COVID-19 and Toxic Stress

The response to the Corona virus is unprecedented. The fallout from so much social isolation will only complicate the new norms that will emerge as we come out of our homes and return to school and work. Unfortunately there is likely to be significant increases in childhood adversities that will lead to developmental trauma and childhood PTSD for many. These children will begin to show up in schools where the system will be unprepared to adequately create safety and comfort for children who cant get it anywhere else.

It is imperative that we get ahead of the increase in mental health needs that are going to arise once we are given the all clear to begin some semblance of normal social life again. School personnel and administrative levels of school policy need to understand that children are going to have other priorities once they come back into the classroom. The underlying socialization that drives motivation will need to take the front seat for a while. If we try to blast back into school work immediately this will prolong anxiety and relationship building for many of the most vulnerable children. While some children will come back to school ready to get back to the routine and activity of learning many others will not and that will cause chaos and increased fear and stress in the school environment.

The more that schools can build a plan of re-entry that includes ritualized authentic greeting, stress management breaks and team building the sooner children will orient towards a healthy future.

Chillin Out!

      Got stress? Think it’s just something that comes with life? Look around you, family members, customers, friends. Do you see anxiety? The number of people being diagnosed with anxiety has skyrocketed in recent years. Millennials and Xers may be habituated but does that make it ok? Just because you are used to something doesn’t mean it isn’t affecting you. The science is very robust, anxiety affects sleep, health and attachment. Let’s break down some ways to stress inoculate, that will be useful in everyday life, with all of the people you come into contact with.

    It is helpful for some people to think about self-care in categories. There is what you do in the moment of crisis, what you do after a crisis has subsided and you need to get all the way back to chill state, and what you do ongoing to keep in a smooth rhythm from week to week. Let’s break it down a bit and remind ourselves of how we work on the inside.

     When we get hit by a stressor, like a tense meeting, or a squabble with relatives or coworkers, it is important to remember what occurs for most of us on the inside. Stress chemicals are secreted into the bloodstream and circulated throughout our bodies. Our digestive system goes offline (chaotic, diminished or no liver, kidney, intestinal tract or bladder function) and our brain begins to compartmentalize. Heart rate increases, lungs prepare to take more air, big muscles are energized, and we get emotional.

     One of my favorite sayings these days is “Anger is like taking poison and expecting the other person to die”, anger does not serve you in most instances, nor does fear. In fact, often, someone else is running your emotional labor instead of you, they get you to react, but it doesn’t have to be that way. Let’s look at the 3 pillars of self-care that can be used to keep you in control of your emotions and at the same time help with sleep and problem solving.

1. Acute safety plan- What you can do in the moment that will reverse the triggering effect of an emotional interaction.

2. Coping skills- Those things you do to get rid of energy and get yourself grounded. Example: Going for walks, listening to music.

3. Self-care plan- attending to 5 of the basic needs of humans that keep you centered, integrated and affectionate.

For this writing piece we will focus on the Acute Safety Plan:

What you do in the moment following an emotional interaction is key, you want to stay in control even though others may not.

Acute safety plan

• Takes 10 to 20 seconds

• Engages 3 to 6 breathing

• Turns back on the digestive system

• Brings the brain back to integration

• Allows hydration to flush the stress chemicals

• Contributes to focus and being present

• Contributes to better sleep.

    Your love matters! Put yourself in a position to see it clearly, without judgment, with curiosity and compassion. An acute safety plan or chill plan will be very useful for the relational part of your life. Next post we will break down Coping skills, the second pillar of self care.

On Transgenerational Trauma

     In 2014 President Obama requested that the Department of Justice put together a group of elders involved with Indian health and mental health, to go around the country and meet with Tribes. The purpose of this group was to better understand what is currently happening on reservations. They wanted to figure out what needs to be done, and what has been done that is working. There were nine members selected for that group from across the country and that group included our own Judge Whitener. This group spent one year touring the country and meeting with Tribal members and agency representatives that work with Tribes. The results of that year are in a report called the “Attorney General’s Advisory Committee on American Indian/Alaska Native Children Exposed to Violence: Ending Violence so Children Can Thrive.”  While the results of a year of testimony won’t surprise anyone, the fact that it is on record, that it is still occurring on the vast majority of reservations and that there is science to show what is happening. We know that it affects every aspect of being human, and this is important. What the advisory committee published in the report, that is most important to the Tulalip community, is an acknowledgment that exposure to challenging and traumatic events is three times the exposure of people in the general population. Paying attention to this finding is important because of what it means for a child in an unpredictable situation. That child must pay much more attention to what is going on around them in order to look for safety. This is also true for the Ancestors that experienced forced relocation, as well as being subjected to the horrific boarding school abuse. That abuse is well documented in Tribal histories but virtually ignored in American revisionist history. The constant betrayal by first the American government in treaty manipulation, exploitation of Native peoples for personal gain and the attempted removal of culture through the boarding schools, has resulted in a profound and cellular level mistrust of all things government. That deep and well founded mistrust extends to federal, state and county government. 

     The sovereignty that many Tribes have, give them room to take a breath from the conditioned exploitation by American culture, at least in the geographical spaces that seemingly are safe. The downfall of these findings is that there is not enough Native American research available to access what is actually happening and which interventions are known to work. Fortunately the advisory committee heard the same information from enough different tribes to come to some consensus. That information combined with the current exploding science on genetics and the brain allow us to know some things with relative certainty. 

1. Transgenerational trauma is real and it is impacting our community every day. 

Translation: what happened to our ancestors with forced relocation, betrayal and boarding school abuse is in the bodies at the cellular level for today’s descendants and drives many of the behaviors and emotions that we struggle with. 

 2. The passed down trauma influences emotion and behavior in a way that continues to retraumatize the next generation. 

Translation: When we cant stand the way someone is acting we treat them the same way our ancestors were treated, we violate,  confront, beat or reject/isolate that person.

3. Everything is connected and everything you do affects the tribe. 

Traslation: What was beat into many of our ancestors was fear and grief. It is not their fault. Their behavior is a result of being tortured. The point here is that it does no good to find fault inside the tribe for sickness that we became infected with. The cure is nurturing and understanding.

4. Being traumatized is subjective. 

Translation: We can’t determine what someone else is traumatized by, the things that make them unique may also be the things that make them vulnerable. A child who comes from a home where there is little or no love is going to be traumatized by a beating or a rejection and their reaction is going to be very different from a child who comes from a good enough home. The difference is love, I will tolerate and learn what you want me to learn from a spanking or rejection because I know that I am loved anyway. If I am not loved, I will learn how to use violence and rejection as tools to exert power as I grow and because I haven’t been taught to love I will use them in a way that will keep me from love.

And finally;

5. Love heals.

Translation: When you are vulnerable enough as an adult to relax and breath in a hug with another human being that you love you release oxytocin, this is a neurochemical that bonds people together, Oxytocin stem cells have been shown to repair heart muscle, when you love you repair the heart, it is not just saying, it is real.

In Light of Recent Events

This past year Iowa has seen the tragedy of two foster youth, in separate instances, who were starved to death. This is devastating for many human service workers, in a very direct way. I would like to introduce some national data and observations I have made in working with child welfare in several states over the last decade. 

First and foremost, the foster child population continues to grow despite static or reduced funding for programs that support and augment healthy adoption. Second, the ratio tends to hold steady at about 2-1 for children in need of a home. This second point is actually perpetuated by the system in the following ways; generally, social workers are the most consistent caregivers in the life of a foster child. The sheer number of kids who are in need of placement is overwhelming and the resources allocated to those children and families are inadequate.  This leaves the state social worker between a rock and a hard place. The lack of funding and understanding at the administrative level, and the application of a mentalist model of behavior, only creates an environment of stress and reactivity across the continuum of care.    This, for some of our most vulnerable children. The standard value of “kids are resilient” is misapplied in the context of social services. We see examples of this with children who are system involved who are generally coming from environments in which they did not get the early input that is necessary.  We know that good early attachment is necessary for self-control, secure attachment, affiliation and/or empathy.  These are foundational elements of a healthy, robust development. Social resilience is grounded in being able to be vulnerable, intimate and attached even under stress. As we understand that these kids never got that kind of early attachment, how then can we expect resilience from them?

The current push for in home care actually complicates the situation in social services and defies the data. Specifically, there are more children in need of placement then there are homes available. The task of cultivating new homes for kids is complicated by the system stress, which is exhausting workers, who are trying to do the best they can with the resources they available to them.  One of the results is that too many kids get placed in a high performance home, who understand complex trauma, because of the acute need.   This short term resolution actually burns out the high performance homes more quickly over time. These high performance, safe homes, become overwhelmed by too many high needs kids leading to the mistrust of the system, suspicion of workers and providers and eventually the collapse of many of these safer homes as a placement option. Additionally, the friends and families of these high performance homes witness what is happening to their friends, and opt out of the consideration of becoming placement homes themselves.  This is a result of being privy to how the existing system works. The result is that the workers have to place more children in fewer and less safe homes, who are not trained in understanding complex trauma. Ultimately the children are not tolerated in these homes which either leads to rejection or abuse in an effort to control behavior. This only deepens the despair, loss, anger and resentment of a child.  Most likely these children were already neglected and/or abused as the beginning event. The system is increasingly overwhelmed and reactive because of the number of moves, alleged incidents and interactions with children and adults who are angry, afraid and depressed.   This in turn actually trains/conditions the children in care to be more resentful, exploitative and helpless. As a result of this broken system we then blame the children for their behavior, and label and medicate them for things that the adults in charge taught them to do. 

Understanding this , it is no wonder that the burnout and transition rates for social services personnel are so high. Many well-meaning people are limited by the projection of their own life experience lenses.  This is the lenses that they use in program selection, however, it most often is dramatically different from the reality of the lives of the clients they are serving. We ignore the research that tells us that relationship is the single most predictable factor in the success of intervention.  However, we are so overwhelmed as a continuum of care that we can’t provide the most basic necessities for children who are desperately in need of consistency, predictability, fairness and unconditional regard.

The absolute need for understanding self-care and the execution of self-care, is often ignored and not supported in our agencies.  These agencies are filled with social service workers that deal all day with intense emotional labor. I find this astonishing, given the expectations for our clients and workers. So many parts of the continuum have retreated into taking care of themselves as opposed to serving the client.  Sometimes this happens out of necessity, liability is commonly cited as a reason that some of these rules exist.  These are rules that are forced on a population that is already resentful, angry and in need of escape.  Unfortunately, this develops a personal mastery of becoming more sophisticated at the exploitation of the system rather than emotional growth that results in prosocial attachment to family, community and society. 

This is the system WE have created and the deaths of young innocent children is the result! Immerse yourself for just a moment in what it would be like to live in a home where you were being starved and slowly wasting away and you were being blamed. This is not the behavior of a country that values life, love and the pursuit of happiness.  It is a stain on the heart of all Americans, even though you can suppress it, it is still there eating away at everything around you. 

High quality homes, respite homes, trauma and development training are absolutely part of the solution, time and again good money spent on the front end has resulted in significant savings on the back end. It is time to pilot a continuum that can follow deep end kids from removal to properly assessed resolution. All of those resources are available to us. It is to our peril to ignore the long term consequences of continuing with our current system.
 

What is Trauma Informed Care?

What is trauma informed care?

“It is absolutely essential that the healing journey be understood from the survivor/warrior perspective. Which means safety and trust are unassailable elements of the beginning of a healing journey. ”

Trauma Informed Care, or TIC, is all over the place in social services these days.  Everyone is getting on board with adopting TIC.  Even training TIC has become popular.  So, I think it is important to explore the meaning and possible consequences of being involved with TIC programs.

A few years ago the Attorney General convened a task force to examine the issues regarding children exposed to violence.  The result of the year long process, in which 12 learned professionals toured the country and heard from in the trenches mental health workers, was a definition of TIC.  I feel that it makes sense to use their definition as a platform for this discussion.

This is the definition they came up with: “Trauma-informed care is a new form of evidence-based intervention continuums and service delivery, implemented by multiple service providers, that identifies, assesses and heals people and their support systems injured by, or exposed to, violence and other traumatic events” (CEV task force report, 2014). This is also the definition adopted by the Iowa state legislature in 2016.

But what does it mean? Let’s dissect it a bit and get down to some brass tacks of TIC that are not well understood and that separate people who are saying they are doing TIC from those who are. The difference can be devastating for someone who is deeply wounded. It is one thing to know what you are supposed to do, it is quite another thing to actually be able to execute it.

Let’s start with the word “new” in the definition. For many people who work in social services it is not a “new” idea, to understand that trauma is impacting the way people behave.  What is “new”, is the science that confirms that people are being compelled into certain behaviors and states as a response to genetics, epi-genetics, environment, temperament, gender, exposure and race. The result of this explosion of science, is an explosion of interventions, that may or may not be useful. Another result is a deepening divide between those who have a mentalist attitude regarding behavior and those who respond in a more curious and compassionate way? Can you tell which one I lean towards?

Those interventions are meant to be evidence based. Evidence based also has its supporters and detractors but since it is the requirement of most funding sources let’s stay in that lane for now.

So, the evidence base from the science perspective is broad and deep. Many fields of investigation are contributing daily to the ways in which human beings are affected by trauma, and the mediators and moderators of that exposure.  An example of that is the announcement of a blood test that can detect childhood abuse exposure in some adults, decades after the abuse (Rachel Yehuda, NIH).

The definition of TIC says that care has to be implemented by multiple service providers (MSP).  This means that they have to be on the same page of understanding what TIC is, and what interventions are necessary.  This means that proper assessment has to be done. I am not sure that most agencies are even aware of what assessments for trauma are out there. I do know that if proper assessments are not being done that it becomes very difficult to actually be doing trauma informed care, and for me this eliminates 90% of those agencies that are claiming to do TIC.

Plenty of agencies are doing MSP work like family court and family team decision meetings (FTDM’s).  However, not much is said about trauma that is functional, in my experience. Nor is it assessed for clients who are clearly trauma exposed.

So finally we get to the “heals” part of the definition.  This is where we are totally under-prepared. The field of therapy is divided deeply regarding how trauma should be approached. I know what I believe and I know what I have seen work, both for myself, and for hundreds of others. So here is what I will say, it is absolutely essential that the healing journey be understood from the survivor/warrior perspective. Which means safety and trust are unassailable elements of the beginning of a healing journey.  For many of the most wounded, the therapist has to be the witness to their despair.  Therapists have to be willing and able to tolerate deep sadness and rage. Many are not, so it becomes easy to default to talk therapies and easy clients. That can’t happen, we are relegating really hurt people to life long institutional care.  We must step up as a system to create a path for those who, through no fault of their own, had to adapt to neglect, abuse, and other traumatic events that they could not control. This then becomes a societal burden.  We can not let this continue. We have to step up to our responsibility to take care of our communities. The positive consequences are immense and that will be the subject for our next blog.

“We are relegating really hurt people to life long institutional care. ”

In conclusion TIC is not a trivial thing, it is a multidimensional undertaking and there is great peril in not doing it right.  What is quite clear is that the less people care about each other, the more likely we are to exploit and hurt each other. Every time we fail in an intervention with someone who has compromised attachments, they lose faith in society and become more oriented towards personal gain.  This then is in opposition to society. We are creating the problem and we are leaving it to our children.

Issues We Face

Social service agencies are exposed to a variety of external stressors. Federal and State requirements, provider requirements, fiscal constraints and client family requirements are present and are often in conflict. In addition, the complexity of adolescence is compounded by domestic violence, disorganized and inconsistent family dynamics, and improper use of medications, forced transitions and exposure to multiple traumatic events. This can result in disjointed services, extreme lack of service coordination and high rates of adolescent transience and self injurious behaviors. The MTSN provides a multi-faceted, extremely structured, trauma focused continuum of services for such children and their partner agencies.

Neuro-Developmental - The Child's Brain Architecture
The conditioning of a child's ability to negotiate social situations is complex. Optimally, early childhood is the best time to allow the child to engage in and be challenged by appropriate social events so that their brain architecture is protected in its crucial developmental period. The increased fragmentation of family is having a tremendous impact on social settings as children come into those settings with limited skill sets. This puts an undue burden on the already overwhelmed early education system.

Systemic
Constantly shifting administrations and funding streams hinder the development of consistent programming and highly skilled caregivers. These types of "social supports" are time and again described in the emerging literature as the necessary components to stabilize our at risk youth populations. Compassionate, energetic caregivers are frustrated by the changes or give up on the systems and move to other more predictable employment.

Environmental
While an at-risk child profile may develop in any social strata, the vast majority of our clients come from low SES environments. The constant stressors that persistently play out all around them create a conditioned hypervigilance and world view that brings them into conflict with law enforcement and social services.

Physiological
The toll of environmental stressors on our physical and mental health comes in part from the chemical messaging in our central nervous system. Everywhere a child turns now they can seek out or observe environmental inputs that disrupt the development of strong pro-social ties and thus can encourage behavior patterns that result in unhealthy and risky attachments.

Cultural
Everything in moderation, we are a consumer nation. The health of our society is tied to consumption and as too many products and producers compete for our resources in financially stressed times we become overwhelmed. This leads to sacrificing long term fiscal health for impulsive short term material acquisition and the creation of multiple social stressors.

Behavioral
The behavior of our at-risk children is most often viewed as something that needs to be controlled instead of re-shaped with understanding and compassion. This population has been repeatedly violated resulting in a complex behavioral picture for which we punish them. The result is a prison system that houses more than 2 million humans at a cost of $44,000 per year per inmate or 88 billion dollars per year (Connecticut). A new minority majority of youth are being incarcerated at an unprecedented rate-today.

Workforce Stabilization
A community's ability to thrive and grow is dependent on a stable workforce. A stable workforce requires a solid education, dependability, attachment to landscape, hope, a sense of community and safety. If you looked into most learning environments you are likely to see the disruptions are being caused by a few students in the classroom but the learning is being negatively impacted for the whole classroom. The children who are struggling are quite often misunderstood and unjustly punished, only escalating their behavior and widening the gap between them and society until finally they make a mistake that cannot be undone. This results for many in a lifetime of high social service utilization that takes away social capital and fiscal capital from community growth.

Academics
How does one motivate a child to learn academically when they are focused on survival issues? If they don’t know how they will get through the day safely, how do they understand or relate to Mathematics? History? English or language classes? The brain and heart demand resolution of immediate environmental threats. The child who lives in a low income and high threat neighborhood will be conditioned to threat detecting and therefore unable to perceive enough safety in a classroom to calm themselves and to attend academic information. Numerous studies now indicate that 5 out of 20 youth in classrooms today are struggling with these challenges which in turn increase the challenges for the entire learning environment. Trauma Informed Care interventions directed at these populations bring them into the present, teach affect management skills, teach how to be safe and available in the classroom as opposed to distracted and behavioral through social skill development. The classroom is re-established as a place of safety, respect, non-violence and engaged learning.