David O'Rafferty, Dawn Briggs & Mel Robinson - Junction Australia - Identifying and Working With Complex Trauma

junctionaustralia.org.au

Junction Australia

Community Workers Conference

Melbourne July 2015


I would like to acknowledge the traditional owners of the land on which we are gathered and pay

my respects to the elders past and present


• Mel Robison: Team Leader

• Dawn Briggs: Service Manager

• David O’Rafferty: Portfolio Manager

Presentation Team


Therapeutic Support Services

Youth Connections

Nexus Residential Care

Fee for Service FLO

Junction Australia


Transforming Residential Care


Therapeutic Residential Care is intensive and time-limited care for a child or young person in statutory care that responds to the complex impacts of abuse, neglect and separation from family. This is achieved through the creation of positive, safe, healing relationships and experiences informed by a sound understanding of trauma, damaged attachment, and developmental needs. [National Therapeutic Residential Care Working Group, Australia]

Therapeutic Care


You should draw a picture

A picture with a twist

A picture with a knife

A picture on your wrist

If you draw it right

A fountain will appear

And in its flowing waters

All your troubles disappear

POEM


Abuse, Neglect and Separation From Family


There is another way


Take the time to look deeper


I have seen the light


• Attachment problems• Eating disorders• Depression• Suicidal behaviour• Anxiety• Alcoholism• Violent behaviour• Mood disorders• Developmental delays

Child trauma


IMPACT ON GROWTH AND DEVELOPMENT

• Chronic state of high stress

• Interpreting neutral cues as threat

• Explosive patterns of fight/flight behaviour

• Extreme patterns of freeze behaviour

• Limited resilience

• Wary of adults in relationships

• Deficits in processing skills


Is the impact of trauma, abuse and neglect during the critical period of early life. This results in the disruption of a child’s growth and development and changes physiology and nervous system responses. Depending on the timing of the trauma will determine the impact on the brain.

Developmental Trauma


Impact of neglect on the brain- Bruce Perry


Window of Tolerance


Co-regulation verses Co-dysregulation


Pervasive Shame


Epigenetics


Neuroplasticity


Children reflect the world in which they are raised. If that world is characterised by threat, chaos, unpredictability, fear and trauma, the brain will reflect that by altering the development of the neural systems involved in the stress and fear response.

What we have learned


• The brain is capable of change due to it’s plasticity.

• Change in the environment and experiences that are consistent, nurturing, caring and supportive all assist in this change.

Can this change?


• Intervention must begin in the Brain stem

• Intervention must match to trauma history, Understand the meaning behind the behaviour

• Intervention to match developmental stage

• Identification of trauma triggers to ensure you are not creating a re-traumatising situation/environment

• Identify the window of tolerance , safe practice of heightened arousal with co regulation

• Life story work - build narrative memory, healing of pervasive shame and guilt

How we create change


So what do we do?


TCI

CTARSYouth

Connections

Trained Staff

Building Blocks

Trauma Informed


• Seek out the best training and advice available

• Build links with other services and agencies

• Therapeutic Residential Care Network: 5 agencies in SA

• All leadership team doing Graduate Certificate in Developmental Trauma through ACF.

• Houses Supervisors training in Developmental Trauma with AFSS and ACF

• Teams training in Developmental Trauma in team meetings with Clinical Psychologist & TCI refreshers

• Other on going workshops and training

Trauma Informed and Trained


Child Centred Practice ModelTherapeutic Support Services: Practice Model

PORTFOLIO MANAGER

SERVICE MANAGER Team Leaders:

Casework Young People

Line Management of House

Supervisors

Case Conferences

Assist with attending

appointments

House Supervisors:

Manage the House

Maintenance

Rosters

Food & Hygiene

Living Skills checklist connects with Youth Connections

Weekly review

Support Workers:

Build relationship

One On One & Group time

Independent Living skills-

connects with Youth

Connections

Referral from PSU to

Service Manager

Transition &

Care Plan

Referral to

Youth

Connections

Weekly Phone review

Eight- Weekly Case Conference

with all Stakeholders

Transition to Long Term Placement

or Independent Living

3R’s

Respect…:

Self

Others

Environment

Team Leader: Supports Young Person to

access other services

Referral to other services

Mentors:

Independent Living Skills

RAGE

Life Through the Lens

A Life Outdoors

Drumbeat

Rock & Water

Team Meetings

Every two weeks

Clinical Psychologist

once a month

Individual management

Plan

Practice Forum

Incident reviews

TCI review


What makes you happy?


• Respect yourself

• Respect others

• Respect environment

• Expectations over Rules

The 3 R’s and Expectations


• Reactive Aggression / Planned Aggression

• Strategies: we respond to reactive aggression by assisting the young person to return to baseline and help them learn a new coping strategy

• With planned aggression we negotiate with the young person and then help them to find alternative strategies to achieve their desired outcome without using aggression.

We do not charge young people with property damage


Intake referral checklist

Initial TCP

Referral to Youth

Connections

Weekly reviews

TCP

15+ TCP

Post care

Trauma informed care planning


• Listening and responding with respect

• Communicating a framework for understanding

• Building rapport and relationships

• Establishing structure, routine and expectations

• Inspiring commitment

• Offering emotional and developmental support

• Challenging thinking and action

• Sharing power and decision making

• Respecting personal space and time

• Discovering and uncovering potential

• Providing resources

11 Interactional Dynamics – James Anglin


Rostering – promote healthy work/life balance Regular supervision – structured coaching, training, professional development

Debriefing sessions/On call support –reflective practice, unpacking of incidents, what worked well and how can we do things better next time

External assistance program - for all staff

Vicarious Trauma - Prevention, manage, repair


Clinical Psychologist


Train

Review

Reflect


Edition 6

Residential Child Care Project Cornell University 2009


Leadership and program support

Clinical participation

Supervision and post crisis response

Training and competency standards

Documentation and incident monitoring and feedback

THE TCI SYSTEM 1


• Assist organisations in preventing crisis from occurring, de-escalating potential crises, managing acute physical behaviour, reducing potential and actual injury to young people and staff, teaching young people adaptive coping skills, and developing a learning organisation.

Therapeutic Crisis Intervention


Incident Monitoring

and Feedback

Trainingand

Competency Standards

Supervision and

Post Crisis Response

Clinical Participation

Leadership and Program Support

ICT


Any thing that makes challenging behavior more or less

likely to occur.

For example:

Organizational culture, e.g., control oriented, poor communication

Environment, e.g., hot, crowded

Program related, e.g., routine, staffing, activities

Personal, e.g., illness, medication, trauma

Relationship-based, e.g., excessive controls, “us versus them” culture

CRISIS PREVENTION AND THE THERAPEUTIC MILIEU 2


Being aware of personal goals, values, beliefs

Understanding cultural and ethnic differences and each other’s worldview

Demonstrating self-regulation skills

Knowing personal triggers

THE IMPORTANCE OF EMOTIONAL COMPETENCE 8


A young person’s inability to cope

results in a change in behavior

THE STRESS MODEL OF CRISIS: A TYPICAL CRISIS 9


SUPPORT: environmentally and emotionally to reduce stress and risk

TEACH: children better ways to cope with stress







ASSESSING THE SITUATION 14

1. What am I feeling now?

2. What does this young person feel, need, or want?

3. How is the environment affecting the young person?

4. How do I best respond?


KNOWING OURSELVES 16

Anger can undermine objectivity

Anger is an emotional and physical state

Cognitive abilities are reduced


KNOWING OURSELVES 17

“When we are at our angriest, we are at our stupidest.”


KNOWING THE CHILD 18

Behaviors

Feelings

+

Needs


Assessing Behavior


All behavior has meaning

Behavior reflects needs

Trauma affects how children behave



Impulsive outbursts

Aggression

Running away

Self-injury

Defiance

Inability to regulate emotions

Trauma re-enactment


CRISIS COMMUNICATION AND ACTIVE LISTENING 27


BEHAVIOR SUPPORT TECHNIQUES 33

Managing the environment

Prompting

Caring gesture

Hurdle help

Redirection and distractions

Proximity

Directive statements

Time away


THE CONFLICT CYCLE 40


MANAGING AGGRESSIVE BEHAVIOR 43





REACTIVE PROACTIVE

Safety Safety

Understanding and support Containment and negotiation

Remove or reduce stimulus Engagement and reasoning


THE LIFE SPACE INTERVIEW 64



1. Return the young person to normal functioning

2. Clarify events

3. Repair and restore the relationship

4. Teach new coping skills

5. Reintegrate the young person back into the program



I – Isolate the conversation

E – Explore young person’s point of view

S – Summarize the feelings and content

C – Connect feelings to behavior

A – Alternative behaviors discussed

P – Plan developed/Practice new behavior

E – Enter young person back into the routine

Conducted by the care worker


Database system CTARS


• CTARS+ is innovatively designed to bring together all the paper-based data collection and record keeping that's done on the ground in high needs youth services or services for people with complex needs. CTARS+ combines incident reporting, progress notes, activity logs, behavioural logs, and data logs, along with the range of other critical data systems into one web-based software program.

Client Therapeutic Analysis and Reporting SystemWhat is CTARS?







































Youth Connections

Mentor Program


Youth Connections

Supporting children & young people to become the authors of their future

instead of victims of their past.


Youth Connections is a mentoring program which focuses on building self-esteem, resilience and self-worth in children and young people healing from trauma and neglect.

About Youth Connections


• The mentors operate from a trauma informed practice framework.

• Mentors understand that lack of attachment and exposure to trauma during their early developmental years may affect a young person’s ability to regulate their emotions.

Our Philosophy


MENTOR: “WHAT CAN I DO TO HELP?”

YOUNG PERSON: “Can you just give me some more time……….”


• This program uses a strength's based approach to support each young person to identify their ‘SPARK’ and provide opportunities to embrace and explore possibilities.

• Fostering a young person’s SPARK can give a young person meaning and purpose in their life to improve emotional, psychological and social well-being.

Finding your SPARK


• This is achieved through individualised and group activities, both informal and structured.

• The young people are offered a range of activities and outings to explore their strengths and interests.

• Many of our young people have not had the opportunity to identify what they are good at or what they enjoy doing.

Finding your SPARK cont…


These activities are some of our starting points to engage and explore possibilities with young people for future pathways.

Drives

Photography

Bike riding

Cooking

Art n Crafts

Favourite Activities


SCENIC DRIVES


Throw in a camera and….


You get the picture




Creating memories


Bike riding & Skate parks



BMXing @ SYX


• Cooking is an instrumental part of our program. This ensures a healthy lunch and also supports them to develop independent living skills in an informal way.

Cooking


Seasonal Activities


Arts and crafts.




Drawn from memory – 8yr old


PLACEMAKING



Life through the Lens


Young people are encouraged to look at things from different perspectives, connect with their school and community through images taken and think about creative ways to display their work.

Through the eyes of Children


THE SKY IS THE LIMIT


new age old skool


SAFETY


alone community


Throughout the program young people are supported and encouraged around the ideas of RESPECT, FOCUS and PERSPECTIVE.

Perspective



Creating memories



Calm B4 The Storm



• The Holyoak Drumbeat program is run over ten weeks and combines the benefits of music to a cognitive approach that develops self-awareness and social learning.

• It was developed to support people who are resistant to traditional ‘talk based’ therapies.

DRUMBEAT


• We use the African DJEMBE drum which acts as a safe form of connection and communication.

• The drumming allows for a therapeutic release of emotion.

African DJEMBE drum


The young people use analogies drawn from the rhythm’s they learn to explore many social and relational issues such as;

• Peer pressure

• Risk taking – safe and unsafe

• Identity

• Emotions and feelings

• Communication & teamwork

Cognitive Approach


Music and the Brain


Life OutdoorsUsing the natural environment we engage in activities that become gradually more challenging.

Young people achieve success over their physical environment, as well as developing self-confidence and self-awareness.


Kayaking


Surfing



Taking Time


Playing it safe Ready for action


I’m with you All the way




(Renegotiating Angry and Guilty Emotions) is a six week anger management program that uses a strengths based rather than problem oriented approach.

The program encourages the young person to gain confidence within the group and themselves before they learn to deal with the most misunderstood human emotion – anger.

R.A.G.E.


Managing the Bull is a six week course that aims to build social resilience in teens who feel they are being bullied.

Through fun games, activities and group discussions the program teaches young people how to profile a bully and equips them with useful strategies on how to manage them.

Managing the Bull


When should we stand firm like a rock…

And when do we let ourselves be fluid and responsive like water…..

Rock ‘n Water


Back to Nature


Fishing


Nature Walks


Exploring


Whale watching


Snorkelling


Nature Therapy


Reach for the sky


Independent Living SkillsThe Independent Living Skills Program aims to support

young people transitioning from our therapeutic houses in to their own homes by developing and sustaining independent living skills.

Specifically the program aims to:

• Improve rates of sustainable successful tenancies through improving living and social skills

• Increase knowledge of and access to local support services to secure and support housing tenancies

• Increase opportunities for young people to develop leadership skills by participating as peer mentors.


Topics Covered:• Job Descriptions

• Resumes

• Mock interviews

• Applying for jobs

Job ready


Culture Connections Girls Group


Girls Group

https://www.youtube.com/watch?v=XtdKEl-0krA&feature=youtu.be


This is their journey


Conclusion


• Therapeutic crisis intervention training • Part-time permanent staff employed by JA• Trauma informed foundation• Setting a criteria for what is an incident • Structured rostered team meetings with Clinical

Psychologist• Structured supervision and review processes• Client involvement and feedback• Therapeutic environment• CTARS – a data base system • Mentoring program

Factors resulting in reduction of incidents and improved outcomes


2012/13 Prior to TCI 2013/14 TCI Framework 2014/15 TCI Framework

Mulberry 48 51 3

Gulfview 24 18 0

Parkview 61 67 13

4851

3

24

18

0

61

67

13

0

10

20

30

40

50

60

70

80

Axi

s Ti

tle

TSS Incident reports 1st July 2012 - 30th June 2015


2012/13 Prior to TCI 2013/14 TCI Framework 2014/15 TCI Framework

Mulberry 137 270 155

Gulfview 164 84 61

Parkview 254 65 45

137

270

155164

84

61

254

65

45

0

50

100

150

200

250

300

Axi

s Ti

tle

TSS Missing Person Reports 1st July 2012 - 30th June 2015


• Our legacy is for every child or young person who stays with us regardless of the period of time, felt they were treated with respect and dignity.

• That each young person who has stayed with us will remember their stay with Junction Australia as a positive experience.

• Young people are proud to say “l lived there and l was respected and cared for.”

Legacy







• For Therapeutic Crisis Intervention: Therapeutic Welfare Interventions twi.org.au

• Australian Childhood Foundation: childhood.org.au

• Cornell University: rccp.cornell.edu• Professor Dr James Anglin: uvic.ca• Dr Bruce Perry: childtrauma.org• Dr Dan Hughes: danielhughes.org• Dr Dan Siegel: drdansiegel.com• Dr Allan N. Schore: allanschore.com

Contacts

http://www.childhood.org.au/

http://www.childtrauma.org/

http://www.danielhughes.org/

http://www.drdansiegel.com/

http://www.allanschore.com/


Thank You

David O'Rafferty, Dawn Briggs & Mel Robinson - Junction Australia - Identifying and Working With Complex Trauma

Government & Nonprofit

impact of trauma

australia therapeutic

developmental trauma

statutory care

impact of neglect

timelimited care

service flo junction

developmental needs