Core Implications For Traumatized Children (CITC)

Core Implications for Traumatized Children Manual

Developed by: Shannon Newcomb, MSW Candidate 2018

Introduction

Experiencing a traumatic or life-altering event is something that causes extreme emotional and physical discomfort for those victimized by it. Traumas cause individuals to feel vulnerable, frightened, and worried about their general safety on an everyday basis. While traumas are experiences that cause great distress and the memory of them never fully goes away, proper clinical treatment allows for distress to become less frequent and more manageable. As Post-Traumatic Stress Disorder (PTSD) is a mental health condition that requires extensive clinical attention and intervention, acknowledging this and incorporating services into our agency that coincide with this condition and help to address it is our central goal moving forward. Creative

Intervention for Traumatized Children (CITC) has been constructed to do just this and it is with great encouragement and hope that we see this trauma-treatment program help to stabilize client mental and emotional regulation and positively impact the overall quality of life they live from the point of discharge moving forward.

What is PTSD?

Post-Traumatic Stress Disorder is a psychological response to experiencing a traumatic or life-changing event that causes negative effects on the mental and emotional stability of individuals victimized. While many individuals are shown to be able to maintain general functioning following traumatic event experience, traumatic cases and their impact vary dramatically from one victim to another. When looking at the age group of focus for the CITC program, children, we are aiming our attention towards improving the mental and behavioral functioning of individuals who are still in the process of developing and establishing independence. As childhood is a life stage in which guidance is at its greatest level and individuals are heavily reliant upon higher level figures and influences, the level of support needed in all regards is high. As this condition is shown to cause children victimized by it to experience intrusive, avoidant, and arousal symptoms that negatively impact their general mental, social, and psychological functioning in everyday life, applying treatment strategies that may help to diminish the severity of these symptoms is the central goal of the CITC program. PTSD is also a condition that can trigger the presence of outside emotional conditions that may become permanent issues if proper treatment is not provided. These can include Depression, Anxiety, Attachment Disorder, Social Communication Disorder, and Disruptive Mood Dysregulation Disorder. As each child to whom behavioral and psychological services are required needs varying levels of assistance and attention, keeping note of this circumstance is critical when moving forward with treatment.

What Causes Children to Develop Traumatic Stress Reactions?

Children develop stress reactions in response to trauma when the information exposed to them during their event is hard to accept or fully comprehend. As we are naturally prompted to try to make sense of things that surround us or events we come across each day, the instances of being incapable of doing so can cause negative altercation in functioning for some individuals if not addressed. The memories that come from more severe traumas cause high levels of distress and while memories may go away for a short period of time after the trauma occurs, the need for such memories to be dealt with has not been addressed yet, which causes memories to come back and emotional instability to continue. For many child trauma cases, the avoidance of reexperiencing or re-visualizing is difficult or almost impossible if proper assistance and support is not applied to the cycle in some way.

Treatment and Recovery Process

While the process of treatment takes a great period of time, just acknowledging your reactions and need for assistance is a dramatic step forward in achieving stability. The process requires numerous stages or steps to take in order to meet the official status of recovery. These stages include but are not limited to: trauma acknowledgment, active engagement in therapy by clients, expanding client knowledge of trauma, PTSD, and other trauma-related disorders, being introduced to strategies that may help dealing with trauma symptoms, applying Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

to allow for clients to face their painful situations head on, and apply relapse prevention so that the impact of treatment services may be maintained. TF-CBT also requires active involvement of the child and their loved ones in order for the best outcome to be achieved.

When looking at active engagement in therapy, our focus is on the clients developing a relationship and sense of comfortability with both the therapist and the group at large. As the level of effectiveness and positive impact are heavily based upon the level of support the individual is receiving and the level of comfortability they have while receiving said services, being knowledgeable of this is key in moving forward with the CITC treatment. Children who experience trauma also, in some cases, lose a sense of trust in not only people they meet along their journey through life but also, people they already know or have strong relationships with such as parents, siblings, extended family, friends, teachers, or other daily social engagement resources. Being able to acknowledge this and find ways to better help children feel comfortable with both themselves and their environments is essential. Acknowledging the client’s courage and willingness to take part in this treatment process and giving positive reassurance is key moving forward.

After talking to the client and taking initiative in the collection of trauma information, moving forward with information gathering and furthering understanding of the particular trauma is the next crucial step. Encouraging the client to express their concerns and setbacks as well as feeling free to ask questions is critical.

In a great majority of child trauma cases, we see children respond to the event by using self-blame and believing that they were the natural cause of the event. By being put in a situation of victimization, social isolation, and self-harm, there are numerous ways in which child stability and comprehension are further dismantled and symptoms of trauma are exposed to an even greater degree. In aligning with this, there are also instances of children victimized by trauma that show this same type of emotional damage and self-blame but with greater levels of confusion than disappointment. “How did this happen to me?” “Why did this happen to me?” In many instances of childtrauma cases, the traumatic event has an even greater level of shock or confusion than scare. Depending upon the child to whom was exposed to the trauma, the “aftershock” or reaction, can have various meanings or resulting outcomes. Being able to be cognoscente of these mindsets, beliefs, and mental hurdles that these children may be naturally tempted to follow by in response to their traumatic event and knowing ways in which to provide encouragement through humanistic, integrative, and cognitive therapy approaches is key and emphasized heavily in CITC.

Education is a tool of tremendous value that is applied in regard to not only scholastic and academic means, but also, emotional and personal means. Being knowledgeable of what resources are around and available for application and asking questions are huge aspects in helping to treat trauma for children. Is there anyone else you know that you would feel comfortable talking to about your situation to help diminish the severity of your symptoms and emotional stance? Are there any books, articles, or appropriate references with examples of other situations that may be similar to yours that may better help you understand the reactions you are expressing in response to your trauma? In some cases, it may be hard for children to fully remember or comprehend the event that has caused them to become traumatized and seek support from us, which makes completing the treatment process even more challenging. Coming to this realization in both circumstances is mandatory in order for our program to be of the highest potential for success and child treatment and mental stability following treatment to be maintained.

Anxiety and stress are two different psychologically themed feelings that can be of result from a trauma. From being constantly nervous or further negative events to arise following the trauma, to experiencing headaches and low levels of energy, to losing sleep or having nightmares that cause for re-experiencing the trauma, to rapid breathing, to continuously viewing your life as being in danger, anxiety and stress put a great level of weight on someone. These feelings create mental and emotional instability that cause fluctuation in the general function of an individual. Being knowledgeable of this and applying proper treatment approaches to meeting the needs of the child is something that our program heavily emphasizes.

When acknowledging each child’s trauma and personal comfortability with sharing information, we know that some children feel more comfortable when it comes to sharing information than others do. While in our program, we do not force specific details to be shared within the group therapy, we do require it to be brought up during individual sessions and conjoined family sessions. As the traumatic stories and situations our clients are sharing are private, parents, caretakers, and close-unit central support systems are expected to be patient and open to hearing what the child has to say. We require the children to share their trauma narrative with their parents or caretakers so that they are better equipped to respond to their children in situations like this if they happen to be victimized again in the future, or if relapse thoughts of this event occur and the child needs an added support in order to get through such thoughts. Our CITC program requires the parents and caretakers to listen when the traumatized child wants to talk and show openness as doing so helps to minimize the level of withdrawal and shutting down the child presents not only in that moment of sharing their trauma narrative but also in the event of another trauma occurring in the future. We are working in this session to develop the parent or caretaker’s level of empathy for the child. We are reinforcing to the child the idea that they can talk to you if needed and reassuring to them that they are in safe hands with you being present.

“I Feel Better…Now Help Me Stay Feeling Better”

After both the child and their caregivers have completed the therapy sessions necessary, the true test of the program’s fluidity and measure of its effectiveness is initiated…discharge. With allowing for a client to leave the program and verifying that they have taken every step required in the CITC Bounce Back program to graduate, we are giving trust in them that they are able to go on by themselves without additional clinical treatment. In discharging the children, we are testing to see whether the services that we have provided have been beneficial enough to keep the child stabilized outside of treatment. Has the child grasped the objectives, techniques, ideas, and strategies that were discussed and utilized in therapy? Is the child applying these aspects in everyday life to help him or her get through the day and maintain mental, social, and emotional stability? Does the child feel safe and as though they can now turn to a friend or loved one when something goes wrong or naturally handle higher stress situations on their own? These are all of the questions that are asked and brought up from the lens of the therapist. We want to know that the services we have provided have been influential and that the mission of our program is being met with each client that takes active participation in it.

In correspondence to discharge, we will have our participants complete a post-test that measures both their level of approval or satisfaction with the services our team has provided and their level of preparedness for future circumstances. We will have the children complete these post-tests on their graduation day and will check in with the parents or legal caretakers of the child 3 months following the child’s discharge from group. With doing this, we are able to give acknowledgement to the importance of both the child’s and the adult’s view on the services while also allowing for true data to be gathered on the level of fluidity and accuracy with treatment quality based upon the measure of time the individuals have no longer been in our care. We use the same posttest for both discharge/graduation and 3-month check-in as the questions are still applicable for or relevant in both time frames. With answering the same questions in two different time frames, we can receive thorough data that will be beneficial for presenting in the future for grants and other financial sponsorships. We will have data that exhibits the level of effectiveness our program has had and whether our clients have been able to maintain stability since leaving our care.

Manage and Maintain Stability

In looking at the goals of both meeting and maintaining stability with trauma, there are numerous aspects that come into play and treatment strategies that are applied to meet such point. With our CITC program, we implement deep breathing and muscle relaxation strategies with CBT treatment. As PTSD is a disorder that causes mental and emotional instability for individuals victimized by it, the level of therapeutic intervention required is of higher quality. We utilize the incorporation of PMR (progressive muscle relaxation) treatment techniques, breathing routines, and narrative cognition exercises to allow for the three core systems to be stabilized and susceptible for daily application. With each group meeting as well as each individual session, we will be focusing on the idea of controlling the unwanted thoughts and reactions and diminishing the severity of

their impact upon mental and emotional functioning.

Our program incorporates “play therapy” or engagement in productively influential activities that allow for distraction from the trauma while at the same time, natural enhancement in comfortability with bringing up the trauma by having children participate in activities that illustrate situations similar to their trauma. Using play therapy and utilizing activities for children to participate not only allows for the central focus to change but also allows for children to utilize physical and mental aspects that can become of comfortability for children to use on a regular basis. Balancing the trauma treatment discussion and “re-living” the trauma with productive activities is the central key to children being able to maintain stability and keep themselves “balanced” after leaving our program.

Bouncing off of this treatment strategy of play therapy, we also work towards achieving stability for the child through having them compose self-statements and “thought-stopping” routines. As the traumas the children are working through and receiving treatment for are intense events, the process of learning to write a narrative and having to “re-live” the trauma is a great struggle for the children. Our clinical staff will help children through the process of writing their stories, re-telling them, and building stability throughout the process of completing both. When discussing the “thoughtstopping” objective, we are discussing the goal of getting children to stop the natural routine of self-blame and feeling helpless and in danger. We are working to have children change their mindsets and give them positive reinforcement that they have control of what effect, not only the trauma has on them, but also what effect everyday events or negative encounters have upon them as well. In the process of re-experiencing the trauma and going through memories of the event, the children will be told to say “STOP” each time they come across an unwanted thought or negative aspect of their trauma story that causes PTSD symptoms to emerge. By continuously saying “STOP” and reiterating the urgency for the child to take control, they are slowly learning to deal with the trauma. As the process of treatment progresses and the children become more and more routine to re-living or re-enacting the event, their capability of facing the event becomes greater and the impact of the traumatic aftershock lessens.

Can I Cope With It?

Exposure to and victimization by trauma are painful events that take great time to truly process and cope with. While the process of “re-living” the event is difficult, it is truly the only way to confront the issue and fully recover. As stated throughout the course of the manual, by applying professional strategies to help manage the child’s anxiety and distress from their trauma, the children served through the CITC program will be better prepared for handling traumatic events in the future, if any arise. It is critical for the children to confront their anxiety head on.

The key to coping with trauma is cognitive restructuring. By challenging the negative thoughts and beliefs that are prompted from the trauma and replacing them with more realistic “happy thought,” the child is taking control and determining the effect the trauma has upon them, rather than the other way around. Identifying negative trauma thoughts, challenging them, and replacing them with “happy thoughts” allows for natural development in realistic views of both the world and the self.

Cognitive restructuring is the psychoanalytic treatment approach that takes the beliefs, thoughts, and interpretations of past traumatic experiences and challenges them. The child, in the post of their trauma, may be overgeneralizing ideas or focusing on the negatives to an extreme, overlooking the positives that their life still holds. Faulting and altered thought patterns are the primary issue behind trauma and it is with cognitive restructuring that the central goal is to identity and challenge the “unhelpful thoughts” with specific reference to the trauma.

Trauma Relapse Prevention

While the focus of the CITC program is to treat PTSD and help the children cope with their traumas, a great concern is the issue of trauma relapse. Trauma recovery is not only focused upon allowing for the child to get better and meet mental and psychological stability but even more so, to stay better and maintain mental and psychological stability. Whether a child experiences relapse through encountering an event that bring back traumatic memories or in the most unfortunate circumstances, comes in tact with another traumatic event, being able to apply treatment strategies and routine learned through treatment is the key to maintaining stability and preventing PTSD from coming back. There are numerous steps that can be taken and are highly encouraged to be taken to help prevent relapse which include being aware of early warning signs for the onset of another trauma, identifying high risk situations and knowing when to leave, maintaining positivity, not being afraid to reach out for help when needed, and being able to generate a plan to cope with relapse if it happens to occur.

Reaching out for help, no matter what the situation, is often times a hard step to take for individuals. Asking for help is in many ways viewed as a sense of “caving in” or “giving up,” when in actuality, it takes great strength and courage to do so. Knowing that help is needed in order to better enhance the quality of life for someone is key and it is with Emerson Academy’s CITC program that we allow the children we serve to see

just that.

It is critical for both the child and their caretakers to stay alert of everyday behaviors and routines. Keeping alert and being able to notice when a child is not coping well or acting as themselves is key moving forward with assuring child well-being. Trauma is something that is generally not brought up naturally by those victimized by it as it is a hard event to re-live or bring up. By staying alert of social and emotional cues exposed by the child, we are keeping ourselves better prepared for emergency procedures

and handling traumatic situations going forward.

In order for stability to not only be maintained, but at the very least, reached, children who have been traumatized and their treatment team need to come up with a blueprint. Having a plan to go off of that gives the child a guide to follow by is critical. Helping the child come up with coping strategies, determining who they feel safe to call in emergency situations, having the child identify which physical, behavioral, and cognitive coping strategies were of the greatest benefit and how to apply them regularly, and knowing how to respond are all key strategies to the CITC treatment program that will be utilized tremendously.

Being positive, while seen as a “simple” statement and task is extremely difficult for children who suffer from a trauma to follow by. As their senses of being positive are many times, ripped out, due to their trauma, this critical step to not only our CITC program but trauma treatment as a whole is something that cannot be highlighted enough. From engaging in activities or hobbies the child enjoys as a constructive distraction to acknowledging strengths and positive traits the child holds that can act as resources for the child in getting through treatment, being positive is essential in CITC.

The mindset, mood, and overall drive the child goes into treatment with is heavily weighted in determining the level of success the child will have. Keeping an open mind and maintaining a positive outlook, regardless of the expected outcome of treatment, is shown to be heavily impactive upon the overall wellbeing of the child.

Closing Thoughts

Traumas are life-altering events that cause for great concern for many individuals victimized. After experiencing a trauma, a child will never fully be the same person, but with receiving the proper attention and treatment through participation in the CITC program, the child will have many new skills to apply to help the child ensure stability for the future. The main hope is that through completing the program, the children will walk away with a greater sense of safety, comfortability, and stability moving forward in their journeys through life. It is our hope and central goal that children that leave our program, may be better place physically, mentally, and emotionally, and that they may be better prepared for handling traumatic events in the future.