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A review of
Summit
on Trauma-Informed Systems and Practice
Gillece,
J., Exline, N, Gpta, R., Jones, V., Szafan, K, Yost, K., Andrea, Dr.,
Crittenden, E., Frankenberry, G., & Thomas, T. “Summit on Trauma-Informed
Systems & Practice.” Capitol
Conference Center, Charleston, WV. 18 March 2016. Lecture.
By:
Danny
W. Pettry II, M.Ed., M.S., LPC, NCC, CTRS
Dr. Joan
Gillece is the Director of Substance Abuse and Mental Health Services
Administration (SAMHSA)’s National Center for Trauma Informed Care. Dr. Gillece had
given the opening remarks and assisted with the collaborating discussion at the
end of this session. Dr. Gillece has 30 years of experience in behavioral
health and 17 dedicated to trauma and seven of those years in the prevention of
seclusion and restraints.
This
event was hosted the West Virginia Department of Health and Human Resources and
the National Center on Trauma Informed Care (NCTIC).
This
paper consists of thoughts and personal reflections on the presentation by
Danny Pettry.
What
is Trauma?
The
definition of trauma was not specifically outlined during this session. Merriam-Webster’s online dictionary
defined trauma as “a very difficult or unpleasant experience
that causes someone to have mental or emotional problems usually for a long
time.” These
events are hard to get over. They could include being the victim of or witnessing:
sexual abuse, physical abuse, verbal/ emotional abuse, neglect. It could be a
terrible accident like a death from an automobile accident. It could be a
weather disaster. Trauma varies. It is often associated with soldiers who are
returning from war and battle scenes. However, it is important to note that
children and adolescents can also experience trauma.
How
it works
There
were many helpful comments and suggestions given for providing trauma-informed
care. Here are some that Danny Pettry
had noted:
·
“You don’t have to be a therapist to be
therapeutic.” Just be compassionate and caring. Danny Pettry would recommend
books on humanistic approach like: Dr. Carl Rogers.
·
The focus is not on what is wrong with the
person (their current condition or behavior), but what happened to them (the
trauma). We not treating behavior.
·
The focus is on healing model opposed to a
clinical diagnostic model.
·
The focus is a strength-based approach. Take
what is working and build on that, much like recreational therapy.
·
These people are hurt. They are in pain and
they need healing.
·
Our job is to help them in the process of
healing.
·
Our job is to help build them up. Here are two
good questions to ask:
o What
do you do that you’re proud of?
o What
can you give to our community?
·
Four focus areas to build
on: safe, healthy, supported, and successful. Decrease the blame. Dr. Gillece
had suggested the audience to study Brené Brown’s talk about
decreasing shame and blame.
·
Use desecration techniques
to calm the child or adolescent down so there is no need to go hands on a
child.
·
Provide a positive
environment: decorate it. Make it friendly.
·
Creativity is conductive to
healing. Be creative.
Treatment
Models
Two
different treatment models for trauma were briefly mentioned during this
session by various speakers. The speakers and presenters did not go into detail
about either of these models. However, the attendee, Danny Pettry (author of
this report) has taken some training in both types and decided to give readers
of this report an overview of these two types of treatment:
1.
Trauma-Focused Cognitive Behavior Therapy
(TF-CBT) was suggested as a treatment during this session. Danny Pettry can
recall the TF-CBT “PRACTICE” acronym can be used to remember the skills that
are taught to clients and patients using TFCBT. Danny Pettry will cover the basic skills
taught in TF-CBT.
a. Psycho-education
about trauma and how it affects and changes the brain.
b. Relaxation
skills training: teach ways to calm down and cope with stress.
c. Affect
regulation skills training: teach about emotions and how to regulate them.
d. Cognitive
processing skills: teaching people how to change their thoughts, feelings, and
behaviors.
e. Trauma
Narrative: this is a creative opportunity for the survivor to tell their story.
Of course, this should never be forced as it can cause more harm. It can be
healing to express and tell it. The survivor has full control in how the story
is told. Some creative ways with children consist of: creating a comic book,
acting it out with toys, painting pictures, etc. There are five main chapters
of the trauma narrative, including:
·
About me
·
A good experience/ or a positive memory before
trauma or a role-model or super hero
·
The trauma: what happened
·
What I’ve learned in therapy
·
My hopes, wishes, and dreams for the future.
f. In-vivo:
real world practice
g. Conjoint
family therapy sessions
h. Enhancing
social skills and safety skills
For
more information regarding the TF-CBT, go here: https://tfcbt.org/
2.
Dialectical Behavior Therapy (DBT). Danny
Pettry has had some training in this area. DBT was created by Marsha Lineham
for the specific treatment of people with Borderline Personality Disorder BPD.
However, DBT skills can be helpful for many people and not just those people
who have BPD. The four main skills consist of:
·
Distress tolerance skills
·
Interpersonal effectives skills
·
Emotional regulation skills
·
Mindfulness/ meditation skills
For more information go here:
http://www.linehaninstitute.org/
Recreational
Therapy in the Treatment of Trauma
Dr.
Gillece did not specifically mention “Recreational Therapy” as a treatment. She
did recognize Mildred Mitchell Bateman Hospital [a psychiatric hospital] in
Huntington, West Virginia as having one of the most compassionate and caring
staff that she has ever seen. She made a reference that “everyone is in an
activity.” Naturally, Recreational Therapy professionals would be assisting
with implementing those activities. Dr. Gillece, et al. had made several
comments about the importance of activities in residential treatment programs
and even prisons for youth offenders.
Some
of the activities Pettry had taken note of that he heard being menchoin
included:
·
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).
·
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.
·
Nails and pedicures: It makes people feel good.
Dr. Gillece had mentioned that those patients at Mildred Mitchell Bateman
Hospital were getting their nails painted green as it was also St. Patrick’s
Day.
·
Having dogs in library for comfort
(animal-assisted therapy)
·
Imagination stories (in particular one about
soup), which allows the individual to practice smelling soup and tasting soup
in imagination. 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.
·
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.
·
Decorate the walls to make it a friendlier
environment.
·
Deep breathing skills: important for calming
down. Teach them.
·
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.” Dr. Gileece had discussed how 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. That staff would say,
look here, a package for you. It could be shampoo, or stickers, or any item
that is donated.
Healing Yourself
Providing
services for people with trauma can be demanding. It takes a toll on person. It
was mentioned during the session that those workers who have the most contact
with patients are the ones will need the most support.
There
weren’t many main tips on providing self-care, but some of those could be the
recreation activities above that were suggested for patients. Those same activities
could be healing and helpful for direct care staff.
Of
course, basic self-care is important too. Many of the skills that professionals
in our field teach can be used to cope as well, including:
Danny Pettry has provided services for
children and adolescents for three residential treatment programs in
Huntington, West Virginia since 2002. Pettry maintained full-time employment
while he completed two graduate degrees. His degrees are in Mental Health
Counseling from Columbia University (2012) and Therapeutic Recreation from
Indianan University (2006). Pettry’s undergraduate degree is in Therapeutic
Recreation from Marshall University, Huntington, West Virginia (2002). Pettry
has been a Licensed Professional Counselor (LPC) in West Virginia since 2014.
He has held National Certified Counselor (NCC) credentials since 2013. Pettry
has held Certified Therapeutic Recreation Specialist (CTRS) credentials since
2003.
Pettry is a good-standing member of the
American Therapeutic Recreation Association. Pettry has won the Peg Connolly
Scholarship in 2004 and an Advocate of the Year Award in 2005. Pettry is also a
good-standing member West Virginia Therapeutic Recreation Associatio (WVTRA).
Pettry has served as the student, ATRA, and CTRS representatives for WVTRA in
the past. Pettry is the author of, Building
Character with Sam, Izzy, and Many Other Dogs: 15 Tips to Help Children Build
Character.
Bibliography
Gillece,
J., Exline, N, Gpta, R., Jones, V., Szafan, K, Yost, K., Andrea, Dr.,
Crittenden, E., Frankenberry, G., & Thomas, T. “Summit on Trauma-Informed
Systems & Practice.” Capitol
Conference Center, Charleston, WV. 18 March 2016. Lecture.
Trauma [defintion]. (n.d.). Retrieved
March 26, 2016, from http://www.merriam-webster.com/dictionary/trauma
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