debor016

Someone I was talking with recently stated that even though he wanted to implement trauma informed care, his agency had to have a points and level system, because otherwise what is going to motivate the children to start doing good behaviors? That is a good question. What does motivate the children to change? I would suggest that there are a lot of built in motivations. These include wanting to be normal, not wanting to live in residential treatment, and the natural urge for mastery. Relationships are the most powerful source of motivation. Once a child feels that someone likes him, believes in him, and expects good things from him he develops a need to please that person and to live up to their expectations. This goes back to the statement: children do well if they can. Children want to do well. Almost any child, if you talk with him when he is calm, will say that he wants to change, stop hitting people, stop cutting himself. It is not that he is not motivated. It is that he doesn’t k...

Amazing as it is to believe, scientists have identified which regions of the brain are associated with self awareness. Self awareness starts with awareness of bodily sensations, such as hunger, thirst, tiredness, and pain. It includes being able to think about the self, form ideas of the self, notice patterns, and assign attributes. These functions seem to be set in the anterior medial prefrontal cortex. Not surprisingly, self awareness develops through interactions with an attuned other. The caretaker names experiences, assigns words to feelings, connects sensation with action and need with fulfillment. Through these interactions this part of the brain is built, and its connections with other regions developed. Therefore, it is understandable that psychological trauma, including attachment traumas, in the first year of life has been observed to negatively impact on the experience-dependent maturation of the circuits of the anterior cortex. The children and families we serve who have e...

I have spent the last week with a JCAHO reviewer who was conducting Klingberg’s Tri-Annual Review. After reading many treatment plans in many of our programs, I have decided to discuss them here. We all know we have to do treatment planning. Why is this an important part of every program requirement? Treatment planning is designed to make us think about what we are doing in treatment and to proceed in a planful way. It forces us to consider what we are trying to achieve with this client, and how we will know if we are making progress. What will success look like? The planning process leads us to consider what change is necessary for the client to leave this particular level of care. Not be perfect, not have solved all his problems or worked on all his issues, but just to be able to step down to the next lower level. And when done right, the process includes the client and his family. How do they define success? What change are they looking for? Treatment planning is the expression of a...

I have just returned from the Moving Forward in Challenging Times Conference in Austin Texas. This SAMHSA funded conference focused on Domestic Violence and Substance Abuse programs, most specifically how they could work better together so the clients would experience fewer barriers. It was sponsored by Safe Place of Austin, an organization that provides direct service, prevention, and advocacy. The conference was very inspiring, and I wanted to share some ideas I learned there. I was inspired by the participants at this conference. They approached their work from a mission base, a deep commitment to their clients. And they were working hard to change their programs so that any person would be welcome, there were no barriers to care, no restrictions to participation. This means that however a woman shows up, drunk, using, dirty, belligerent, whatever, she is welcomed with food, sleep and talk. They had carefully redesigned their intake and assessment to be welcoming, and not designed t...

Several boys were playing basketball outside their residential dorm. Marcus made a basket despite Jeff’s guarding him. Jeff began to taunt Marcus, saying the basket was luck, he didn’t know how to play, he was too short and too ugly. The insults expanded to include racial slurs and comments about Marcus’ mother. Marcus was flustered and missed his next shot. Jeff started to laugh. Marcus went over and punched him, hard. The staff stopped the game and brought the boys inside. Marcus and Jeff were bother restricted, and Marcus’ punishment was seven days of unit restriction because he had used physical violence. This incident happened at a place I was training. This provided a great opportunity to put these theories into practice. There were many men in the training, all shapes, sizes, ages, and races. I asked the men to consider that they were in a pickup basketball game with some friends and someone started insulting them, including using racial slurs. I asked for a show of hands of tho...