Comfort Dogs helping after tragedy in Orlando

ABC News:

Comfort dogs are helping after the tragedy that took place in Orlando.

Read about it here:

http://abcnews.go.com/US/comfort-dogs-provide-hope-encouragement-tragedy-orlando/story?id=39823119 

Tips to manage distress after trauma from APA

You’re probably aware of the Orlando shooting

The American Psychological Association put out tips for managing your distress in the aftermath of a shooting. I’d add that these tips are good to use after any trauma:

http://www.apa.org/helpcenter/mass-shooting.aspx  

Mindfulness and trauma

From Mindful.org: Mindfulness practice can help people with trauma to learn how to feel safe again.

http://www.mindful.org/point-of-view-when-vulnerability-and-trauma-collide/

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

Copyright, CanStockPhoto/ gstockstudio

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 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

stress affects the brain

I’m a big fan of TED talks. I hope to give one someday.

Below is a link to a TED talk about how stress affects the brain.

My focus as a practitioner is providing services for children with abuse-reactive needs. These kids have suffered traumatic experiences.

The trauma causes major changes to the brain as well.

Here is the TED talk link:

https://www.facebook.com/TEDEducation/videos/1127655593914312/?fref=nf

7 ways childhood adversity changes your brain.

https://www.psychologytoday.com/blog/the-last-best-cure/201508/7-ways-childhood-adversity-changes-your-brain?utm_source=FacebookPost&utm_medium=FBPost&utm_campaign=FBPost

childhood trauma looks a lot like ADHD

I (Danny Pettry) provide therapy for children who have suffered trauma.
Here is an interesting article:
http://www.theatlantic.com/health/archive/2014/07/how-childhood-trauma-could-be-mistaken-for-adhd/373328/ 

Stress is bad as (maybe worse than) second-hand smoke.

CNN health often has interesting articles.

They had an interesting article that argues stress can be as bad as second-hand smoke.

Recreational therapists (in mental/ behavioral health) settings as well as physical rehab settings (based on my personal experiences) provide stress management interventions.

I provide a mix of interventions for children and adolescents at a residential treatment program for three different needs. My primary triaging and experience is providing services for children with abuse-reactive needs. These children have all had suffered some type of abuse or traumatic life experience. Some of the kids have Post-traumatic stress disorder.

I provide several types of interventions under the recommendation and supervision of physician to help these children (patients). Some of these include: psych-education about stress and trauma, relaxation skills training, emotional regulation skills (to cope with various emotions), and components of Trauma-Focused Cognitive Behavior Therapy (TF-CBT), which I’ve had additional training.

Of course, many types of relaxation skills for children are play-based. It includes outdoor activities, sports, games, fitness, and activities as a healthy distraction.

In my opinion, Recreation Therapists provide interventions that are best suited for helping people learn ways to cope with stress. I do think we, as RTs, need to find more ways to make outcomes measurable.

There are several ways. In examples, the Heart-Rate Variability measurement is one tool to determine if a person is in Heart-Rate Coherence. I’ve had training on using HeartMath tooks at several of the American Therapeutic Recreation Association (ATRA) conferences.

There are other ways to measure too, in example: measuring cortisol levels, which are associated with stress.

I’d like to argue that the education component of RT is very important. Patients/ clients/ (kids in my case who I provide services for) need to having an understanding of the benefits (what is in it for them), the outcomes: like less feelings of stress, less stress-related health problems,  improved health, less likely to have physical illness as a result of stress. That sentence felt redundant. The client also needs to have an awareness of the skills that they can take-home with them and use in daily living. This could be a mix of relaxation skills: taking walks, physical exercises, taking a mini-vacation/ relaxation break, self-care, basic renewal. In other words, work ourselves out of a job.

I’d like to point out that RTs should be using the American Therapeutic Recreation Association’s standards of practice. Services (in clinical settings) need to have physician order for assessment and treatment. A comprehensive assessment should be used to evaluate client’s strengths and areas of needed improvement in the functional domains. Treatment plan goals need to be written (with client) to be part of the overall treatment team plan. RTs will provide interventions they are competent to provide (in example: relaxation skills training, psycho-education or leisure-education that teaches healthy life skills, and of course, activity-based interventions to allow the client to practice the skill. The RT will be providing these interventions along with other members of the treatment team. In a psychiatric setting, this will probably include: professional counselors, social workers, psychologists, nurses, mental health technicians or direct care providers, dieticians, and other allied professionals.

Documentation along the process is important as well. Individual and group RT-based interventions are to be documented by the RT as part of the medical record to evaluate the client’s outcomes and progress (or lack of progress).

Well, I could go on for hours about this.

I will leave you with the CNN link about the harm of stress here:

http://www.cnn.com/2015/09/03/health/stress-work-secondhand-smoke/index.html

Nightmares and trauma

Here is an interesting article about nightmares and trauma:

http://www.ptsd.va.gov/public/problems/nightmares.asp

A Book Review of: Hope: a memoir of survival in Cleveland: Amanda Berry and Gina DeJesus with Mary Jordan and Kevin Sullivan

Disclaimer: This is a book review by Recreational Therapist Danny Pettry. If you suffer from a health condition, you should never use Rec. Therapy Today blog and newsletter entries instead of professional medical advice. Please seek a professional evaluation for treatment. For practitioners (recreational therapists, counselors, healers), many of the suggestions at this blog could be used in medical treatment under the recommendation and supervision of attending physician.

 

Title: Hope: a Memoir of survival inCleveland

 Amanda Berry and Gina DeJesus (two of the three girls who were kidnapped in Cleveland).

It was written with Mary Jordan and Kevin Sullivan.

Published: 2015, Viking, Penguin Publishing Group, Penguin Random House.

 

I work at a residential treatment facility where I provide services for children ages 7 to 12 who have suffered trauma. (physical abuse, emotional abuse, sexual abuse, severe neglect, or domestic violence or have witnessed a disaster).

I read books on trauma to learn more about resiliency and to build more empathy for those who I provide services for.  In the past, I’ve read books about those who have survived and escaped, like

• Natascha Maria Kampusch,
• Jaycee Lee Dugard; and
• Elizabeth Smart.

I’ve also read Jessica Lynch (who was rescued in Iraqi freedom operation).

 

About the book: Hope:

Amanda Berry had been kidnapped by A. Castro in Cleveland on her way walking home from her shift at Burger King. He raped her and held her captive for ten years. There was another woman who was already being held captive there (Michelle Knight). However, she was not part of this book. Later, A. Castro kidnapped a third victim, Gina DeJesus.

Amanda became pregnant and had his child, Jocylyn (Joci)

The three women were raped often. They were chained to radiators and locked in their bedrooms (with boarded windows) or in the basement. They suffered emotional abuse (being called names and having put-downs). They were physically abused beaten.

Finally, one day, Castro let his guard down and didn’t chain Amanda or lock her in her room. Her daughter Joci told Amanda that her dad was gone. Amanda sneaked downstairs, knowing if caught she could be beaten and tortured. She discovered Castro was gone and then realized the front door had another padlock. She was able to yell for help and beat down the door and got out and rescued.

 

My Thoughts and Feelings:

I think it is awful what these girls have experienced. I think Amanda was very brave to do what she did (to escape). Amanda new her mother had passed away from the news. She said she felt her mother pushing her to go and escape.

 

I thought it was awful when Amanda reported that one woman (who was older) outside didn’t believe Amanda was Amanda and didn’t help. It sounded like the woman was shaming Amanda. I felt real irritated at that.

I thought many times during this book: why does this have to happen?

 

More Feelings:

I felt a mix of emotions reading the book.  It was an emotional roller-coaster ride of empathy. Of course, I’ll never truly know what Amanda, Gina, and Michelle felt and experienced.

I know I felt extreme sadness during the book. Feelings of excitement, delight, and hope filled my heart when Amanda went for the move to escape. I’m so glad she did.

 

My Hopes:

I hope we are able to find more missing people.
I hope we can find ways to help stop these things from happening.

 

My Plans:

I am trained as a recreational therapist and a mental health counselor. I’m currently a provisionally licensed counselor and working towards obtaining a full license to practice counseling. Counselors work with all age groups and for people with a variety of needs. I’ve worked with children who have been abused since 2002. I plan to continue working with this population and continuing advancing my training to be the best service provider I can be. I find this to be meaningful work.

Naturally, I want to be an advocate for people who have suffered traumas, abuse, or other major problems. I plan to help teach safety skills to children and teens. I plan to encourage children in my family to have cell-phones handy so they can contact someone in case of an emergency.

Who might benefit from reading this:

Some therapists may consider using this book as a biblio-therapy technique to help teens or adults who have suffered trauma and abuse.

Some therapists who teach Dialectical Behavior Therapy (DBT) Skills may want to have teens or adults to read this book as a comparisons tool. One DBT technique is to compare yourself to others who are in worse off situations. I can’t imagine many people who have experienced worse than these girls and yet, here they are, bright as ever today and resilient.

 

Source:

Jordan, M, and Sullivan, K. with Amanda Berry and Gina Dejesus. (2015). Hope: a memoir of survival in Cleveland. Viking: Penguin Publishing Group, Penguin Random House: New York, NY.