Fear Response

Mount Saint Vincent Home

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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.

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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.

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Greater and Less Than – Lessons in learning Through Movement

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

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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.

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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

 

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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.

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Surrounding woodlands

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Woodland Trail

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Deep in the woodland trail

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Alexander Youth Network Grounds

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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.

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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.

 

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Art Therapy room including Kiln

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Play Therapy Room

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Play Therapy equipment

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Play Therapy Room – role play and dress ups

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Play Therapy puppets

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Play Therapy sand tray and figures

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Occupational Therapy room

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Developmentally matched classrooms

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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


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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.

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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!!