Thoughts on Japan, Disaster Relief and Resilience

The recent and ongoing disaster in Japan once again brings up the question– just how do helping professionals assist children after an acute traumatic event like an earthquake or tsunami? Here are some recommendations:

Establish and maintain close relationships with trusted adults. Even under the most adverse circumstances, most children and adolescents can cope as long as they have connections to adults, including helping professionals and caregivers. Young people who have someone they know is concerned about their well-being, provides them with guidance, structure and information, and spends frequent time with them do better than those who do not have such relationships. While parents are usually the source of support, others (counselors, teachers, childcare staff) can also supply a sense of meaningful connection.

Insure a sense of safety. All children need to feel safe, but particularly those under stress. In acute trauma situations like disasters, sharing knowledge of what is being done to help everyone be safe and secure is important. Many individuals have a tendency to worry more than usual after a catastrophe or negative event; for example, some children believed that airplanes could hit their homes after the events of September 11, 2001. Helping professionals and caregivers can assist them by providing age-appropriate and realistic information to reduce undue fright, anxiety or obsessive thinking. Monitoring children’s exposure to violent images or reports of death or disaster will also reduce feelings of vulnerability and the sense that “it is happening again” when, in fact, there may no longer be a threat.

Practice self-regulation techniques. Knowing a method or two to relieve emotional and physical tension can enhance and build resilience over time. Play is a natural form of self-regulation if it calms and relieves the individual. Talking, drawing, making music or physical activities or sports can help, too. For children and adolescents who are anxious or showing signs of hyperarousal, many of the more well-known self-regulation activities and strategies (breathing, mindfulness, and muscle relaxation) are useful; mastery of a “resilience-building” skill also is positive resilience factor, in and of itself.

Encourage optimism. Traumatic events like disasters make it difficult to feel positive about the world; even children and adolescents who have a natural tendency to see a positive future can be emotionally shaken by certain events. Those individuals who believe that these events are temporary will do better than those who obsessively belief that things will not change for the better. It is extremely important that helping professionals and parents help children and adolescents develop a sense that they can effectively deal with stress.

Identify values and beliefs. Commonly used lists of resilience factors include several concepts that underscore the importance of values and beliefs in trauma informed practice. Individuals who are altruistic, for example, and seek to help others in need build personal resilience and reduce depression and anxiety in the process. Values that involve connection to others are particularly important because they reinforce connection to a larger group and emphasize the welfare of others. After a traumatic event, beliefs about religion or spirituality are also a source of resilience for some individuals; trauma informed practitioners can help identify these beliefs within a framework of cultural sensitivity for individuals’ and families’ preferences for sharing information on religious or other practices.

Practice all of the above. This list of recommendations began with the importance of relationships in resilience-building after a traumatic event, underscoring that one of the most significant factors in resilience and trauma recovery is a meaningful relationship with either a parent or a helping professional. In order to make that possible, parents and professionals must be able to be available and supportive. Practitioners must make sure that they are feeling safe, calm, well-rested, and in good emotional health in order to implement the resilience-building strategies in this list. Practitioners can also help parents/caregivers understand and practice these same principles so that they can be available and supportive to their children.

Finally, it is important to look for any trauma reactions even months after exposure to an acute event; it is common for individuals of any age to begin experiencing symptoms 2 to 3 months after the occurrence. Anxiety, depression, avoidance of certain situations, problems with cognition and concentration and irritability can signal that some resilience-enhancement is in order. If reactions persist, professional assessment may be appropriate to make sure children and adolescents retain the ability to function at home, school, and with peer groups.

Be well,

Cathy Malchiodi, PhD, LPCC, LPAT

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Sensory-Based, Trauma Informed Assessment

In a previous post in September 2010, I discussed some concepts pertaining to “trauma informed art therapy.” Over the past few months, Dr. William Steele and I have been working on a new book called Trauma Informed Practices with Children and Adolescents. How we apply trauma informed principles to assessment and evaluation of children and teens is an important part of this book. Trauma informed practices do not only apply to interventions, relationships, and environments inherent to our work with traumatized young people; we also can apply these principles to how we evaluate individuals, especially those who have experienced chronic abuse, neglect, interpersonal violence, and other challenges during their lives.

There are several excellent trauma informed assessments that evaluate multiple dimensions, including physical and medical status, cognition, psychosocial issues, and the impact of trauma itself. However, how do we capture additional information that may be missed through standardized, paper and pencil assessments or parental, caretaker, or professional observations? Trauma informed assessment also includes evaluation of the sensory experiences of children—in other words, how the mind and body respond to traumatic events and the flight, fight, or freeze responses of the individual. It also includes the recognition that these responses are adaptive coping strategies rather than pathological reactions.

I also believe that trauma informed assessment includes an evaluation of how traumatic events may have impacted neurodevelopment. Neurodevelopment is a term used to describe how the brain develops over the first 20 years or so of the lifespan, from infancy through adolescence into young adulthood. Bruce Perry (2006) and others have presented comprehensive theories about what neurodevelopment and specifically, neurosequential development entail.

In order to fully understand and evaluate sensory responses in young clients, sensory-based methods of assessment are necessary. These can include many types of action-oriented activities, but the most widely applied involve art and play-based protocols, many of which are found in the fields of art therapy and play therapy. Why art and play? Because for children and adolescents who may not be comfortable with standardized, more cognitively-based assessments, they have an opportunity to use materials, media, toys, and props to give us a series of snapshots about their experiences, trauma reactions, and worldview. Because there are identifiable developmental sequences for play and art expression over the first decade of life, applying this knowledge to child clients provides another way to use the senses to engage individuals in treatment. And, as most of you already know, art and play are child-appropriate forms of communication that allow for a wide-range of expression and for many, a way to tell us about their terrors when words are not available.

Finally, in using sensory means to conduct assessments (especially in a trauma informed, culturally sensitive way), isn’t it nice that many children will find a degree of self-soothing in using toys, paint, or props to communicate their perceptions, feelings, and experiences to you? This is one of the core principles of trauma informed work—to create a sense of safety through all interactions and to capitalize on positive relational aspects between helping professionals and young clients as much as possible. Look forward to reading more about this topic as Bill Steele and I finish up the book!

Until next time, be well,

Cathy Malchiodi, PhD, LPAT, LPCC

Reference

Perry, B.D. (2006) The Neurosequential Model of Therapeutics: Applying principles of neuroscience to clinical work with traumatized and maltreated children In: Working with Traumatized Youth in Child Welfare (Ed. Nancy Boyd Webb), The Guilford Press, New York, NY, pp. 27‐52.

Get Your Trauma Certification with TLC this February in San Antonio!

Today, National Institute for Trauma and Loss in Children (TLC) training programs are in place in more than 3,000 schools, community-based programs, treatment centers and childcare facilities across North America and internationally. More importantly, they are giving parents, teachers and childcare professionals the early intervention tools and techniques it takes to change trauma-related behaviors and to help traumatized children survive and thrive.

If you haven’t attended a TLC Training and Certification in awhile or you are new to the trauma field, why not join TLC Certified Trainers for a special weekend of learning from February 18 through 20, 2011 in San Antonio, TX. For your convenience, courses begin on Friday morning and end early on Sunday and are a short complimentary hotel shuttle ride from San Antonio International Airport. Whether you want to work on your trauma certification [for more information, click here] or would just like to improve your skills in working with children, this weekend will provide you with practical knowledge and activities that you can apply immediately. There is a school track and a clinical track, plus courses that meet Association for Play Therapy (APT) continuing education requirements; the following courses are scheduled:

Structured Sensory Interventions: From Sensory Memories to Play Therapy— William Steele. This is a practice day. Participants will be engaged in the evidence-based, grief and trauma psycho-educational and play therapy intervention processes used in schools and community settings across the country. Cases, including the mother of a 7-year-old who died of cancer at home, a 12-year-old exposed to repeated domestic violence, a 15-year-old, raped multiple times at a drug house, a spouse’s husband tortured and killed, will be presented along with the remarkable evidence-based reduction of their PTSD and other mental health and cognitive related reactions. Participants in schools or agency settings will feel comfortable using any of TLC’s structured manualized psycho-educational and play therapy trauma intervention programs and tools at the end of this practice-directed training.

Creative Play Therapy Crisis Intervention: Promoting Posttraumatic Growth— Lennis Echterling and Anne Stewart. Traditional crisis intervention has focused on distress, deficits and traumatic wounds of survivors. However, recent research on the inherent resilience of people and the importance of play and their attachment relationships has exciting implications to child, family and play therapists responding to traumatic events. The psycho-educational and play therapy techniques presented emphasize personal strengths, enriching personal relationships; feelings of resolve and helping survivors try new coping strategies. The play therapy interventions presented require minimal materials, are developmentally appropriate, culturally sensitive and can be implemented in any setting. Out of Ashes, A Coping Heart, Eggactly: Supporting One Another, Colors From Your Emotional World, and Reaching our with LUV will be presented as way to help those in crisis play, make meaning, regulate their emotions and move forward.

Advanced Sensory-Based Interventions: From Sensory Memories to Play Therapy—William Steele and Caelan Kuban. This presentation will engage participants in a variety of advanced psycho-educational, sensory activities to allow for the use of these interventions beyond the core TLC program or for use in those situations where it is not possible to use the full program. Play therapy activities will cover early childhood through adulthood and address the sensory experiences associated with trauma or grief. This is a practice session so participants experience the full value and application of these play therapy activities. Rap It Write, Strike A Pose, Ready…Set…R.E.L.A.X., My Play Island and This Reminds Me Of… are just a few of the sensory activities presented. TLC activities are used in school and agency settings.

After the School Crisis— Glenn Carlton, Jennifer Haddow and Michael Markowitz. Participants will be introduced to the Traumatic Event Crisis Intervention Plan (TECIP) that provides the tools necessary to initiate protocols that offer crisis team members a proven structure to stabilize all involved in recovering from the crisis, mobilize resources, accelerate normalization of routine, and minimize the adverse impact on students and staff by restoring adaptive functioning. The Rapid Assessment Guide Traumatic Event Briefing Process, TECIP, 4×5 Development Flow Chart, the what, when, where, who and how to initiate and navigate through the Roadmap to Recovery will be presented. Lecture, demonstrations, small and large group discussion, and practice make this a “must attend” for school crisis response members. The TECIP Manual will be given to every attendee.

And did you know you can take Children of Trauma with William Steele as an online course from the convenience of your home or office? It’s the prerequisite course for all certification levels and now it’s even easier to get the benefit of this excellent presentation.

Don’t miss out of these opportunities to improve your skills in working with traumatized children, adolescents and families! For more information about the upcoming San Antonio, visit this page to learn more and register.

Be well,

Cathy Malchiodi, PhD, LPAT, LPCC

Follow TLC’s Twitter at http://twitter.com/TLCchildtrauma

Become a Fan of the National Institute for Trauma and Loss in Children– join our Facebook Fan Page today!