusion of patterned, repetitive somatosensory activities in primary school classes.

So often we hear teachers and educators ask about strategies for managing traumatised children and their resultant behaviours in the classroom.   All too often in my clinical practice teachers have looked at me, perplexed when I suggested they could include somatosensory activities into curriculum.  In fact I had almost got to the point that I believed this maybe wasn’t achievable and that I had to enlist an education champion to help me articulate my meaning more clearly.  The latter may still be the case, but in Charlotte NC I had the professionally heart warming experience of watching a relatively new teacher to the Alexander Youth Network (AYN) Psychiatric Residential Treatment Facility (PRTF) School do exactly what I’ve been talking about for years.

The PRTF School do what most neurodevelopmentally and “trauma” informed education programs do, by providing frequent “brain breaks” for their children.  Essentially this is where they step down from academic learning and engage in some form of somatosensory activity such as playing outside, water play, sand play, play doh, calming corners with sofas, bean bags, blankets and soft toys etc. They do this routinely, repetitively and frequently – in fact given the arousal and dysregulation of the children AYN sees in its PRTF, these breaks seemed to work best when applied every 10 or so minutes.  Having access to a staff member dedicated to leading these breaks and co-regulating the children in between them worked a treat as well.   All of this impressed me, but what really stood out was this one teacher who found a way to incorporate somatosensory activities into curriculum based learning!IMG_7140

You know maths and mathematical concepts is a difficult gig at any school, let alone a classroom of children struggling with emotional, social and behavioural difficulties.  So when this teacher came in to teach the concepts of less than and greater than I thought to myself this will be interesting.

Immediately on entry into the room, she invited the children to the front of the class and had them all stand or sit around her as they preferred. She didn’t get flustered or annoyed when children came and went from her teaching space and in doing so, actually appeared to manage keeping them around her and in the vicinity of learning for the whole exercise.  Each child was given a piece of paper containing a number, each child read their number out aloud.  The greater than symbol was drawn on the board and there was minimal question and answer time to ensure that everyone understood the concept of the greater than symbol.

GreaterTHanLessThan

Less than & Greater than

Then engaging the students in an activity based process, moving them around she asked them two by two (based on those most engaged in the moment) to identify their number and stand either side of her – as she held the greater than symbol.  The student’s task – to put themselves in the right spot – who’s number was greater than the other.  Each student excitedly took their turn and much celebration was had as each pair got it right.  In addition to the movement which we know provides sensory and motor based regulation to the lower parts of the brain, this teacher relied on her voice to ensure up regulation and down regulation in the moment and what was most impressive was that she made the lesson punchy and brief.  In and out in no more than 15  minutes and a key mathematical concept was taught and grasped by these children.

Can somatosensory activity be incorporated into curriculum?

I think it can.  It might take a bit of creativity and planning, and maybe even a shift in basic education philosophy about how to teach children, but I still think this is very achievable.

Alexander Youth Network

 

AYNIMG_7171

In the last week of May I journeyed to beautiful Charlotte in North Carolina to spend the week with my colleagues at Alexander Youth Network (AYN).  AYN’s main campus or headquarters, and the home of it’s Psychiatric Residential Treatment Facility (PRTF) and one of their Day Treatment Programs, is located on a picturesque 60 acre property with buildings nestled in a woodland area with open grounds and recreation areas for their clients.  This campus also houses facilities including a gym, indoor swimming pool and cafeteria.

AYN is a non profit community based organisation receiving funding from fees for services (medicaid, insurance and the like) as well as contributions from individuals, corporations, foundations and government agencies.  AYN serves children ages 5 to 18, who are referred from hospitals, physicians, parents, schools and from state and county organisations such as department of social services and juvenile justice.  AYN serve over 7000 children each year.

IMG_7175

Surrounding woodlands

IMG_7176

Woodland Trail

IMG_7179

Deep in the woodland trail

IMG_7180

Alexander Youth Network Grounds

IMG_7167

Onsite Playgrounds

AYN provide an array of mental health treatment for serious emotional and behavioural difficulities including: diagnostic and outpatient services, community based programs, multisytemic day therapy, therapeutic foster care and an onsite, 36 bed psychiatric residential treatment facility.  The idea being that children, young people and families accessing their services can move from service to service with established working relationships of trust within the one organisation.  Added to this is the strong grounding the staff have in child development, trauma, attachment and neurodevelopment as a core component of their orientation and ongoing training.

AYN array diagrams 2012

It was a contrast to go from services that have decisively removed themselves from the medicaid system or appear to have more flexibility than is given from the public health system and as a result appear better funded and able to provide longer term intervention for their clients.  At AYN the financial resourcing struggle of service delivery was evident in comparison to the private services I had visited.  While the AYN staff were at times a bit despondent about this, I was nonetheless impressed at what they were offering and able to offer.  There is something about not having resources at your fingertips that can contribute to a creative resourcefulness and the team at AYN do this well.  In fact when it comes to neurodevelopmentally informed and respectful interventions AYN have lots to offer:

  • Individual therapy including EMDR, play therapy, sand tray and an awesome play room furnished largely by donation and financial grants
  • Art Therapy including pottery and their very own kiln
  • A ropes course for adventure therapy
  • A Labyrinth
  • Occupational Therapy with a motor and sensory furnished room including a swing and tunnels.
  • Physical Therapy
  • Reiki
  • Swimming
  • Vegetable and flower bed gardens and gardening program
  • Woodland walking trails
  • Playgrounds
  • Gym
  • Developmentally matched classrooms that afford children regular (every 10 – 15 mins) brain breaks and recreation
  • Classrooms that are highly sensory and provide calming, alerting and regulating activities including rocking chairs, bean bags, chill out areas and such
  • Bike program whereby each PRTF child has their own bike.

 

IMG_7148

Art Therapy room including Kiln

IMG_7147

Play Therapy Room

IMG_7146

Play Therapy equipment

IMG_7145

Play Therapy Room – role play and dress ups

IMG_7144

Play Therapy puppets

IMG_7143

Play Therapy sand tray and figures

IMG_7142

Occupational Therapy room

IMG_7141

Developmentally matched classrooms

IMG_7140

Chill out area in classroom

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Of more concern to me than their financial resourcing issues, were the systemic restrictions being placed on AYN in relation to the length of service delivery they are able to offer their clients.  The public health system funding children coming into the PRTF, those clients with the most serious of emotional and behavioural disturbances, are placing pressure on the service to treat and “repair” these children in 3 months.  The years of clinical practice, much of the theory out there, and my more recent acquisition of neurodevelopment and trauma expertise have taught me that it takes more than 3 months to form a trusting relationship with some of these kids.

 And we know that it is only in the context of such trusting relationships that these children can being to heal.

So with that knowledge I take my hat off to my colleagues at AYN and their ability to work within a public health system that places considerable restraint on their ability to really heal these kids.  The staff I met talked openly of the 30 day review process they have to undertake to retain or regain funding for ongoing work and the associated challenges. Despite this, the passion and commitment for their work and the children and families they serve sees them rise daily to these challenges and provide meaningful connections and healing opportunities for North Carolina’s more vulnerable citizens.

 

Adventure Therapy


IMG_7001

Think about a time when you took a risk, stepped out of your comfort zone, challenged yourself!

Scary right?

How did it feel when you succeeded in spite of your fear?

Did it feel good?

I bet you felt proud!

And you know what? If you reflect on that experience long enough and with a level of insight you will notice the skills you learnt or enhanced and the ways in which you coped and managed your anxiety.

Now think about a world where you never feel safe or secure.  A world full of fear and distrust. This is the life of the traumatised child. An existence where safety is stolen and experience leaves templates of mistrust.

Imagine a situation whereby the traumatised child can experience success and a sense of accomplishment in the context of relationships that demonstrate “in the moment” trust. Adventure based therapy like kayaking, ropes courses, wilderness adventure programs and the like can afford traumatised young people this opportunity.

The magic in adventure based therapy is in weaving together into one activity the following developmental and healing opportunities. Participants are faced with activities that challenge and extend them at a skill level, but are absolutely achievable.  What’s more many of these activities involve fear, risk taking and induce anxiety, but are provided in a way that they can be scaffolded for success and achievement. So in a direct experiential way the individual participant has to draw on their competencies, explore problems and difficulties to develop solutions and fundamentally achieve and succeed in the face of trauma. All of this is done in the context of a relationship that implicitly enforces trust and as a result of individual success provides a positive experience of helpful, supportive and trusting relationships.

I observed a kayaking adventure therapy session with a group of adolescent boys at Cal Farley’s. These young men were preparing for an open water kayaking trip the following week and were practicing the skills of rescue post capsizing.

Fascinating in this observation was watching these young men anxiously anticipate the notion of flipping their kayak and deliberately capsizing themselves. Staff engaged in a lot of cognitive discussion based reassurance, what was awesome was that this was done as they kayaked up and down the length of the pond, back and forth, repetitively paddling and talking. This allowed for somatosensory regulation of anxiety, or quietening down of the dysregulation caused by the anxiety, so that the discussion based reassurance and coaching could be heard and internalised by the young men.

Then in pairs – either paired with an intervention therapist, or in peer pairings with one more skilled peer as mentor for the other, these guys practiced capsizing their boats and rescuing each other. There was ample time provided to allow them to work up to and get themselves emotionally and cognitively ready to tip their kayaks, including repeat demonstrations from intervention staff and more competent peers, paddling laps and step by step instructions and reassurance.

Eventually one by one, these young men tipped their kayaks and capsized themselves, were successfully rescued and able to get back into their kayaks from in the water in the middle of the pond and fist pumped the air with the experience of success.

These lads were able to experience in the moment moderate levels of fear and anxiety activation paired with somatosensory regulation and the experience of relational trust all of which culminated in the experience of success. What was really nice was the processing or discussions that took place together about the experience and the learning for the young men after their initial success – talking about what it was like, how it felt, what they learnt about themselves, about their relationship with their partner – some really nice “talk based” therapeutic work attached to a really cool direct experiential learning opportunity.

Dr Perry talks about the importance of repetition to strengthen the new neural pathways and connections that are made with these experiences and you know repetition was not an issue after that first capsize and recovery – these guys just kept doing it over and over and over again.  I could see the increase in confidence right there in the moment by moment repeat of the activity.

IMG_7002

Rhythmic Riding

IMG_7033

Mindfulness connection

Rhythmic Riding is an equine based therapeutic approach that is one part of the Trauma Focussed Equine Assisted Psychotherapy (TF-EAP) established by Tim & Bettina Jobe from Natural Lifemanship.  In short “TF-EAP utilizes the rhythmic, patterned, repetitive, bilateral movement inherent in riding a horse to increase and reorganize the connections in the brain, thereby increasing the brain’s ability for emotion and impulse control. The horse is able to provide the rhythm required to effectively heal the traumatized brain until the client is able to independently provide that rhythm. In effect, clients passively learn to self-regulate through the use of the rhythmic, patterned, repetitive movement of the horse.” Spirit Reins Website.

Music is often incorporated into the mounted work allowing the horse and rider to move in time to and with the rhythm of the music, again requiring and providing a medium to scaffold regulation and connection between the rider and horse.

I had the opportunity to watch a Rhythmic Riding session at Cal Farley’s.  The session observed was with a group of adolescent girls who had been engaged in TF-EAP work for the whole school year.  As the session I observed was the last for this group for the school year, the focus of the group was less on riding to the rhythm but rather the creation of a mindful connection between rider and horse.

Each participant had their own horse with whom they had been working the whole year, hence I was observing well established rider/horse relationships.  In the spirit of a mindful connection with the animal, the girls rode bareback and the session commenced with a mounted meditation to regulate and ground participants.   Then cue music and the riders and horses were left to regulate and re-organise neural brain networks via the riding or horseback activity. Participants chose to either ride to the rhythm, lie across, over or back on their horse, or even attempt to stand on the back of the horse.  Clinical and Equine Intervention staff observe, comment and process experiences with participants as regulatory and relational successes and difficulties between horse and rider emerge.

Now as I said, this group had been active for a full school year – so the girls, in most cases, had established enough self regulatory capacity that the rhythm provided by the horse merely provided a value add.  This was not the case for all participants however.  Fascinating for me was the experience of being witness to one young woman who arrived to the group clearly dysregulated – slamming the car door, storming past those of us milling about and stomping into the yard to collect her horse.  Naturally the process of getting her horse was complicated by her emotional presentation, her horse on seeing and sensing her turned and moved away from her.

Despite eventually haltering her horse and mounting him bareback, it was obvious the connection between the two was tenuous, the horses ears were often back, his eyes looked a little wild and big and his rider was really struggling to control him.  The mental health clinician in the group reflected to this young woman what she was observing, however this girl’s dysregulation was such that she wasn’t in the thinking and hearing part of her brain – instead she explained the relationship with the horse away as the result of her not liking or being able to ride as well bareback.

IMG_7032

The trusted connection

IMG_7036

Riding with Rhythm

 

 

 

 

 

 

 

The session was a real struggle for this lass, while the other participants were riding in time to the rhythm, clearly demonstrating their self regulation and ability to connect with and trust their horse, she just couldn’t get the connection. In fact watching on I could just tell that the horse was waiting for the right moment to assist her off his back.

That moment came not long after the session commenced.  Instead of focussing on herself and taking care of her own emotions, the participant, watching what others were doing and becoming increasingly frustrated at her inability to manage herself and her ride, decided to try and throw her leg over so as to ride the horse side on.  Sensing the movement in balance, the horse took quick action and dispensed of her from his back.  From there the session quickly took a turn for worse and despite the attempts of very skilled clinical and equine support staff, she was unable to remount the horse or develop insight into her emotional state and it’s impact on the situation at hand.

In hindsight, which is always 20-20, maybe on arrival staff could have suggested that today wasn’t the day to participate, but then who knows, it could have gone the other way, she could have got on the back of that majestic animal and the rhythm and movement of the horse could have been enough to start to regulate her and afford her success in the experience.  It’s a tough call and it just highlighted to me the absolute importance of the attuned relationship that knows and gets the young person so as to be better placed to make that call.  Unfortunately for this young woman that key relationship wasn’t present that day.

While this is a reflection of a challenging Rhythmic Riding session – it was clear to me the value of such activity and from my experience on horseback previously discussed I can see how this activity provides the necessary patterned, repetitive and rhythmic activity for enhanced regulation.

 

 

 

 

Cal Farley’s Boys Ranch: A Shirttail to Hang Onto!

IMG_7083

I had the absolute privilege of spending the week of 19th – 23rd of May in Amarillo Texas on Ranch at Cal Farley’s residential treatment centre.  It is hard to know where to start when describing Cal Farley’s and my experience there. One blog is not going to even remotely capture the breadth of what the service offers.  First and foremost I have to acknowledge the absolute generosity of the Cal Farley’s team from their Chief Operating Officer, Clinicians, Training team, House Parents and well basically everyone on the property. My visit was catered for most generously and my schedule was very busy – largely because there was just SO much to see and in the spirit of my Fellowship,  I didn’t want to miss a thing.

Cal Farley’s is a one of a kind service, of this I’m pretty confident.  It is one of America’s largest privately-funded child and family service providers specializing in both residential and community-based services at no cost to the families of children in their care.

Yes you read me right, NO COST!

The founder of the Ranch, Cal Farley was quite a visionary for his time and in 1961, he established the Cal Farley’s Boys Ranch Foundation. Contributions from the Ranch’s friends and supporters provide approximately 30 – 40% of the funds required to meet total annual operating expenditures. Through the foresight of Cal Farley and his Board of Directors, the remaining funds required to operate are available through the Cal Farley’s Boys Ranch Foundation.

IMG_7055

Cal Farley Statue

Cal Farley’s operates like a small town – in fact it’s almost big enough to be a small town.  It hosts a chapel, fire station, it’s own bank and post office services, has it’s own independent school district, complete with administration, including their own superintendent, elementary, middle, and high school.  An activity centre, gym, pool, football field, indoor horse riding arena, rodeo stadium, athletics field, stores and the communal dining hall.  Many of the staff live on site at the Ranch, which in addition to the staff homes, hosts 28 residential homes each of which caters up to 12 children and young people.  At capacity Cal Farley’s can have up to 260 children and young people at a time.  Residential homes are staffed by 2 sets of house parents, the lead house parents and relief house parents. The residential homes as you can see from the photos are all designed similarly and provide a very homely feel.

BR girls home exterior

Example of Cal Farley BR home

 

BR girls kitchen no kids

Kitchen/Dining

 

BR grils home living room

Living Room

 

BR girls bedroom

Bedroom

Neurodevelopmentally informed interventions/activities included (and I will probably leave some out):

  • Individual Therapy
  • Neurofeedback
  • Play Therapy
  • Art Therapy
  • AAT – largely equine based including colt and filly training and Rhythmic Riding
  • EMDR
  • Adventure Therapies – Ropes Courses, Kayaking, Trail Rides, Challenge course
  • Rocket Club
  • Computer Lab
  • Woodwork Studio
  • Robot and other electronics programs
  • Rodeo skills
  • Drumming
  • Archery
  • Gardening/Agriculture
  • Agriculture workshop – where they built a trailer for example so that they could transport their livestock to agricultural shows.
  • Mentoring of younger children by older children
  • Capacity for vocational training and part time employment

All of this is embedded in a community where relationships serve as the key to success.  As I wandered around Cal Farley’s I had to remind myself that this was a service for children and young people who had mental health, emotional and behavioural problems, because often what I saw and experienced seemed just like any ordinary community.  The importance of relationships whereby the kids were positively supported, contained and nurtured by multiple adults in their daily experiences was evident in the way the children and young people conducted themselves in the community. I’m not saying that there were no challenges, as there were, but on the whole the adults in this community do a wonderful job of creating a relationally rich environment filled with amazing activities, “interventions” and opportunities.

If you work in the child and welfare sector and you ever find yourself in Amarillo Texas – look Cal Farley’s up and see if you can visit – it’s nothing short of impressive and it’s folk are just downright good people who are absolutely and only in this for the best outcomes for kids.

IMG_7001

Kayaking Adventure Therapy Session

 

IMG_7002

Practicing capsizing and rescue and the experience thereof.

 

Robot built in rocket/robotics/electronics/computing lab

Robot built in rocket/robotics/electronics/ computing lab

 

IMG_7017

Pre therapy jigsaw pieces – goals and wishes

 

IMG_7016

Therapy Closure Jigsaw Pieces – outcomes

The Impact of Fear: My Firsthand Experience.

It has been a while since my last entry and I apologise for that.  The last 3 weeks have been so very busy and I became a little unwell (nothing too serious – just allergies) so that’s put me a little behind on the documentation of reflections. I can’t help but wonder however if some of the delay in getting another story out, was because I’m a stickler for chronology and really wanted to talk about & reflect on an experience I had in Albuquerque, the night before heading to Cal Farley’s in Texas.  The difficulty being that I was auditory witness to what sounded like a horrible domestic violence incident in my hotel that left me nothing short of scared if I’m to be honest.  I think it’s taken me time to process and think about that experience and how to reflect upon and turn it into something I have learnt from, but can also help others to learn from.images-3

In all the training and staffings I have done as part of my NMT certification with the ChildTrauma Academy I have a pretty good understanding of Dr Perry’s notion of the arousal continuum and the impact of increasing levels of stress and fear on the way in which our brain operates.  I even use examples of my own stressful situations to illustrate the arousal continuum when I teach and train.

Arousal continuum, Chelle what are you talking about? In short, there is a universal human phenomenon whereby activation of the stress response system or the experience of stress or threat, moves us along a continuum of arousal from calm to alert to alarm to fearful to terrified.  Now as Dr Perry often says, in today’s world it’s quite rare to achieve a state of calm and for most of us we operate on a day to day basis in the mental state of alert.  At each different state of arousal and because all of our functioning is brain mediated, there is a different part of the brain that is most active.

So when we are in a state of calm or alert this is when we have access to our cortex – the thinking and problem solving part of our brain.  We can recall information, manipulate thoughts and come up with solutions.  Moving up the arousal continuum to a state of alarm, fear and then terror sequentially reduces the access we have to our cortex.  Essentially the more stressed or afraid we become the less access we have to our thinking brain and our ability to problem solve and think clearly. Dan Seigel describes this here in his hand brain model https://www.youtube.com/watch?v=DD-lfP1FBFk when he talks about rising emotions leading us to flip our lids.

Unfortunately on the evening of the 17th of May, I was staying in Albuquerque, where after tucking up in bed, excited about the week ahead of me I could hear very clearly the screams and pleas for help from a woman.  Coupling these terrifying screams were loud bangs, the sounds of things being thrown around, threatening yelling from a male voice and then the sound of skin hitting skin.  It was clear that somewhere very close to me a woman was being assaulted and needed assistance.

Now if I were in my own country and feeling less isolated I may have had a different response, but what happened that night was that I became overwhelmed with fear.  Here I was a woman, alone, in another country and not having immediate access to the things that make me feel safe – my husband or my family.  I could feel my heart racing and I found myself almost paralysed with fear.  I couldn’t move, didn’t want to move.  Initially I thought about the notion of calling 911, but the fear of being heard or drawing attention to myself was so great and the possible threat to my own safety took hold.  Instead I found myself lying completely still, like a mouse not making a sound and jumping on Facebook messenger to connect with my safe base – my husband. Essentially in that moment I “flipped my lid”.

Not only did I have the first hand experience of the arousal continuum where I found myself unable to do anything but focus on what I needed to do for my own safety.  I couldn’t think, sort out solutions or even contemplate what I might need or be able to do to assist this poor woman being assaulted.  My cortex, the thinking part of my brain was shut down and the survival parts of my brain in full force – keeping me safe.  I didn’t sleep a wink that night, not even after the three hour ordeal settled, I was hypervigilantly on guard for additional threat.

The next morning, when I had resumed a baseline level of alert arousal and my cortex accessible again, I was struck by my experience of shame.  I didn’t let this consume me – reminding myself of neurobiology and the response I had as being natural, but nonetheless for a short period of time, with emerging access to my cortex, I felt bad for not having acted to protect that woman.  For those concerned, someone who wasn’t as scared was able to seek help for the woman and her abusive partner was arrested and taken away.

In the time that has passed since then however, I have spent a lot of time thinking about being a child in another room of the house, while those you love are being hurt and/or hurting each other.  I am a grown adult, I’ve had a really solid upbringing and I have relative security in my attachment and relationships, I had no personal connection to those individuals being violent and yet I still found myself terrified and immobilised by fear.  Imagine being a child, vulnerable, alone, scared and unable to do anything to help your loved one from being hurt.

I’ve heard all too often from parents, “the kids don’t know or see it”, “they are in another room”, “our fighting (aka domestic violence) doesn’t have an impact on them”.  I have always challenged these notions and beliefs of parents, knowing that this is nothing short of a fallacy.  Of course kids know and hear.  What concerns me more now though as I reflect on my experience in Albuquerque, is that when you can hear domestic violence and not see it, it might be just as, if not more scary than actually witnessing it.  When it is not in front of you and you “flip your lid”, your imagination about what is happening or what might happen can take hold, exacerbating your fear.

What’s more, if you have grown up in an environment of such violence and aggression between those you love, you are more likely to have an overactive stress response and hence be more alert to the cues of aggression and violence and more reactive to them.  The witnessing, be that visual or just auditory, will only serve to reinforce and exacerbate that overreactive stress response and possible resultant shame for not being able to help due to fear.

My experience has left me further adamant of the fact that hearing and not seeing domestic violence is absolutely in NO way less frightening or  damaging to children, than being visual witness to it!!

An Excuse for New Boots!

1381726_10154158690375626_7062570073222167917_n

The Sandhill Trail Ride with Acacia Riding Adventures: San Lorenzo Canyon New Mexico.

I’m always looking for a reason to add to my collection of cowboy boots. Now there’s more to this story and while this blog is really about neurodevelopmentally informed interventions and I’ll get there in this one, just let me set the scene a little.

There I was in Denver – a little over a week of being in the States and well I hadn’t really packed for a cold snap.  In fact, despite what seemed to be seamless organisation in relation to my packing – I really didn’t consider or even think about researching the spring weather conditions for places like Denver, Banff and Calgary.  So after a 102/38 degree day in Wichita, I head to Denver – where it was a crisp 63/17 degrees and my footwear is pretty much a pair of canvas Toms and two pair of open toe summer sandals!  This coupled with a Facebook post from a dear colleague in Calgary showing their spring snowfall (looks like our winter on the ski slopes) resulted in a rapid move up the arousal continuum to a state of mild stress activation.  “Will it be like that when I get there in June ?” “I’ve only canvas and open toed shoes, hello frostbite…”  and then as I engaged some self regulation, calmed and regained access to my thinking brain, came the problem solving “…Hello Boots!” On that very same day I get an email from Cal Farley’s to let me know that I’d be doing a trail ride – on a horse.  It is meant to be and now the deal is sealed, new boots for me!

I haven’t ridden for over 23 years, so the idea of getting back on a horse caused me some apprehension, however in the last two weeks I’ve now had opportunity to do two trail rides, firstly with Sandhill in one of the most picturesque canyons, secondly at Cal Farley’s around the treatment centre campus.  I’d love to be able to tell you that it’s just like riding a bike and one of my observers suggested to me that it looked just like that – on the back of that animal although – that’s not how it felt.

The mere idea of getting back up on horseback was in and of itself anxiety provoking for me.  I’m not a lover of heights, and well I’ve put on a bit of weight since I was a kid riding and being a lover of animals was quite concerned about my horse having to bear my weight.  On both rides what was fantastic was the reassurance from experienced horse handlers that both of my horses were more than capable of carrying me and doing so safely.  The other thing that I loved about both Dacodah and David was their ability to scaffold a feeling of competence and in turn begin the process of co-regulation of my anxiety.  I couldn’t help but think about what this experience would be like for a child or young person so used to negative human interaction, to have both an animal and its handler working together in the most natural of ways and leaving you feeling nothing but important and what’s more, even with skill.

me on horse

Cal Farley’s Trail Ride

Once on the back of the horse, there was no going back on either occasion.  In fact on the first ride there may not have been any going forward either had the horse not clearly communicated to me that I was anxious and she was not enjoying that experience.  My horse kept looking at me and snorting almost with derision.  Initially this did nothing to quell my anxiety and left me thinking all sort of negative self talk about my weight and the horse’s experience of it.  Not unlike the float tank, it was interesting to notice the thought processes that emerged about myself and the importance of sorting that stuff out or at the very least challenging it, for the success of the experience.

Dacodah and David on both occasions reminded me that the horse, being a prey animal, have an overactive stress response system – not unlike the abused and traumatised kids we work with and that they are finely attuned to threat.  Sensing my anxiety both the horses had started to become a bit “on edge” really just feeding off my own anxiety.  So in order to calm them, I had to calm myself.  The horse like the frightened and traumatised child, at the heart of it, really wants a calm, regulated, nice, nurturing, rewarding rider who can take control and be respectful of them.  The more I was able to manage my anxiety and relax into the animal while at the same time retain a sense of confident control the more attuned the horse and I became, the more responsive they were to me and the more confident and skilled I felt.

I can only imagine living a life where you feel out of control all the time and then having an experience like this where you have capacity to control the success of your interaction.  Yeah sure we could argue that our kids have capacity to control the success of their interactions with us all the time, but the immediate feedback from the animal that is without judgement, mixed messages and completely non verbal is so very powerful.  If you don’t get yourself sorted and regulated then your horse is going to do what it needs to take care of itself. There’s not going to be responsivity, let alone the chance of working together.   I watched young people who got this and were able to, in the moment, do what they needed to do to have a successful and pleasant ride with their horse.  I also watched other young people struggle to manage themselves, then end up more dysregulated when their horse wouldn’t do what they wanted, making the horse even more non compliant and not interested in the process.  I could absolutely see the benefit for in the moment reflection and wondering about the experience with the kids and the power of experiential learning when observations and interactions could be reflected on and internalised.  Aside from the physical sensory experience of riding there is definitely something in this equine based work!!

IMG_6917

Not so new anymore

IMG_6907

San Lorenzo Canyon

IMG_6909

On the trail

IMG_6910

A Self Portrait on horseback

IMG_6911

Canyon Pictures

IMG_6913

More of the Canyon

IMG_6902

Pictures do not capture the beauty of this place

IMG_6904

Just like in the movies

IMG_6905

Views from a top San Lorenzo Canyon

 

 

 

 

Sensory Deprivation and Relaxation: The experience of a Floatation Tank.

 IMG_6876

Have you heard of a Floatation Tank or the use of floating for sensory deprivation and/or relaxation?

I’m not going to go into detail about the Floatation Tank and what it is, the rationale for its use and some of the benefits that have been derived from its use.  Instead for all of that information you can follow this link http://en.wikipedia.org/wiki/Isolation_tank and read all about it on Wikepedia.

Suffice to say that I’d not heard much about the floatation tank or the experience of sensory deprivation using this device before.  No I haven’t seen Altered States, although I believe that is now on the must watch list given the number of times I’ve since been asked.  Enough of this chatter, let me tell you about my experience of the Floatation Tank!!

On arrival at Sandhill and during my initial tour, I was presented with the float tank and the offer to go in it.  I was initially quite apprehensive and said no.  However after a wise conversation and keen reminder that there is a difference between theoretically understanding and experientially understanding something, coupled with some self reflection about really learning and understanding neurodevelopmentally informed interventions,  I agreed to give it a go.

Now I get a bit claustrophobic! I do not like enclosed spaces or the sensation that I’m trapped or cornered.  Needless to say my stress response was a somewhat active and my initial heart rate was a little elevated after 1. getting into my bathers and coming out in front of a relative stranger and 2. considering the idea of climbing into the contraption pictured above and knowing the door was going to be closed and there wasn’t going to be much light.  In fact I think from memory my heart rate was somewhere in the high 90s. My blood pressure was also taken, it was pretty normal, if anything a bit on the low side but not clinically low.

So the time had come and in I climbed, laid my body down in the epsom salted water, put my head back and began to float.  The door was closed and the space became dark.  I’d like to tell you that I quickly came to feeling relaxed, but that’d would be a lie.  My first 5 minutes (well it felt like 5 minutes) was spent just trying to calm my heart rate, which upon closing the door had cleared passed the 100 barrier – I could feel it in my chest.  I found myself wondering how the children and young people we see at Take Two, with significant abuse and trauma histories would go in this situation? I’m still not sure I have an answer on this one and I think it could be tricky for some of our kids.

After I’d managed to calm the anxiety about being enclosed, I let myself relax into the water that was holding me afloat and just experience what was going on. Now this is when I started to learn all sorts of things about myself.  Things I probably knew, but because of a world filled with sensory distractions I’d not ever really taken notice of.   You know, every time my body was almost or had just tipped over the edge into a state of relaxation, I found the need to sensory seek.  I’d pull at my togs (bathing suit), scratch an itch (there was a bit of itchiness in the first bit of the float), need to push myself off a wall and move about in the tank and then try and work out where I was positioned or as I do best, have a string of thought processes to keep the mind busy.

This went on for some time, and then out of no where I could hear my heart beating slow and steady, in fact at that moment that was all there was.  I just listened to it and found myself experiencing the beginnings of a deep sense of calm and dare I say it, even relaxation.  I found myself thinking “now if I had one of these at home, I could do 30 mins in one of these and feel relaxed”.  Before I knew it the door was opened and out I climbed, wet and salty but feeling really relaxed (note I’m not someone who relaxes often or really even takes the time to relax). Post heart rate measures saw a 20 beat per minute drop to somewhere in the 70s and a slight (still healthy) increase in blood pressure.  What’s interesting is that my results were consistent with the patterns Sandhill are finding in their children.  I can’t wait for them to do some research on this and get it published.

What blew my mind more however was the fact that I honestly believed I was only in there for 20 minutes, 30 at a push!  I was in the tank a whole hour, 60 minutes and that’s when I realised that I had experienced the state of such relaxation that I’d lost sense of time.

Floating is an interesting experience and I will definitely be doing it again and again.  I highly recommend it, even if you just try it once.  If nothing else, like me you might learn things about yourself you didn’t really know beforehand.