Trauma Focused Rec Therapy Sound Test Do you
- Slides: 107
Trauma Focused Rec Therapy
Sound Test Do you hear me? Type “yes” in the question box.
Sight Test What animal do you see? Type “dog” in the box.
Important: Got questions? There is an inbox to submit questions. You can also email me at my personal email: Danny@Danny. Pettry. com I’ll reply. I might not see your question in the inbox in this webinar and wouldn’t leave you out. .
Icebreaker • What age group to you provide services for?
Icebreaker • What age group to you provide services for? • What setting?
Icebreaker • What age group to you provide services for? • What setting? • What treatment needs to this population have?
Icebreaker • What age group to you provide services for? • What setting? • What treatment needs to this population have? • What do you hope to get out of this session?
Pretend to Laugh!
Enough humor already. These jokes are “ruff. ”
But for real… I get it. You’re a busy professional. You’re here to get your CEUs and possibly learn something too.
And If You Stay Until The End. . . I’m going to give you several gifts!
Do you want the slides? • I’ll pass around a notepad so you can put your name and email. • I’ll email you the slides to you.
Need Your Attention Please. . .
I Need Your Attention Please. . . • Turn off cell phones • Turn off Facebook • If you're a Recreational Therapist and you’re serious about helping children to make positive character choices… then you’re going to want to stay focused…
Why is it good to stay focused? • It makes you smarter • I was recently reading, Dan Hurley’s book: Smarter. • One of the tips was being focused on one thing/ being mindful. • Author, Tim Ferris had a blog entry that said multi-tasking kills brain cells.
You might be asking yourself: • Who is Danny Pettry? • Why is he qualified to present this session?
I want to briefly discuss my credentials And Then I want to tell you everything I know about trauma-informed care for children.
Who is Danny Pettry? • Professional Practitioner – Completed undergraduate internship (in 2002) with adults and seniors for an acute-care psychiatric unit at a medical center. – First job offer (Aug. 2002) was providing services for children with abuse-reactive needs. I’ve worked there ever since.
My Qualifications • I maintained full-time employment while completing two graduate degrees! – M. S. Recreational Therapy, Indiana University, 2006, where I studied with Dr. David Austin. – M. Ed. Mental Health Counseling, Lindsey Wilson College, 2012
My Awards Employee of the month several times
2014 Practitioner of the Year by Child Life Association
My real qualification
Credentials • Certified Therapeutic Recreation Specialist (CTRS) since 2003 • National Certified Counselor (NCC) since 2013. • I am a Licensed Professional Counselor (LPC) in a state that does not license rec therapists yet.
Specialization • I’ve provided services for children with abusereactive needs since 2002 (16+ years). • I’ve had a lot of experience with children and adolescents who’ve experienced trauma • And a lot of experience with TF-CBT.
Okay that is way too much about information about me. Because This Session is About YOU and providing you with tips to help children who’ve experienced trauma
Today - you’ll discover what you need to know about trauma-focused Care
About the kids • The kids in this program have had some type of abuse: physical, emotional, sexual, neglect, witness to violence. • These kids have reactive behaviors that consist of: physical aggression, verbal aggression, sometimes sexual acting out behavior, and other self-destructive behaviors.
IF a Kid speaks Spanish? • How do you imagine that kid learned Spanish? – Parent – Teacher – Neighborhood friends – School – Television
IF a Kid is acting sexually? • How do you imagine that kid learned that behavior? – Parent – Teacher – Neighborhood friends – School – Television
Trauma Impacts Children • It is often easier to understand a solider returning from war, or a survivor of 911 or the Boston bombings. • Sometimes, Based on my experiences, people forget kids can be traumatized too (by events we don’t know about). • My pet peeve: “that kid is being a brat. ” • The truth: that kid has been traumatized
Video time • Rescuing an abused dog: https: //www. youtube. com/watch? v=xh. Lri. N 3 n. B d. E
Video time • Abused dog being gently petted for the first time: https: //www. youtube. com/watch? v=WChy. Gk BPv. ZI
Video time • Abused dog: shutting down: https: //www. youtube. com/watch? v=g. Mi. Op 5 uv dlo
RESULTS! / PROOF! • Evidenced-based practices • What works • The models provided today are grounded in evidence.
What We'll Cover: • Introduction: About the Child with Trauma • Part # 1: Trauma-Focused Cognitive Behavior Therapy (TF-CBT) • Part # 2: Dialectical Behavior Therapy (DBT) • Part # 3: Humanistic Approach • Outcomes: A Healthier Functioning Child!
Introduction: About the Child with Trauma
Assessments • Trauma Symptom Checklist for Children (TSCC) is often used by mental health counselors. It is valid way to determine symptoms. Six clinical scales: Anxiety, Depression, Posttraumatic Stress, Sexual Concerns, Dissociation, and Anger.
Rec Therapy Focused • Read reports in Medical Records/ patient history (so you won’t trigger by accident). Of course, it will happen and you learn as you go. • Rec Therapy assessment covers: social, emotional, cognitive, physical, and ( • Strength-based – what is working – build on it
Rec Therapy • It really doesn’t matter what the “recreation activity is” as long as you’re brining about improved: interpersonal skills (people skills), affect regulation skills (coping with emotions), distress tolerance skills (coping with emergencies), cognitive skills (promoting frontal lobe activity) and physical health and wellness (as well as safety skills)
Part # 1: Trauma-Focused Cognitive Behavior Therapy
TF-CBT • There is an easy-acronym for this model. • It is: PRACTICE
PRACTICE • • P - Psycho-education about trauma R – Relaxation skills training A – Affect regulation skills C – Cognitive Processing skills T – Trauma Narrative I – In-vivo C – Conjoint family therapy E – Enhancing safety skills and social skills
Trauma Brain • The brain doesn’t do well after a traumatic event. Frontal lobe is impaired. • Think of it like a fire alarm that has gone faulty. • The brain is now triggered to “go off” when it might not be an emergency.
Psycho-education • Teach the symptoms of trauma. • Let the child know it is not her (or his fault) • Let them know about the good news – that therapy (TF-CBT) has shown to help! • A Terrible Thing Happened by Margaret Holmes is a book I read
The book
Possible symptoms • • • Anxiety, depression, anger Sleeping problems, nightmares, bedwetting Aggressive behavior Stomach aches/ head aches Loss of appetite Don’t want to talk about it.
Relaxation Skills Training • This is major recreational therapy ideas: • Hobbies, music, sports, yoga, imagery, progressive muscle relaxation (PMR), deep breathing, music, (See DBT skills in next section). • Relaxation cards game! • Animal Yoga Cards
Relaxation skills • Healthy distraction to get mind away from dwelling on past or worrying about the future • PMR: kid friendly names – squeeze the lemons, tin man to rag doll, toes in the sand, mad face – relaxed face.
Affect Regulation Skills Training • Learn to identify more feelings. • IT is okay to feel all feelings. • Create emotion cards – how many can you identify • Then ask to share aloud what was going on with each emotion.
Monster emotions • Poster was created by a rec therapist. • Of course facial expressions work • Use pictures from newspapers or magazines with cut out faces
Play therapy – color my heart • List emotions. Add a color for each emotion (like a key) blue could be sad or red could be angry – let kid pick colors for emotions. Good for assessment and evaluation.
Emotions intensity • Scale 1 to 10 • How to bring it down a notch or two
Trauma Narrative • • This is the hardest part of therapy The child tells his (or her) story. Complete autonomy. Sometimes this process starts to leak out in rec therapy – self-expression groups.
Autonomy • • • Write a book Set it up in sandbox tray and take photos Act it out – drama Make a comic book And other creative ideas Collages
Five chapters of a TN • • • All about ME the wonderful kid A positive memory or a super hero The bad thing (or things) that happened to me What I’ve learned in therapy My hopes, wishes, and dreams for the future!
Never pressure • A child should not be forced into giving a trauma narrative because that could do more harm than good. • Most who complete one share aloud feelings of relief and freedom. It has therapeutic values.
In-Vivo Exposure • This involves identifying triggers. • May be returning home to a place where triggers occurred • And learn ways to use relaxation and cognitive processing skills (from earlier sessions)
Conjoint Sessions • Getting the child and caregiver (legal guardian) person she (or he) is returning (with mental health therapist) • Rec Therapist is often one going on community re-entry passes with the child and family member. Focus on trusted adult, support from adult. Identify concerns.
Enhancing Safety and Social Skills What can you do if. . Situations Simplyfun. com has a really neat key chain with safety skills questions/ and social skills questions. Works great.
Review • PRACTICE – – – – Psycho-education Relaxation Affect/ emotions regulation Cognitive processing TRAUMA Narrative In-vivo Conjoint Family Enhance safety skills and social skills
Part # 2: Dialectical Behavior Therapy (DBT)
Developed by: • Marsha Linehan as a treatment for people with Borderline Personality Disorder. • Previously, in the DSM-IV, personality disorders fell under the Axis II as they were thought un-treatable. • The DSM-5 does not have Axis II. There are treatments for personality disorders- i. e. DBT
Dialectical • Two ends of a pole. Both could be right – Planned a party – but people don’t have fun. • For teens, I like to play, Alanis Morissette’s “Isn’t it ironic. ” – Won lottery – died next day – Good advice – didn’t take.
The focus • Creating a life worth living!
Validation is key • Validate that their emotions are real. Their experiences are real. Their suffering is real.
Four Main Skills are Taught My internship supervisor in mental health counseling uses an acronym that one of her patients had created for the four skill-sets: • D: distress tolerance skills • I: interpersonal effectiveness skills • M: mindfulness meditation skills • E: Emotional regulation skills
Distress tolerance skills • Learn skills needed to cope with distress • Becoming more flexible • Acronyms like: – IMPROVE – Imagery, meaning, prayer, relaxation, one-thing-at -at-time, mini-vacation, encouragement (self and from others)
Interpersonal skills • People skills/ Assertiveness skills/ manners – DEARMAN • • Describe the situation (facts only) Express emotions Ask assertively Reinforce the benefits Mindful – stay focused Act confident Negotiate
Interpersonal skills • People skills for keeping relationships • GIVE – – Gentle Be Interested Validate Easy-going
Teaching manners • This isn’t DBT, but I use my own book, Building Character to teach children basic banners.
The concept is • If you’re rude and disrespectful – it pushes people away. • Kind of a cycle: • They don’t like me – I’ll yell at them – they leave. I knew they didn’t like me – so, I’ll keep being mean to me. Why don’t they like me?
Mindfulness Meditation • Difficult concept to teach. • I’m still struggling. • I often call it FOCUS time for children.
Book that teaches Mindfulness
Focus • On the past: dwelling – feel bad. • On the future: dwelling – feel worried. ? • The focus is here and now. OF course a person could have rough feelings in the moment, but it would be a lot worse if you add the past problems and future worries to the moment. • Just do the moment – get through it.
Focus • Inside – – Your breathing Your heart-rate Your thoughts Your feelings • Outside – – – Sights Sounds Smell Scents Sensations
Loss of Focus • It happens. Your mind will start to think of other things. • Someone said it was like training a puppy to sit still in one place – it will get up and go, but you return the puppy to place. – the same with your mind. • Don’t give yourself a hard time.
Sample • On a nature trail – great outdoor experience. • Focus on the moment – it is enjoyable. Nature smells nice. Beautiful colors. Awesome view. And my mind slips to progress notes or bills or family concerns or relationships and I’m like – okay back to relaxing in the moment. • Spend some time in nature! Smell the roses!
Emotional Regulation skills • Learning to cope with emotions – ACCEPTS • • Activities Contribution Compare to worse Distract with opposite emotions – humor? Push away – put problem in a time-out box Distract with thoughts: puzzles Distract with sensations: using senses
Part # 3: Humanistic Approach
Carl Rogers • • • He founded person-centered therapy. It is a humanistic approach. There are three concepts – Be Real – Empathetic listening/ validating – Unconditional positive regard
Be the one • Be the “one” person who makes a difference. • Many people who got through a tough childhood attribute it to having at least oneperson who cared and made a difference. • That could be you!
Be Real • • • It is about being authentic. Nice can’t be faked. Caring can’t be faked. They will know it is faked. Emotions match body expressions – “You never get angry – you don’t know what it is like. ” Self-disclosure time! Only if it helps the kid.
Empathetic listening/ validating • • Pay attention. Validate their emotions Explore with questions. Paraphrase from time to time
Unconditional Positive Regard • Hey kid – No matter what, I’m going to care about you. The truth – you’re going to mess up in the program. Maybe I’ll mess up too. But with you kid – I’m going to care about you no matter what. • Ethically – I don’t try to mess up. • Truth it happens:
Outcomes A Healthier Functioning Child
What has the child gained? Understanding of how trauma affected them Relaxation skills to deal with it Affect regulation skills to cope Cognitive processing skills to change thoughts, feelings, and behaviors • Shared trauma narrative for therapeutic benefits • Developed people skills, interpersonal skills • Developed safety skills • •
Rec Therapy Interventions • Reading bedtime stories and providing blankets at nighttime for those kids/ adolescents in residential treatment for trauma. Nighttime is often difficult. Many experience nightmares (often about reliving the traumatic event).
Rec Therapy Interventions • Gardening: Patients and grow it and eat it (pending if the state/ agency allows self-grown veggies for consumption. Some people give back by giving the food to help with the homeless. It allows the patients to feel important and needed.
Rec Therapy Interventions • Nails and pedicures: It makes people feel good. Patients were getting their nails painted green as it was also St. Patrick’s Day.
Rec Therapy Interventions • Having dogs in library for comfort (animalassisted therapy)
Rec Therapy Interventions • Giving back: Our kids can use their extrinsic reward points to buy pet food and blankets and pet toys. We make a trip to the local no – kill shelter to deliver items. Kids get to pet the safer dogs and cats.
Kids say the funniest things • Art Linkletter's Kids Say the Darndest Things. • I keep record of things kids say like the time the kid told our school teacher, “ • Wow, Danny just got out of the cat house and now he’s going to the dog house. ”
Rec Therapy Interventions • Imagination stories (in particular one about soup), which allows the individual to practice smelling soup and tasting soup in imagination.
Rec Therapy Interventions • Danny’s comments: this works in part because it allows the mind to be mindfully focused on (imagination) opposed to unmindfully drifting off to think about past trauma or drifting off to worry about future and what if it happens again. It is being in the moment (right here/ right now) and safe.
Rec Therapy Interventions • DVD/ children’s book: Mother (parent) reads book to child while it is being recorded on video. Child takes DVD and book with her to residential treatment program.
Rec Therapy Interventions • Decorate the walls to make it a friendlier environment.
Rec Therapy Interventions • Deep breathing skills: important for calming down. Teach them.
Rec Therapy Interventions • You’ve got mail: Some patients never receive mail. It could be saddening to hear staff say, “no, you didn’t get any mail today. ” an employee at one facility had collected items and put at front desk for those people who didn’t get mail/ those who didn’t have any outside connections or social support.
Rec Therapy Interventions That staff would say, look here, a package for you. It could be shampoo, or stickers, or any item that is donated.
Self-Care Providing services for children with abusereactive needs can be stressful. Many people are not cut out for this type of work. Turnover is high. (Vicarious trauma is real) Take care of yourself too. You won’t be able to do any good if you’re worn-out.
We've covered: • First: Trauma-focused Cognitive Behavior Therapy (TF-CBT) • Second: Dialectical Behavior Therapy (DBT); • Third: Humanistic Approach • Fourth: Self-Care
Questions and Answers • Be sure to get your CEU sheet. • I don’t want you to forget that. • And I’ll email out the slides and a few additional resources in the next few days. • Have a wonderful day – your friend, Danny.
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