State dependence

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.

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.

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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.

“Heartwaves”

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“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.