Stress Response System

Transitions, Change and Loss

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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.

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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!!

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

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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

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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.
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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!

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Del Rio Swimming Pool

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Del Rio Academy onsite at Del Rio Property

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The Bath House: Home to the Float Tank and Neurofeedback

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Sports Court @ Romero (note trampolines in background)

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Romero Sports Court

 

 

 

 

“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.