Sustaining Trauma Informed Care in a Punitive World. Patricia Wilcox, LICSW Traumatic Stress Institute Klingberg Family Centers 2016

Transcription

1 Sustaining Trauma Informed Care in a Punitive World Patricia Wilcox, LICSW Traumatic Stress Institute Klingberg Family Centers 2016

2 Forces that pull towards the punitive Cutbacks and diminishing resources Client severe behaviors Staff being hurt Feeling hopeless System-level trauma External pressure to make quick change External pressure to be more punitive

3 How Can We Sustain Trauma Informed Care? Administrative buy in Training and refreshers Staff meetings Treatment planning Policy Hiring and promotion Publicize and celebrate Attention to vicarious traumatization and transformation Supervision Good teamwork

4 Administrative buy in Provide resources Willing to tolerate some chaos Target praise Possibilities for undoing Value and provide opportunity for supervision

5 Training and Refreshers Original training for all staff Including support NEO Regular refreshers Trainers as leaders

6 Develop a common language throughout the agency

7 A Common language

8 Treatment planning Treatment planning expresses a theory Express what we think heals Not just or particularly uncovering Make link between relationships and trauma symptoms clear

9 Policy Behavior management Recreation and activities Philosophy of treatment Intake explanation Handout for parents

10 Hiring and promotion Hire and promote people who get it Questions for hiring

11 Publicize and celebrate Choose measures- Reduce restraints Reduce turnover Positive discharges Follow up Track Celebrate and publicize success Staff appreciations

12 12 The Trauma-Informed Treatment Team

13 13 How Does Our Team Functioning Matter to Trauma-Informed Care? Clients notice everything we do Can t treat clients any better than we treat each other Our happiness in our jobs largely influenced by our social surroundings Our connection is our strongest defense against VT

14 14 Do teams matter in outpatient and community based settings? Contribute to well being of treater Combat isolation Bring diverse providers into same approach Avoid splitting and blaming Combat VT

15 15 Structure Every staff member has some time to reflect, talk, learn and plan away from direct care while working. Every staff member receives regular supervision. All full-time direct care staff know each client s history, treatment goals, and discharge goal. All treaters working with the same client have time to communicate with each other

16 16 Every staff member is clear who his/her supervisor is. (Congregate care) The clinicians are on the unit interacting with staff and clients, and do not rely mainly on scheduled office appointments for their therapeutic interactions. (Congregate care) The clinicians participate in fun activities and celebrations on the unit.

17 17 Treatment We discuss why a client is doing a harmful behavior, what problem is it solving for them, before we decide how to respond to it. We use a common trauma-informed language to discuss our clients and avoid labeling and blaming them.

18 18 Community and outpatient Staff form strong relationships with clients while maintaining clear boundaries, and discuss boundary dilemmas with their teams Staff have time to connect with supervisor and team and discuss their cases

19 19 Boundaries are clear and open; boundary questions are discussed with the team Most aspects of the client s treatment are shared with the team.

20 20 Relationships We handle conflict directly and respectfully. We tag each other out when someone gets caught in a power struggle.

21 21

22 22 We share with each other how the work is affecting us and how we are feeling towards individual clients. We value our relationships with each other and we create activities to enhance them. We share humor.

23 23 When there is a problem in the program or a decision to be made staff of all disciplines get together to discuss it and decide. We can ask each other for help.

24 24 We do fun activities together. We celebrate milestones and excellent work Administration is supportive and appreciative.

25 25 The Role of supervision in a great team Regular supervision helps with counter transference and vicarious trauma The supervisors reactions to inter-personal splits is essential in magnifying or solving them Ideally all team members have the same supervisor

26 Why focus on supervision? Primary method to embed trauma thinking into every day life Opportunity to step back and think Chance to vent Teach clinical thinking- looking beneath Create culture of self awareness Fight erosion of TIC thinking Awareness of and attention to VT Handling staff performance issues Helping staff to grow transforms the pain Opportunity to notice trends in milieu

27 What trauma principles are important in supervision? Relationships matter We are all doing the best we can at the moment Symptoms are adaptations- yes, even for adults Current relationships are influenced by the past Self awareness is essential Relationships are the vehicle of growth Parallel process Collaboration, empowerment, caring, respect- it matters In other words, ALL of them.

28 Trauma principles at work Make time Be on time and pay attention Connect Set frame and boundaries Remember details

29 Trauma principles at work Validate Safe relationship to explore personal reactions Use symptoms as adaptation lens Self awareness essential

30 Trauma principles at work Acknowledge validity of concerns Explore connections between reactions and past Encouraging and deepening self awareness

31 Trauma principles at work Validation and push for change Need to handle difficult issues kindly Clear expectations Collaborative and empowering Mutual problem solving not blaming Can t have relationship with the kids if you are feeling blamed, scapegoated and angry

32 Challenging Issues in Trauma Informed Supervision Support vs. accountability Multiple roles - clinical supervisor, boss, evaluator of job performance, When to listen, when to problem-solve Working with resistance and defensiveness Supervising former peers, people older than you, etc Boundary between supervision and therapy

33 33 What Makes This So Difficult? In small groups, discuss barriers to this type of team functioning. What have you done to improve/enhance team functioning?

34 When Things Start to Go Wrong 34

35 35 What is a Program that Has Become a War Zone? Staff is demoralized and overwhelmed They are just trying to make it through the night. The program relies excessively on the use of force, restraint or intervention teams. Structure and programming are lost. In community/outpatient programs, staff are feeling overwhelmed and exhausted, and may miss appointments or be inflexible

36 36 What is a Program that Has Become a War Zone? The staff are in a state of fear, and move from one crisis to another. The staff are often responding to their fear of what could happen if this situation got worse The clients are not feeling safe, and are acting more aggressive. For both the staff and the kids there is a sense of imminent catastrophe

37 37 How Do Good Programs Become War Zones? More difficult population A new type of client Staff turnover Not enough training Understaffing

38 38 How Do Good Programs Become War Zones? New treatment approach. Lack of integration of therapists Changes in regulations Serious incidents

39 39 Signs that a Program has Moved Towards a War Zone Culture Staff injuries increase. Child injuries increase. Lack of structure, few activities planned or carried out Inconsistent application of limits. Power struggles leading to restraints.

40 40 Signs that a Program has Moved Towards a War Zone Culture Over-reliance on control. Over use of calls for assistance Living areas look bad Treatment plans are not communicated or followed through.

41 41 Signs that a Program has Moved Towards a War Zone Culture Staff do not feel part of the treatment. Therapists are staying in their offices High turn over. Supervision does not take place.

42 42 Signs that a Program has Moved Towards a War Zone Culture Individual therapy does not take place Routines are not followed. Use of sick leave increases. People speak of the clients in hopeless, blaming terms. Splits occur and deepen between parts of the team

43 43 Signs that a Program has Moved Towards a War Zone Culture Staff reduce interactions with clients People are not sure how to intervene when problems begin so they do nothing and feel helpless

44 44 How Can a Program Regain Its Treatment Focus? Staff must move towards the youth, not away from them. By their behavior the youth are telling the adults that they do not feel safe or connected. We have increase their connection to adults. How do we do this?

45 45 How Can a Program Regain Its Treatment Focus? See handouts for article and a detailed recovery plan for senior administration, middle management, therapists and line staff

46 Vicarious Traumatization How this work will change you VT refers to the negative changes in the helper as a result of empathically engaging with and feeling, or being, responsible for traumatized clients. Laurie Pearlman, PhD Kay Saakvitne, Ph.D.

47 47 Vicarious Traumatization (2) The single most important factor in the success or failure of trauma work is the attention paid to the experience and needs of the helper. Addressing VT is an ethical imperative. This is as true with teams as with individuals, maybe more so.

48 Attention to the Experience of Treaters A critical component of maintaining trauma informed care Case study: Nia Sage Group Home

49 Therapeutic Group Home Five teenage girls with long trauma and treatment history Staff trained in Risking Connection and the Restorative Approach Low staff turnover Thoughtful, caring and insightful staff

50 Events Complete turnover to population within three months Three positive and two difficult New clients younger and very dramatic, high intensity Constant aggression, self harm, property destruction Increased use of outside resources

51 Symptoms More punitive responses Dissention within the team Cynical comments Labeling Push to make rules and argue about issues

52 What helped Trauma informed culture Restorative Approach system Relationships Consultation and larger system support Staff skill Intervention at many levels

53 Actions taken Staff appreciation events Discussion Vicarious Traumatization exercise Retraining in Restorative Approach RC refreshers Support for leadership Individual supervision

54 What to do Make time for supervision and clinical discussion Cultivate a culture of self awareness Develop strong teams that give and accept help Develop organizations that treat employees well Pay attention to vicarious traumatization and self care

55 To Get the Article For a PDF of the article on which this presentation was based Text WARZONES To

56 Making It Real! New Course Available Soon! We are launching a new course designed for childserving teams. It guides you through all aspects of implementing trauma-informed care in your program. TEXT MAKINGITREAL to To get more information and to be notified when registration opens. 56

57 To Get Our ebook Starting and Sustaining Trauma-Informed Care Text STARTING To

58 For more information contact: Patricia D. Wilcox, LCSW Vice President, Klingberg Family Centers 370 Linwood St. New Britain, CT