Self regulation

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

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

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.

 

 

 

Sandhill Child Development Center: Authenticity in Relationships

IMG_6920

Del Rio House

I spent the week of May 12 -16 with the staff and residents at Sandhill Child Development Center in Los Lunas New Mexico.  “Sandhill Child Development Center is a residential program for children ages 5 to 13 at admission, who are experiencing significant difficulties functioning in their current home, school or community due to an inability to regulate their emotional states. By repairing a child’s trust in care and adult guidance, Sandhill gives the child the tools necessary to proceed with a healthy and bright future. Sandhill Child Development Center emphasizes a relationally-based clinical approach that is grounded in the Neurosequential Model of Therapeutics (NMT) developed by Bruce Perry, M.D., Ph.D. and The ChildTrauma Academy.” www.sandhillcenter.org  Sandhill takes children from all over the United States.

As one of the ChildTrauma Academy’s initial partner certification sites there was no question about visiting Sandhill.  Having been at the implementation of neurodevelopmentally informed interventions in their residential treatment for some time now, I wanted to see for myself where they were up to and what discoveries they had made.

Sandhill have two homes located on two different sites a short drive from each other in Los Lunas, New Mexico.  The home pictured above and it’s surrounding property align the Rio Grande River and both homes look out onto majestic mountain ranges.  Spending time with Sandhill you can’t help but feel relaxed and like you’ve known these people all your life.  The Zimmerman Family who run the service, exemplify nothing short of authenticity in relationships and with that as their template their recruitment of staff seems to follow suit.  It is clear from Management to Direct Child Care staff that relationships are the core of the healing approach at Sandhill.  Wrap that up with all the staff having a thorough grounding in neurodevelopment theory and you have a program applying all sorts of playful, rhythmic, sensory and somatic interventions with the children staying there.

Interventions include:

  • Individual weekly therapy for the child
  • Family therapy – both face to face during visits and via Skype sessions
  • Parent training sessions
  • Modelling sessions/co-parenting on site
  • EMDR
  • Animal Assisted Interventions – Horses, cats, dogs, chickens and peacocks.  Including day to day care of animals, as well as play and working with the animals therapeutically.
  • Nutrition – provision of a “brain friendly” diet which strives to use many organic and whole foods.
  • Exercise and recreation – including sports, team building, martial arts and other exercise based activities.
  • Service Learning via voluntary interaction in the community – litter/trash clean up on roads & volunteering at the local animal shelter.
  • Neurofeedback
  • Floating
  • Wilderness Adventure Therapy.
  • Daily education program through Del Rio Academy whereby the students are closely monitored from skilled and attuned education staff and given “brain breaks” when needed to help re regulate.  This involves taking the children out of the classroom in small groups and having them engage in exercise such as running laps, bilateral stimulation exercises, walking and talking and much more.
IMG_6881

Romero House

All of this provided on site or as part of the one program!

Sandhill has capacity for up to 30 children and adolescents at any given time and their average length of stay is around 18 months.  While the lists of interventions is broad, it is by no means all of what they do and one of the lovely observations I made was in fact the individual consideration given to each child’s sensory or regulatory need in the moment and matching all sorts of movement, sensory, mindful, relaxation and/or exercise based regulatory activity to them.

As I left Sandhill I reflected to their staff, that you know a program is doing a good job when the clients come up and tell you about themselves, why they are there and what they have learnt and how thankful they are for the experience at Sandhill.  Even more so when this happens in a house full of preadolescent and adolescent boys!

IMG_6924

Del Rio Swimming Pool

IMG_6921

Del Rio Academy onsite at Del Rio Property

IMG_6923

The Bath House: Home to the Float Tank and Neurofeedback

IMG_6880

Sports Court @ Romero (note trampolines in background)

IMG_6879

Romero Sports Court

 

 

 

 

Therapeutic Preschool: Building Emotional Regulation

IMG_6803

Dr Rick Gaskill: Clinical Director Sumner Mental Health Services

Sumner Mental Health Services provide therapeutic support to the Futures Unlimited Preschools in Wellington KS. Specifically they provide support via the provision of Mental Health Case Management and a role called Individual Psychosocial Rehabilitation workers (IPR), for children classified with Severe Emotional Disturbance (SED). Provision of these services is made available via the USA Medicaid system, and each of the children receiving these services must have met diagnostic classification to receive services.

I observed the absolute value of the IPR role in the preschool setting as I watched an IPR with a 6 year old child with significant emotional disturbance.  From the outset of allocated time, the IPR provided this child with one to one, undivided attention, co-regulation and supported emotionally and developmentally respectful redirection when necessary.  Enacting her role, the IPR was regularly in physical contact with the child in the classroom.  During circle time the child placed herself in the lap of the IPR, leaning back and cuddling into the worker, while the worker provided gentle touch, stroking and running her fingers through the child’s hair.

The IPR worker scaffolded the child from activity to activity in transitions, keeping distractions to a minimum and providing nothing short of opportunities for success for the child, all of this done through largely relational based interaction and regulation.  At the outset of their time, I watched the IPR prepare the child for her impending departure and watched her regulate the rhythm of the hour for the child, so that in the 10 minutes before the IPR’s departure, they moved to a corner and engaged in a quiet activity, drawing together so that their separation provided drawings that could be swapped as transitional objects.  The IPR giving the girl the drawing she had done and vice versa – the child then able to take and keep a piece of her precious IPR worker.  In the two minutes prior to the IPR leaving – the teacher joined the dyad and a process of “handover” occurred and here again while the IPR made her exit, the teacher provided hugs and relational interaction to enable the child to succeed in the moment emotionally.

What really stood out to me was the fact that this child, in the hour supported by the IPR was able to experience success and a baseline level of emotional regulation, contrary to descriptions that had been given of her.  Her IPR remained attuned to her emotional state and danced the dance of catching early signs of emotional dysregulation, such that the child was able to be redirected, be that via comfort, movement, touch or scaffolding to another activity.

Imagine the long term benefits we could achieve if our kindergarten/preschool children who struggle emotionally, received opportunities like this at the time when their brains are still actively organising neural networks.  Could we start to create early changes in neural templates from over active stress response systems and emotional dysregulation to enable younger children a better platform for self regulation?

Therapeutic Preschool: The Safe Place

Sumner Mental Health Services provide therapeutic support to the Futures Unlimited Preschools in Wellington KS.  Specifically they provide support via the provision of Mental Health Case Management and a role called Individual Psychosocial Rehabilitation workers (IPR), for children classified with Severe Emotional Disturbance (SED).  Provision of these services is made available via the USA Medicaid system, and each of the children receiving these services must have met diagnostic classification to receive services.

I really want to spend time reflecting on the role of these IPR workers and the amazing early intervention and skill development they provide to kids between the ages of 0 – 6 years with respect to emotional regulation.  However before I do, one feature of the classrooms really stood out to me and I think there’s some direct application others may be able to use.

Firstly the therapeutic preschool enviornment, like our Kindergartens in Australia, are a wonderful sensory environment, with lots of different activity stations, bright and lively colour, lots of structured, predictable schedules and developmentally appropriate activities for children .  One of the things that Sumner Mental Health and Futures Unlimited have incorporated into their preschool classrooms, which really interested me was the SAFE PLACE.

In each room there is a corner where a little wall juts out and in this space are a variety of sensory toys.  The idea behind this space is that at any point during the day, when the students become dysregulated, upset or need some “emotional space”  they can take themselves to the “Safe Place” and chill out, calm down and then when ready rejoin the group.

 IMG_6795  IMG_6794  IMG_6792

During my visit, I had opportunity to witness the “Safe Place” in action.  After lunch the preschool children had some outside exercise time in the playground.  One of the male students struggled with the transition from exercise to circle time on the mat when they came back into class.  This boy was not a child allocated an IPR who could sit with him, rock him, hug him or co-regulate him, so when his teacher attempted to move him into the next class activity he became upset and tearful.  Instead of creating a scene however or requiring the teacher to stop the class activity and attend to his emotional needs, I witnessed this child get up, take himself to the “Safe Space” corner and cuddle a big green frog.  He kept himself there for a couple of minutes, huddled in the little alcove, cuddling the frog and when he seemed to have calmed down, taking the frog from the safe space, he rejoined his classmates and was able to participate in the classroom activity.

What was clear to me was the expectation and permission that self regulatory self-removal from the activity was acceptable and in fact preferred.  There was little to no disruption to the preschool activity, the teaching or the other students and the time away from task for this child was minimal.  The materials provided in the “Safe Space” were highly sensory and what’s more,  just outside the wall of the “Safe Spaces” were mini trampoline’s for indoor physical movment & activity.  I also really liked that the children could bring items from the “Safe Space” as transitional items to help them rejoin the class, without any comment, restriction or intervention on part of the teacher.

IMG_6793

“Heartwaves”

a.baa-Heart-wave

“I need to be able to keep myself calm, if I can’t do that then how can I send her the heartwaves she needs to regulate, she needs and relies on my calm heartwaves”.
Tammy: Mental Health Liaison for Head Start part of Futures Unlimited , Wellington KS.

In the days of rest and jetlag recovery before my visit with Sumner Mental Health Services and the therapeutic preschool they provide services to at a Futures Unlimited, I had time to think and reflect on the last couple of months, the many consultations I do with our Take Two staff, but also the direct clinical work I do in my own private practice. With time on my hands and minimal demands on me, some of the struggles we have in our work became clearer.

A large part of the initial work in trauma recovery for children isn’t in treating the child themselves, but rather supporting and educating their carers/parents, workers, and teachers. Essentially it has to be about getting these significant relationships in the lives of children, armed and ready to provide the wrap around support and developmental guidance necessary for the child to heal from trauma.

This is often no easy task. Many of the direct care staff, parents, teachers and workers are at the coalface of the worst emotions and behaviours of traumatised children. Carers, teachers, parents sometimes can’t see beyond the behaviour, others less trauma informed may reinforce notions of the issues being purely behavioural. Often by the time these children get to a trauma informed therapeutic service, carers, teachers and workers are tired, worn out, at their wits end in how to manage these kids – some of them even ready to give up, if they haven’t already.

As therapeutic intervention staff, we can often get so child focussed that we charge on in, giving information and education about why the child behaves the way we do – All of it great and accurate information. Then we find ourselves perplexed that these significant adults in the lives of children continue to engage with the child as they did before, or retreat to explaining the behaviours of the child as naughty.

It occurred to me that we often approach this work with the best of intentions and assumptions that we are working with alert and rational adults. I want to be clear here, on a good day that’s exactly what most, if not all, of these adults are – rational, alert and thoughtful about the children they care for. But when you are under the pump, dealing with difficult, challenging and even aggressive and violent behaviour day in and day out, then maintaining a state of alert and rationality is challenging. In fact, these carers, parents and/or teachers may be stressed, angry or reactive in response to their child’s behaviour.

We know that many of the traumatised children we work with have overactive stress responses, these young people due to infant or early childhood exposure to threat, chaos and danger are ‘wired’ for stress. (Remember the brain organises as a function of our experience.) We know that when we move up the arousal continuum, the more stressed, fearful, aroused we become, or in other words as our state changes we have correspondending changes in our behavior. We become increasingly reactive and more likely to engage in fight/flight/freeze responses. We also know that there are changes in our cognitions or more simply, our ability to use the thinking part of our brains. In fact the more we move into a state of arousal, the less likely we are able to problem solve, recall memory, rationalise, reflect and in fact learn.

This arousal continuum is a universal human experience and with this in mind we can be more clearly directed in our treatment planning. Yes we need to get the direct care staff, parents, teachers and the like to a place of understanding their traumatised children, understanding the child’s self regulatory abilities and the reasons for this and then in turn help them in the support of enhanced coping and regulation for the children.

BUT

If we are going to be truly sequential and systemic in our intervention then we have to notice and respect the state of the carers, parents and teachers of the children we work with. Often time the struggle we have in getting these individuals to be able to learn and hold a trauma informed understanding of their kids is because we are less attuned to their state. Like Tammy said, the client she was working with the day I observed her at Sumner Mental Health and Futures Unlimited, needed her to have calm heartwaves to share for co-regulation. In the same way we need our carers, parents and teachers to have more regulated heartwaves and state regulation to hear, learn and hold the messages we have to give.

I came on this fellowship to explore regulatory activities and interventions for infants, children and adolescents, but many of the things I’m going to observe are going to be equally relevant in the wholistic and systemic work in the therapeutic web of a child. What’s more they are essential in order to ensure those caring for and teaching our clients are really able to internalise and reflect on our psychoeducation.

In essence, when necessary, state regulation of those caring for or teaching our infant, child & adolescent clients, in my mind must be one of the primary treatment goals.