TLC’s Childhood Trauma Practitioners Assembly
Summary Paper
August 2006
Written by,
William Steele, MSW, PsyD
TLC Director
Over
two hundred and fifty practitioners attended TLC’s first annual Childhood
Trauma Practitioner’s Assembly held July 11-14, 2006 at the Macomb ISD
Education Center. During that time
forty presentations were conducted, in addition to TLC’s Level-1 and Level-2
Certification courses.
On Friday morning,
the last day of the Assembly, over eighty professionals from twenty states
attended “Trauma Interventions, Resources and Recommendations for Unique
Populations: Best Practices” to discuss their concerns and compile their
recommendations for the future of trauma work. These professionals come from varied disciplines and work in
a wide range of settings including: education, pediatric hospital, community
mental health, residential, juvenile justice, psychiatric inpatient/outpatient,
domestic violence shelters, community-based programs, pastoral care, and
private practice.
Participants
were randomly placed in ten groups of eight people. Each group was instructed
to meet in a separate area and participate in a Breakout Session. Each group
discussed and recorded their responses to the following eight questions:
The groups reconvened and a
discussion of their responses was held and recorded.
The
participants all reported that this was a wonderful opportunity to identify new
resources and network with peers who work in similar settings. Most importantly, practitioners
discovered that even though they worked in different settings and locales, the
issues they faced were similar. It helped them feel less isolated and powerless
in the struggle to meet the increasing service needs of traumatized children
and their families.
Author’s
Note: The summary of the participant’s collective responses
follows. This process allowed us
to categorize needs, emerging problems and intervention strategies by
priority. TLC will use these
results to develop future programs and resources. This information will also
serve to document the need, which will be used to support future grant
proposals.
I
want to thank everyone who participated for the seriousness in which they
conducted their Breakout Sessions. Responses were thoughtful, thorough and
insightful. The first three days
of the Assembly were fairly intense. Even though many took the opportunity to
enjoy themselves during the evenings, all came ready to work Friday morning.
I
dropped in on each group during their Breakout Session. The one observation that was common to
all groups was the need to talk about specific cases or situations. Even though the Breakout Sessions were
quite structured, I had the sense that I was hearing a lot of ‘debriefing’
taking place. The intent of this
assembly process was to give practitioners a collective voice. I travel
extensively across the country and meet with thousands of professionals yearly.
The alarming message that is consistently expressed is, “We are being
overwhelmed by the sheer numbers of traumatized children in our care which is
intensified by the number of national disasters and constant threat of
terrorist activities, while at the same time resources for children are
disappearing, including the resources we need (time, money and training) to be
more effective and helpful ‘helpers’ in our settings and communities.”
After
talking with some of those who participated in this Friday morning process, and
reading the evaluations, I do believe participants felt less isolated, a little
less overwhelmed while, at the same time, being reminded that they are and can
be a major influence in helping traumatized children find some relief from the
terror of their experience.
1. What do you consider to be the
pressing need in the field of
childhood trauma?
All groups listed education and money as the most
immediate need. The need for training for themselves and the need to educate
the public about trauma, specifically parents, in addition to policy makers and
educators.
Every
group did not list money as a pressing need; however, it was seen as a
necessity to support training, education and the provision of trauma-specific
intervention in agencies and school settings.
Author’s
Note: It is interesting to note that evidenced-based research was
not identified as a need. In
practice, we know that there is a demand to respond immediately to emerging
problems. Substantial research of any interventions can take years to be
completed. In essence,
practitioners often intervene using strategies that are not research-supported
and are not likely to be for a long time.
However, at TLC we do believe there is a responsibility to at least
provide minimal documentation of outcomes with every client. It may be as simple as the client
indicating, “When I came I was an ‘8’ (on a scale of 1-10, with 10 being the
worst it could be) and now I am a ‘4’.”
Some documentation is better than none. When it comes to funding and support for continuing an
intervention process, documentation is key. Perhaps this is an area practitioners can attend to more
carefully. The reality is that
non-profit service delivery systems are now being held accountable for outcome-driven,
evidenced-based practices and programs.
The definition of what constitutes evidenced-based is still broad but
certainly will be moving toward a more structured, formal research definition
of what is acceptable.
2. Of the different approaches used which has
presented the best
outcomes?
TLC’s
Structured Sensory Interventions for Traumatized Children, Adolescents and
Parents (SITCAP) was identified by every
group. Beyond TLC intervention
programs, art and play therapy were identified but with no specific
descriptions. No other specific
interventions were identified such as EMDR, etc.
Author’s
Note: These results were surprising, as the group was comprised of
practitioners from varied disciplines whose brief survey responses indicated
the use of many strategies, including EMDR and CBT. In the group discussion that followed the Breakout Sessions,
several comments were made that those other intervention strategies were
successful and beneficial, but only in limited situations, whereas the SITCAP
approach was beneficial in an array of situations. The reasons given for this was the program’s focus on
sensory interventions versus cognitive intervention, and that SITCAP provided a
very structured series of interventions.
TLC
has always stated that there is no one intervention that ‘fits’ every child and
yet, working at the sensory level the many cultural, psychological, and
cognitive variables become less significant barriers than the traditional
approaches present. That said,
practitioners in today’s world need to be trained in several strategies. Although TLC’s primary focus is sensory
we do integrate our approach with cognitive approaches as well. The Practitioners Assembly itself
presented participants with over twenty-five different approaches to help
enhance the intervention choices available to help improve the child’s chances
of doing better.
3. What has been the worst part of working with traumatized children?
“Getting
parents on board!” Parental involvement was high on everyone’s list, followed
by working with children who had ongoing exposure and the sheer number of
children now presenting.
Multiple-generational trauma history was listed by several groups as
very difficult because of the deeply entrenched “victim patterns” of families
which can be overwhelming.
Throughout the responses “hope” or “staying hopeful” was a central
theme. It was a theme that was
applied to the children/families with multiple exposures and also to
practitioners retaining optimism in their ability to help. The absence of resources for children,
systems not supporting early intervention and intervention for younger
children, and over-medicated children were listed as “frustrations” by
practitioners. Finally, many
mentioned the absence of culturally appropriate resources and resource
materials.
Author’s
Note: This question was a difficult question because it asked
participants to discuss the presence, absence, or weakening of their own
resources in dealing with traumatized children. Compassion fatigue, the need to debrief, and “having to
remind myself I can only do so much,” was the theme presented by each
group. In the group discussion
following the Breakout Sessions, it became clear that agencies, organizations,
and schools did not generally provide staff the opportunity to debrief
periodically. All reported they
are given less time off to attend training, and that their mental health needs
related to vicarious trauma or compassion fatigue are not given support. Although systems and administrators may
be lacking in their understanding and support of the needs of staff working
with traumatized children, we find that the practitioners themselves have a
difficult time taking the initiative to “be good to themselves,” to turn to
peers for support, find the time to debrief, etc. At a time when demands on practitioners time continues to
increase, while financial resources for the same practitioners and the families
they serve decrease, practitioners will need to become strong advocates
of self care as well as be more disciplined in ‘taking time’ for themselves.
4. Of all that was heard, experienced the past three
days of the
Assembly
what one thought/experience stands out the most for you?
Given
comments to the previous question it was quite interesting that what stood out
for most was “The need to
celebrate what we do!” “I can make a difference!” and, “The need to network.” Many mentioned
the Assembly’s presentations on “taking care of yourself” and being introduced
to new approaches that were stimulating as well as comforting.
Author’s
Note: One of the objectives of the Assembly was to give
participants the opportunity to do some self-care, to re-energize, to increase
their sense of competency and confidence.
The group’s responses to this question supported the accomplishment of
this objective. Participants
identified that, “The sessions on taking care of one’s self were great!” along
with getting exposure to new ideas and new strategies. They also found helpful to learn that
their difficulties were not particular to their agency, school, city, county or
state but were shared by all the participants at the Assembly. There is no doubt that we need to do
more of the same at future assemblies and conferences.
5. What do you find to be the most intimidating/overwhelming?
One
of the most frequently mentioned factors was that of unrealistic expectations
placed on practitioners to “take care of the problem quick” by administrators
and others who do not understand trauma or take the view in so many words “This
is life, get on with it.” Also mentioned was the sheer frequency of large-scale
traumatic events in the country, like Hurricanes Rita and Katrina that just
adds to the day-to-day sense of being overwhelmed. Lack of experience was mentioned by a few, but a more common
theme was again knowing ones “personal boundaries” and how to protect oneself
from becoming traumatized through overexposure to so many
cases/situations. Finally, several
groups again mentioned lack of funding.
Author’s
Note: In many ways these responses summarize many of the
previously identified issues: the
need for funding, networking, self-care, support from others, and education and
training.
6.
If you were to
give your colleagues one bit of advice about working with traumatized children,
what would it be?
Self-care
was number one. Continuing
education followed in importance.
This was followed by, “Never make assumptions,” “Listen!” and, “Do not
overanalyze.”
Author’s
Note: Over the past fifteen years TLC
has stressed that it is impossible to know what is best for a traumatized child
until we can actually be a “witness” to how that child now sees himself/herself
and the world around him/her as a result of exposure. Not every child will experience a situation as
traumatic. The responses of “make
no assumptions” and “do not over analyze,” relate to the prevention of
over-intervening and creating unnecessary anxiety when it did not previously
exist. Misdiagnosis, the uses of
cognitive statements that miss the mark or further victimize the child occur
when we focus only on the situation, as opposed to how that child actually
experienced the situation. Books
cannot teach practitioners how to be “witnesses” which is primarily a sensory
process and the reason for TLC’s existence.
7. What is your “biggest resource”, source of strength?
Being part of a
team was the number one response.
This was followed by, “being passionate,” and “having faith that you are
valuable.”
Author’s
Note: Many of the participants of the Assembly could be classified
as ‘working in the trenches’ or ‘veterans’. Given earlier comments regarding practitioners difficulties
with self-care, working as part of a team emerged as being the most accessible
“self-care” resource practitioners have within an organization. A team provides some protection in that
responsibilities can be shared, “no one person is held accountable.” A team has a stronger voice than a
single individual. It is very
difficult to say “no” to ten people all proposing or presenting the same request. There are many benefits to working as a
team. What was evidenced in the
responses to this question was that education, training, funding, etc. was less
important than “not going it alone,” and “staying connected with peers.” Over the fifteen years of working with
schools and agencies across the country and spending time with thousands of
practitioners, I concur – being part of a team is not only a wonderful resource
but also good mental health for practitioners.
8. List three questions your group would
like answered before
leaving
today.
Responses
included questions and recommendations.
Several groups recommended TLC develop a bulletin board/message board
online so practitioners could continue to network as needed with one another. Others suggested having specified
‘online time’ for practitioners to do a ‘show and tell’ related to specialized
areas, a way to share strategies that have been helpful.
There
were many questions related to parent involvement, administrative “buy in,”
working with generational/trans-generational abuse, the traumatized infant
population, sexual offenders, somatic processing, working with non-verbal
children, and chronically traumatized children.
Author’s
Note: The questions related to interventions will become the focus
of presentations at the 2007 Assembly.
The suggestions related to online networking once again address the need
to work together, to be connected to others in the field, to better manage the
day-to-day exposure to difficult decisions. TLC will work hard to provide these
opportunities in 2007.
SUMMARY:
TLC
considers the 2006 Childhood Trauma Practitioners Assembly a wonderful
success. Not only were forty
different practice strategies presented but practitioners were given the
opportunity to work with peers from a variety of settings and different states
to identify what would help to improve upon their already existing expertise in
childhood trauma. It also provided
the opportunity to look at a variety of ways to better help them manage the
vicarious trauma that can be difficult in the face of day-to-day interventions
with traumatized children. TLC
will definitely incorporate these suggestions, recommendations, areas of
concern and expressed needs into the structuring of its 2007 Assembly. It will also move to develop more
online support for practitioners as well as written resources and training that
respond to the questions asked about specific populations and intervention
strategies.
If
you were a participant of the 2006 Assembly and wish to add to this report
and/or offer further assistance to TLC’s efforts to provide additional
resources please do email or call.
We do listen and we do certainly value your expertise.
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