Advancing Trauma-Informed Practices: Bringing Trauma-Informed, Resilience-Focused Care To Children, Adolescents, Families, Schools & Communities
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What matters most in our efforts to help victims of trauma? Even before children were included in the 1994 American Psychiatric Association (APA) diagnostic category of posttraumatic stress disorder (PTSD), the National Institute for Trauma and Loss in Children (TLC) was researching and developing trauma specific intervention strategies for children, adolescents and adults. Founded by Dr. William Steele in 1990, and currently a program of the Starr Institute for Training, TLC decided to approach trauma, not as a diagnostic category or set of symptoms, but as an experience or series of experiences that left those exposed vulnerable to a wide range of emotions, thoughts and behaviors we know as primary survival responses today. Twenty years later, TLC’s evidence-based Structured Sensory Interventions for Traumatized Children, Adolescents and Parents (SITCAP®) intervention programs are used in schools and agencies across the country and listed as best practices on the California Evidence Based Clearinghouse and the Substance Abuse Mental Health Services Agency (SAMSHA) National Registry of Evidence Based Programs and Practices (NREPP).
When We Listen To Survivors…
Over TLC’s long practice history, the voices of thousands of victims have expressed quite clearly to the 6,000 TLC Certified Trauma Specialist practicing across the country: "If you don’t think what I think...
feel what I feel... experience what I experience... see what I see when I now look at myself, others and the world around me... how can you possibly know what’s best for me?"
This is a simple yet profoundly wise mandate. When we can appreciate how traumatized children are experiencing themselves, others and their lives as a result of their experiences, we can assign far more timely, useful, and appropriate interventions. Ask two children exposed to the same situation what their biggest worry is since what happened and you will often hear two different responses because each experienced that situation in different ways. One might say "Does this mean the football game is cancelled?" while the other worries about who else might die. Each is experiencing what happened differently and will need different responses from us.
This may appear to be an overly simple example of how we arrive at what constitutes trauma informed interventions yet, knowing how children are experiencing themselves, others and their environment, represents the foundation on which we ought to select and apply our interventions.
The Subjective Experiences of Trauma
In 2005 and again in 2009, Bessel van der Kolk, Robert Pynoos, and colleagues proposed to the American Psychiatric Association a new diagnostic category presented as far more reflective of the trauma experience than presented by the current PTSD category. It in fact offers the following criteria of the subjective experiences of trauma: rage, betrayal, fear, recognition, defeat, and shame. In 1990, TLC listed the following subjective experiences children revealed to them: terror, hurt, worry, anger, revenge, guilt and shame, feeling unsafe, powerless, and engaging in victim versus survivor thinking. This even more extensive description of the trauma experience has been and remains the focal point of TLC interventions which, it’s published research clearly documents, significantly reduces not only trauma symptoms across the three major subcategories of PTSD, but also related mental health reactions that emerge when treatment is delayed or not forthcoming.
Assessment Alone is Not Enough
The details of a child’s experiences are also essential in determining the most of efficacious treatment. The fact is using assessment all comes alone to determine treatment is not necessarily safe. If all we did were complete an assessment on a traumatized child and found, for example, that trauma had created sensory integration challenges, we would have a basis for treatment. However, if we design that treatment without being aware of the kinds of experiences that child actually faced, the treatment may further traumatize that child. If, for example, a weighted blanket is recommended as part of the sensory integration treatment to help calm that activated child, but the child has been sexually abused and the full weight of adult on top of them was part of that experience, that treatment, that blanket and the sensation of heaviness could in fact re-traumatize that child.
Not having information about the details of the experiences associated with trauma places that child at greater risk when determining treatment. If for these and many other reasons, we decide to relate and respond to trauma as an experience, we must ask, "what are the subsequent implications for treatment and intervention?"
The purpose of this paper is threefold: 1) to define the primary experience of trauma in order to support trauma informed practices grounded in evidence based research, neuroscience and the essential components of trauma informed practices; 2) to view trauma not as a diagnostic category but as a series of experiences that result in survival driven behaviors, thoughts, emotions, sensations and needs unique to traumatized children yet often misinterpreted and assigned as symptoms of disorders other than trauma; and 3) to explain the essential importance of understanding the child’s experience, within a trauma informed context, in order to guide practitioners in evaluating, identifying and initiating trauma informed, developmentally appropriate interventions beneficial to the unique needs and world of traumatized children and youth.
By: William Steele, Psy.D., Founder, The National Institute for Trauma and Loss in Children; and Caelan Kuban, LMSW, Director, The National Institute for Trauma and Loss in Children
The entire white paper, "Advancing Trauma-Informed Practices: Bringing Trauma-Informed, Resilience-Focused Care To Children, Adolescents, Families, Schools & Communities," from The National Institute for Trauma & Loss In Children is available online at http://www.openminds.com/library/121611_trauma-and-children.htm.
Steele, William and Caelan Kuban. (2012, January). Advancing Trauma-Informed Practices: Bringing Trauma-Informed, Resilience-Focused Care To Children, Adolescents, Families, Schools & Communities. OPEN MINDS, The Behavioral Health & Social Service Industry Analyst.
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