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Excuses

"I guess I can understand how his trauma history can be an excuse for his behavior yesterday" Sarah, a child care worker, said to me in training. "But today, he was feeling fine and I don’t see how his past is an excuse today."

The fact is that a child’s trauma history is never an excuse. It is always a reason. The child’s daily life, emotions, and thoughts are always affected by their past. The child’s biologically different, hyper-responsive nervous system does not change from day to day. His distrust of others is always present. His fear of being weak or vulnerable remains a part of his choices. His lack of emotion management skills, his sense that he is not worth while, that he is to blame for everything bad that happens, his inability to maintain a connection with others, stay present in every day life.

However, this does not mean that the child cannot change. He can begin to feel safe and to relax. He can slowly learn to trust a few people. Through experiences of success and approval from others, he can discover positive parts of himself. He can learn feeling management skills.

If a child had diabetes, we would not refer to his diabetes as an "excuse" for his reaction to sugary foods. We would not speak of his diabetes as an "excuse" to avoid eating certain foods. We would hope that the child would gradually increase in his competence in managing his diabetes, and would use the skills and technology available from others, and would lead a largely normal life. And, the diabetes would be always present as a reason for some actions and choices.

Even if a child had a broken leg, we would not call his broken leg an "excuse" to avoid a hike. If we were taking the child some where, we would make adaptations to promote the child’s success on the trip. We might bring a wheel chair for long distances. We would plan frequent stops to rest. We would teach him how to use crutches and bring them along with us. We would not be blaming the child for needing these adaptations.

At the same time, we would expect the child to get better. We might enroll him in physical therapy and encourage him to work hard at the exercises. We would gradually do less and less for him as he healed. His whole leg cast would be reduces to a smaller cast and then to a bandage. There would be a constant balance between understanding his pain and incapacity, and supporting his efforts to heal.

How we speak about kids can strongly influence how we feel about them and thus how we act towards them. When we speak of their trauma histories as an excuse, we imply that kids should have no responsibility and that what will help them is to simultaneously blame them for their incapacity and to have low expectations. This is, in fact, the opposite of what will help. If instead we understand the child’s trauma history as a reason, a fact, a condition they have been given, we will both not blame them, and we will have hope for their potential to heal and to achieve greatness.
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Thinking Blogger Award

I was tagged for a Thinking Blogger Award!

Congratulations, you won a Thinking Blogger Award! The participation rules are simple:
If, and only if, you get tagged, write a post with links to 5 blogs that make you think,
Link to this post so that people can easily find the exact origin of the meme,That was that! Please, remember to tag blogs with real merits, i.e. relative content, and above all - blogs that really get you thinking!

This all started at:
http://www.thethinkingblog.com/2007/02/thinking-blogger-awards_11.html

The blog that tagged me is:

http://theyreourchildren.blogspot.com/
And I was very interested to discover this blog and add it to my reading list.

This is the link to the entry in which I was tagged:
http://theyreourchildren.blogspot.com/2007/09/thinking-blogger-award.htm

I was also fascinated by another blog that was tagged, Sunshine Girl On A Rainy Day. She's a former foster child who now writes about foster care issues and how kids in foster care could be better served. Very interesting!

So now I have to tag 5 blogs that make me think. I have not been able to find many blogs in the therapy world, so if any one knows good ones please post in comments. I read a lot of blogs about promoting change, and non profit management.

One of them is: Change This
http://blog.changethis.com/changethis_newsletter/
"ChangeThis is creating a new kind of media. A form of media that uses existing tools (like PDFs, blogs and the web) to challenge the way ideas are created and spread. We're on a mission to spread important ideas and change minds." Since I am working on changing how treatment is provided to children, this blog often gives me good ideas.

World of Psychology
Dr. John Grohol's daily update on all things in psychology and mental health. Since 1999.
http://www.psychcentral.com/blog/
This blog is part of Psych Central, "the Internet's largest and oldest mental health social network created and run by mental health professionals to guarantee reliable, trusted information and support communities to you, for over 12 years." It contains updates of the latest news and information in the mental health field, which can be very helpful.

The Trouble With Spikol
http://trouble.philadelphiaweekly.com/
is a blog by Liz Spikol, "managing editor of Philadelphia Weekly. She writes the award-winning column which began as a chronicle of her struggle with mental illness, and has since expanded into humorous musings on everything from graphic novels to how to use a mop. This blog is about mental illness- policy, news, personal journeys and more." I like the combination of personal experience and news updates.

Net Squared
http://www.netsquared.org/blog
New Squared is a central site for the non-profit community which introduces us to Web 2.0. They state that: "Our mission is to spur responsible adoption of social web tools by social benefit organizations. There's a whole new generation of online tools available - tools that make it easier than ever before to collaborate, share information and mobilize support. These tools include blogs, wikis, RSS feeds, podcasting, and more. Some people describe them as "Web 2.0"; we call them the social web, because their power comes from the relationships they enable." I have gained much useful information here.

Nonprofit Communications
http://www.writing911.com/blog/

Descibes its content as: "Tips and ideas on nonprofit communications, publications, marketing and PR. As a nonprofit consultant, I love helping organizations communicate more effectively with their members, donors, volunteers and other supporters, so they can make the world a better place." I like the fact that each entry is a "carnival"; a compilation of many articles on a certain subject. It is a wealth of information.

Then here is a bonus blog. I love Mind Mapping and use Mind Manager for all my planning, writing and thinking. Therefore I also love the official Mind Jet blog:
http://blog.mindjet.com/

"This is the blog of the Mindjet Corporation, the makers of MindManager® software. Mindjet Corporation is the leading provider of productivity software for visualizing and managing information, allowing individuals and teams to more effectively think, plan, and collaborate. The Mindjet® MindManager® enables users to visually connect and synthesize ideas and information to improve decision making, shorten business planning processes, and harness the intellectual capital in their organizations."
I get many ideas as to how people are using Mind Manager in new and creative ways.

I hope this post leads you to some interesting reading. Please add your own favorite blogs in our field in the comments. Thanks!
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The Children are Running the Program

"Help us Pat!" the call comes in.
"We need you. Ever since we moved away from points and levels, the children don’t care what they do. They are getting worse and worse, rude, defiant, acting out. Since they don’t lose points they have no deterrents to bad behavior. A two-minute apology letter means nothing to them. We need to put back some more consequences."

What are the assumptions behind this plea for help? That the main reason that the kids ever acted politely was because they would lose points if they didn’t. And that the only response we have to address problem behavior is consequences.

Do we really believe this? I don’t.

What about the relationships?I think what happens is that when the behavior management system of a program is changed, if we are not careful a staff paralysis sets in. If I cannot take away points or drop levels, what can I do? So I do nothing, and sit by helplessly, another sort of neglect.

In fact, points, levels and consequences are a small part of our arsenal of tools to impact the kids’ behaviors.

Here are some other tools:
· Talk about it. Say you don’t like it. Describe how the behavior affects you and the other community members. Express hopes that change will happen.
· Work hard and constantly to form caring relationships with the kids so they care what you think.
· Validate the feelings behind the behavior.
· Express an understanding that this is the best the kid knows at the time- and the hope and confidence they will learn better.
· Develop in the child the basic feelings management skills of maintaining an inner connection to others, feeling worthy of life, and feelings management.
· Teach specific feelings management skills to do things differently.
· Use feelings management skills your self and label out loud that you are doing so.
· Have group meetings about what kind of place we want here.
· Have group meetings about bad things that happened and how everyone felt and how we can support each other to do better.
· As a team, discuss how we understand this behavior. What is our formulation about what is going on here? What problem is this behavior solving for this child? How can we teach her to solve that problem a better way?
· With the kid, develop a treatment theme- what is the basic thing this kid is working on? Examples would be: feeling emotion without acting to make the situation worse. Learning to trust. Growing up. Then relate all behavior to that theme.
· As a team support each other in the long, difficult process of doing this work.
· Work on developing self worth.
· Address shame.
· Use (possibly as restorative tasks) exercises that help the child understand and manage his behavior, such as mood charts, emotion thermometers, collages of how they are feeling and/or things they can do differently, interviewing others about how they handle emotions, etc.
· In treatment team develop restorative ideas for each child that are significant, require thought, and are related to their treatment.
· Don’t take the kid on trips when they have just hurt you- and explain why you don’t want to.
· Make sure you have enough fun and interesting things going on so that kids who can’t participate because they are working or restorative tasks will be missing something they want to do.
· Make sure your structure and planning supports success.
· And- TALK ABOUT IT. Address every problem. Take the kids on. Tell them what kind of behavior you expect. Tell them how different actions make you feel.
· And tell them, and show them, over and over again, all the good things you see in them and how delighted you are by everything positive (and even neutral) that happens.

Points and levels are so insignificant when compared with these (and other) more powerful tools. Changing to a trauma focused approach does NOT mean paralysis in the face of destructive behavior. It means active, complete and relationship based engagement. And then both the staff and the kids will be co-running a programs that supports growth and change in all.

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Attention

Many times when we start discussing what is going on with a particular child I hear staff say: "she is just doing it for attention". We say this dismissively, as this invalidates the behavior and means we don’t have to take it seriously.
If you go to a play ground where children are playing and adults are near by, what do you hear constantly from the children: "Look, Mommy!" "Daddy, watch this!" "See how high I can go!" The children are clamoring for attention.
In fact, as adults we also demand attention. When you receive a compliment or an honor, do you call someone to tell them about it? Do you get upset if you try to tell your partner something and they are not paying attention?Attention is the food of the soul, the building material of the brain. It is necessary for growth and change. It is through the attuned attention of another that our brain develops and we form a sense of who we are, what the world is like, and what we can expect.
Attention is one crucial part of what was missing in the development of traumatized children. They were not central. Their needs were not put first. Often there was no one to listen to their stories and to take their disappointments seriously. Their needs were problems to be dismissed, not legitimate. Their cries were not answered. They have an attention deficit- not just that they cannot concentrate, but that they have empty spaces that have not been filled through the loving attention of another. No one was watching.
And now they are in treatment programs in groups of 12, 14, 17. Adult attention is in short supply, and is often monopolized by extreme behaviors. It some times seems the only way of being heard is to scream.
Paying attention is the greatest gift you can give another person. So next time you hear the words "he was just doing it for attention" stop. Pay attention. Listen. Express delight. Remember. Comment. Watch. Look, and describe what you see.
Attention is the nourishment you can give that will enable others to grow.
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Change Your Conversations, Change Your World

You can further your change towards a trauma informed treatment program by changing the conversations you have as a staff.

Lisa is a sixteen year old girl who has been at this therapeutic group home for almost a year. During that time she has been known to sneak off and be where she is not supposed to be, and to lie to staff. However, recently she has been doing really well and everyone is quite proud of her. Lisa is scheduled to be transferred to a lower level of care shortly- a graduation which makes her staff very proud.

The other night Lisa sat with her favorite staff and said she had some thing to tell her. She then proceeded to confess a series of occasions when she had lied that no one knew about- such as saying she was at her job when she was really with her boyfriend, and sneaking out of the house at night. These things happened weeks and months ago.

What is the FIRST thing that you talk about at a staff meeting?

Is it what is the correct consequence- should she be grounded even though these things happened a while ago? Do staff take sides on yes, ground her, she needs to learn; no don’t ground her after all she told us voluntarily?

If this is your conversation, the fact that you decide not to ground her does NOT prove that you are using a Risking Connection® / Restorative Approach™ approach.

Instead, your first conversation, and ultimately the only interesting one is: what is going on here? Why is Lisa telling us these things? What was happening with her when she was doing them and what is happening now? Of course, her telling this is probably related to her impending discharge. She is probably saying: Look you guys I’m not so sure I am ready for less help. I know you are proud of me and all but I am scared to death. Plus I don’t want to leave you just as I am finally getting used to you. Look what I am capable of- I should stay right here.
And that conversation leads us to lots of possibilities. Is there more we can do to help her get to know the people at her new place? What conversations can we have with Lisa about her fears of going, the difficulties of saying good bye, and what she needs? We do not need to lecture her on the dangers of running away, or how she will never keep a job if she is not reliable. Instead we can talk about what it all feels like to her, the job, the boyfriend, this group home, the place she is going.

And with these interesting conversations going on we never even need to get back to boring subjects like whether or not she should be grounded.

If you want to change your program, after every event ask: what is going on here? What does this behavior mean? How is this action an adaptation for the kid, what problem is it solving for her? How can we help her to meet her needs another way?

These thoughtful conversations among staff and with the kids will strengthen relationships, teach feelings management skills, help the child (and staff) feel sane and worthwhile, and offer the greatest possible power for healing.
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Cereal on the Counter

Scenario number one:

It’s a school day and Dahlia is sluggish and half awake. She scatters cereal all over the counter and leaves the milk out when she goes over to the table to eat. "Dahlia!" Mary, a staff member says. "Clean up this mess you made! Put away the milk!"
"No" replies Dahlia. "You do it".
"Dahlia, I have given you a directive. Please get over here and put away this milk and clean up this mess!" Mary insists.
"F you" replies Dahlia.
Eventually Dahlia leaves for school, counter unclean, milk untouched. Mary cleans it up.
Mary is fuming. "These girls" she says to a co worker. "They are so lazy and they have no respect for me or for this house. They are hopeless. How will they ever be able to live on their own?"


Scenario number two:

It’s a school day and Dahlia is sluggish and half awake. She scatters cereal all over the counter and leaves the milk out when she goes over to the table to eat. Mary looks at the counter and says: "Hey, Dahlia, what a mess. How about I’ll put away the milk- will you get the counter after you are done eating?"
"Okay I guess" says Dahlia.
After she is done with her cereal Dahlia cleans off the counter in a half-hearted way, leaving some cereal. Then she goes off to school.
Mary finishes up the cleaning.
"Ahhh, teen agers" she thinks to herself as she goes on with her tasks.

Which was your morning like?

We have all had both types.

Notice the power of how a request is made: a "staff directive" or a request and a mutual effort.

But even more important notice the power of how an event is defined. Is this an obstinate child defying a Staff Directive, a sign of disrespect and a hopeless future? Is it clear evidence that the child has no caring for Mary or for the house? Does it demonstrate beyond doubt that Dahlia will never manage her own life well?

Or is it a teen ager in the morning?
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The Real World

I have not written anything in this blog for a while because I have been working on a SAMHSA grant application that has demanded every bit of free time and writing energy I could dredge up.

However, in a Risking Connection® training we were doing recently, a participant made the familiar objection: "we are not preparing these kids for the Real World". I’ve heard this a lot. The idea is that if we do not punish the kids for their behaviors they will never learn that these behaviors are not tolerated in the Real World- we are coddling them, spoiling them, and giving them an unrealistic view of life.

Consider the following analogy:
My 8 year old friend Ryan is in Instructional Little League this year. In this league the kids get five strikes, some times more if the coaches decide that the ball throwing machine isn’t working right. Everyone always says encouraging things to them: "good swing Cameron" (Ryan's team has three kids named Cameron, two girls and a boy) for a strike; "nice try" for a throw to a completely unpredicted part of the field. And the coaches constantly teach the kids skills: move your foot up a little. Keep your eye on the ball. Move your body to catch the ball, don’t just stretch. Every thing the kids do that is even remotely in the direction of what they are supposed to do is highly praised. They can only run two bases (otherwise everyone would get a home run every time, as no one ever catches the ball) and the innings are over when a team gets 5 runs. Obviously, the idea here is to begin teaching the kids the skills, and to limit the humiliation/ disappointment/ frustration they feel so they will want to play again. The game is set up to encourage success and limit damage.

And no one ever says: "we aren’t preparing these kids for the Real World if we give them special treatment like this".

Maybe we can consider our treatment centers to be instructional real life.

In the actual Real World ideas of Restorative Justice are gaining ground, and many more court systems are using them.

I would also hope, however, that the Real World that our kids live in will contain (as mine does) people willing to negotiate, and flexibility, and understanding. I hope that they will not in fact be punished for everything they do wrong (luckily, I am not). When they hurt someone, I hope they will have a chance to make up for it and heal the relationship. I hope that their Real Worlds will not be characterized by unremitting harshness.

In the mean time, maybe we can continue with the Instructional level and teach them skills, encourage them, and limit the damage so they will want to continue to play.
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