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Friday, March 25, 2016

Personal Reflection on Trauma-Informed Care Summit A review of Summit on Trauma-Informed Systems and Practice

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Personal Reflections on Trauma-Informed Care Summit
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 Bren√© 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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