Identifying and Meeting the Mental Health Needs of Children In Foster Care Part 2 L. Michelle Codington, MS, LMFT, RPT, CFTP Executive Director/Co-Founder Where Kids Thrive The e Mi Miss ssing ing Ingredie In edient nt Support portin ing g the Caregiv egivin ing g System tem
Le Learning arning Objectives jectives Identify the pattern that often emerges between children in (foster) care and their caregivers that often leads to placement disruption Provide a framework to understand behavior that’s often mislabeled Illustrate ways to reframe behavior for a foster parent/caregiver
Le Learning arning Objectives jectives Describe 3 caregiver-centric models that address complex trauma Practice 4-6 specific techniques that support attachment, co-regulation and recovery from complex trauma
Familiar?
Ch Child ild = pr = prob oblem lem Iso solated ed Scared
Grown rown up ups s . . . T . . . Try ry to to co control ntrol
Sq Squeeze eeze ha harder rder Behavior Frustration
“Unmanageable” placement disruption
Di Disc scuss ssion Qu Ques estions ns 1 - What would any reasonable rational human being come to believe about themselves (intellectually, emotionally, spiritually, psychologically, physically, socially, and academically) from having these things occur in their life ? 2 - What would any reasonable rational human being come to believe about important relationships (intellectually, emotionally, spiritually, psychologically, physically and socially) from having these things occur in their life 3 - What would any reasonable rational human being come to believe about the world at large from having these things occur in their life?
Wha What t ar are w e we mi e missi ssing? ng?
Foc ocused used on on th the e wro rong ng is issu sue
WRONG G TOOL WRONG G ISS SSUE
Tradi aditional tional ap appro proach ach Do what you’re told! “Compliant” Traditional behavior modification approach does NOT work
Behavior is communication
NO NOT T SAF SAFE
UNSAFE = alw lways s on edg dge There is no one in charge here! In order to survive, I have to be in control. Bad things keep happening to me. The world isn’t safe. People who love me hurt me. I can’t trust anybody. No one is looking out for me. The only way to get my needs met is to do it myself.
2 2 SHIF SHIFTS TS
SH SHIF IFT From “BAD” BEHAVIOR to DYSREGULATION
SHIFT System focused Child/youth focused (caregiving system)
Alg lgebra?
Trauma is a body thing
Fee eeling g = b = bigg gger er than an ab abilit lity to o cop ope e Not necessarily DEFIANCE
These are not bad behaviors – just proof of what system is currently in use ( ac acti tion oriented behaviors fi fight or flight) • Bossy • Angry • Aggressive • Tantrums • Defensive • Name calling • Reactive • Hitting • Coercive • Fidgety • Impulsive • Anxious • Hostile • Irritable • Irrational • Sleep disturbances • Self-centered • Delays in reaching physical, • Poor focus language or other milestones on • Inattention time
These are not bad behaviors – just proof of what system is currently in use ( pass passiv ive oriented behaviors fight or fl flig ight) • Freezing, stuck, paralysis of • Self-centered action • Sad • Dissociation • Withdrawn • Emotional numbing • Whining • Distraction • Crying • Self-soothing • Sulking • Reactive • Clingy • Impulsive • Reluctance to explore the • Emotional and psychological world (take risks) distancing
The * connecti ction * part of the brain is locked away when the ** prote tecti ction ** part of the brain is in charge
Dr. Stuart Shanker, K Weins - The Mehrit Centre, 2016
Common Caregiver Reactions • Feeling ineffective • Guilt • Shame • Anger/frustration • Hopelessness/Helplessness • Sadness • Anxiety/worry
How Brains are Built
How is this child wired? Rage / anger
3 MOD 3 MODELS ELS
Ci Circle rcle of of Securi curity y Cooper, Hoffman & Powell -- Circle of Security.net
Ci Circl cle of e of Secu Securi rity Treatme eatment nt As Assu sump mpti tions ns • Learning (including therapeutic change) occurs from within a secure base relationship • The quality of the parent/child attachment (which can be changed) plays a significant role in the life trajectory of the child • Interventions need to be based on differential diagnosis (informed by research-based theory) • Lasting change comes from parents developing specific relationship capacities rather than learning techniques to manage behaviors Cooper, Hoffman & Powell (2016); Circleofsecurity.net
SHARK HARK MUS MUSIC IC
Bigger, ger, Wiser, er, Str tronger onger, , Kind ind Cooper, Hoffman & Powell (2016); Circleofsecurity.net
Cooper, Hoffman & Powell (2016); Circleofsecurity.net
Cooper, Hoffman & Powell (2016); Circleofsecurity.net
Kinniburgh et.al (2012); Adapted from Blaustein and Kinniburgh (2010)
What Exactly is is ARC? 3 Prim imary Domains • Attachment A • Regulation R • Competency C Kinniburgh et.al (2012); Adapted from Blaustein and Kinniburgh (2010)
3 Primary ry Domains Sub-categories Kinniburgh et.al (2012); Adapted from Blaustein and Kinniburgh (2010)
Parallel rallel Pro rocess cess Kinniburgh et.al (2012); Adapted from Blaustein and Kinniburgh (2010)
Parallel lel Pr Proc ocess ss = cycle e of of treatm eatment ent Child: I’m bad, unlovable Caregiver: This child is “bad,” impossible Professional: This caregiver/family is impossible
Energy What is comfortable and effective? • Normalize and teach the concept of “energy” • Link energy with feelings • Build an understanding of degree of emotion or energy • Teach ways to turn UP or turn DOWN energy (build a toolbox) Kinniburgh et.al (2012); Adapted from Blaustein and Kinniburgh (2010)
Energy What is comfortable and effective? Kinniburgh et.al (2012); Adapted from Blaustein and Kinniburgh (2010)
Ene nergy rgy check-in in Tell me how you’re feeling right now. Is your energy high? Low? Somewhere in the middle? In order to feel most comfortable, would you like to bring it up? Bring it down? Or leave it where it is?
Wh What at is is Se Self lf-Regulation? gulation? Being able to act appropriately when tempted to do otherwise
Mo Modul dulati ation on
Mo Modu dulation lation • Ability to know what you are feeling. • Ability to identify and connect to subtle changes in state. • Ability to tune into what we are feeling. • Ability to tolerate what we are feeling. • Ability to sustain connection to what we are feeling, without shutting down or acting out. • Ability to identify what it feels like in the body to experience subtle changes in state. • Ability to use skills to manage stress and emotions. Kinniburgh et.al (2012); Adapted from Blaustein and Kinniburgh (2010)
Example mple Mo Modulati dulation on Ac Activiti vities es • Breathing Activities • Movement Activities • Grounding Activities • Muscle Relaxation • Deep Pressure Activities • Music
Trauma is a body thing
Experiment (techniques)
How w do you u feel? el?
Feelin ling g Safe (C (Calm) lm) Isn’t necessarily accomplished through rational or verbal channels . . . It’s more sensory (especially for children)
Stretch break
Ch Chil ildren ren fr from om Ha Hard rd Pla lace ces
TBRI Trust Based Relational Intervention
THE HEMES ES ac acro ross s 3 3 mo mode dels ls
When the parent is the activator of the threat/stress response system rather than the regulator, dissociation and emotional distancing are primary sources to reduce threat and stress.
Rel elationsh ationships ips are re sc scar ary Dr. Janina Fisher, 2007
Attachment
Att ttunement: unement: What need isn’t being met right now? Curious stance What BIG feeling is this child trying to manage? How can I respond in an empathic, supportive way? Kinniburgh et.al (2012); Adapted from Blaustein and Kinniburgh (2010)
Regulation is is mir irrored (non verbal) l)
Children have no capacity to be more regulated than the environment in which they live and function.
Sh Shift ft NOT “behavioral problem” Survival Rational Stress = Intentional = Reactive = Comfortable = Diminished Optimal Functioning = Functioning CHOICE = NO CHOICE Nervous system problem
Nothing bad is is about to happen LEARN
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