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HomeMy WebLinkAboutCASSP Newsletter June 2013Karen!s trauma history started when she was a small child and took her through mulitple placements before she was finally able to discuss her life in a way that led her to recovery and healing? What follows is part of her “trauma narraitve” as written by her primary therapist at The Bradley Center? Karen was 15 years old when she ar– rived at our agency? She came with a his– tory of mulitple place– ments in various mental health seitfngs including five inpaitent hospitalizaitons: two previous residenital treatment faciliites: two shelter place– ments: as well as one foster home place– ment? She was not unlike many other chil– dren who seek our services? Karen had a long history of complex trauma beginning at age 5 and ending at age 12 when she was removed from her mother!s home by Children: Youth and Families Services and placed in kinship care? Her behavior was also complicated by suicidal ideaitons and gestures: running away from home: and a history of self– injury? Further: Karen tended to decompensate whenever she discussed her future? She also had feelings of hopelessness due to the lack of contact with her family: especially her mother? During sessions: Karen reported experi– encing tashbacks of her previous abuse that were triggered by males? She also re– ported witnessing domesitc violence and discussed the impact it had on her per– cepiton of the world and adult roles? The Bradley Center: a Sanctuary–cerit– fied agency: was able to recognize Karen!s trauma and slowly began the process of helping Karen discuss and heal from her past abuse? This process began within the milieu of the unit where Karen was admit– ted? She was introduced to members of the Bradley community including her ther– apist: unit staff: psychiatrist and several other members of the treatment team? Karen was encouraged to build healthy re– laitonships with the members of her team and in therapy she began to discuss and process her past trauma? This process: of encouraging a child to tell their story: is part of the effort to help a child put his or her trauma into the context of the past? Karen!s recovery began slowly and there were many itmes when her progress appeared to be non–existent? This is not uncommon in treatment: and there can be itmes when a child!s outward behavior regresses as they get closer to dealing with discussing their past trauma? With the support of staff: Karen was able to work through her emoitons in a healthy: safe environment while conitnuing to build strong relaitonships? She was also encouraged to be an acitve paritcipant in her treatment by having regular discus– sions with her psychiatrist? Empowering children to advocate for themselves gives them a life skill they can use outside of treatment: and it is also an integral part of the healing process? Having a voice: with the strength and the willingness to use it: enables children to learn the skills neces– sary to overcome trauma and protect themselves in the future? Learning to control one!s own behav– ior is also part of the healing process? Karen had a significant history of physical aggression towards others: as well as a history of aggression against herself in the form of cuitfng? Her level of aggression oflffien increased when she was addressing her past trauma and the uncertainty about her future since there was not a co– hesive plan for her at discharge? Dialecit– PA CASSPPA CASSPNewsletterNewsletter Pennsylvania Child and Adolescent Service System Program A comprehensive system of care for children’ adolescents and their families Volume 22’ Number 2 June 2013 Healing from Violence and Trauma by Lisa Fox’ Chuck Lord’ and Craig Taylor conttnued on page 7 page 2 June 2013 June 2013 Volume 22’ Number 2 Tom Corbeti Governor Beverly Mackareth Secretary of Public Welfare William E- Harner Acitng Secretary of Educaiton Michael Wolf Secretary of Health Julie K- Hearthway Secretary of Labor and Industry James E- Anderson Juvenile Court Judges! Commission Children“s Commitiee of the Office of Men. tal Health and Substance Abuse Services Advisory Commitiee Co.chairs Connell O,Brien Gloria McDonald Dennis Marion Deputy Secretary for Mental Health and Substance Abuse Services Stan Mrozowski Director’ Bureau of Children,s Behavioral Health Services Harriet S- Bicksler Newsletier Editor Department of Public Selfare Oflce of Mental Health and Substance Abuse Services Bureau of Children,s Behavioral Health Services DGS Annex Complex Beechmont Building’ 2nd ffioor P: O: Box 2675 Harrisburg’ PA 17105 Telephone. (717) 772/7984 Fax. (717) 705/8268 E/mail. c/hbicksle®pa:gov Website. www:dpw:state:pa:us Subscriptton informatton® The PA CASSP Newsletier is distributed exclu– sively in electronic format and online? Subscribe to the CASSP News listserv to receive e–mail noit– ficaiton when a new ediiton is available at http,••listserv?dpw?state?pa?us•cassp–newslet– ters?html? Access back issues since 2002 by click– ing on the “2011” link? For issues before 2002: contact the editor? Please feel free to print: copy and distribute the newsletter freely? The Impact of Violence on Children and Adolescents The shooitngs at Sandy Hook Ele– mentary School in Newtown: Connecitcut in December 2012 not only focused at– teniton once again on issues related to gun control but also on the effects on children of exposure to violence? While that incident was understandably grab– bing naitonal atteniton: however: many other children were conitnuing to experi– ence violence on a daily basis in their homes and communiites? Consider these facts, / Exposure to violence affects almost two out of every three children in the United States? / One out of 10 children are exposed to mulitple kinds of violence (sexual abuse: physical abuse: initmate partner violence and community violence)? / Children are more likely to be exposed to violence than adults? / About 1 in 10 children have seen an– other family member assaulted: and more than 25 percent have been ex– posed to violence in their lfeitme (De– fending Childhood Iniitaitve) What is the effect of this regular on– slaught of violence and trauma on the healthy social and emoitonal develop– ment of children. When children are very young: their brains are the most vulnera– ble to stress? Not all stress is bad for a de– veloping brain: but when it lasts a long itme or is extreme: it can permanently damage the brain!s “wiring?” Toxic stress (like abuse and neglect) can prevent the healthy development of the connecitons in the brain that are the most important for later success in school and work? Re– search at the Center for the Developing Child at Harvard University shows that significant early stress – including expo– sure to violence – can lead to lifelong problems? A working paper from the center en– ittled “Persistent Fear and Anxiety Can Affect Young Children!s Learning and De– velopment” puts it this way, Studies show that experiences like abuse and exposure to violence can cause fear and chronic anxiety in children and that these states trigger extreme: prolonged acitvaiton of the body!s stress response system??? These experiences cause changes in brain acitvity and have been shown to have long–term: adverse conse– quences for learning: behavior: and health? Studies show that soluitons for children are available through programs that effecitvely prevent specific types of fear–eliciitng events: such as physical or sexual abuse???? $T®here also are effecitve treatments for children experiencing high levels of anxiety or chronic fear that result from serious emoitonal trauma? The good news is hinted at in the last sentence? In fact: because the brain is very “plasitc” in early childhood: the bad effects of trauma and stress can be re– versed with proper care and atteniton? If children have secure and stable relaiton– ships with their parents or caregivers: the effects of previous trauma don!t have to be permanent? In addiiton: with appropri– ate intervenitons: some of the effects of exposure to violence can be miitgated? Through their use of the Sanctuary] Model: several providers across Pennsyl– vania are offering trauma–informed care and treatment to children and adoles– cents who have experienced violence that is successfully helping them move forward with their lives? This ediiton of the newsletter highlights the impact of vi– olence on children and tells the stories of some who have been able to posiitvely overcome the legacy of that violence? Harriet S? Bicksler: editor References® Defending Childhood Iniitaitve, www:jus/ ttce:gov-defendingchildhood-index:html Harvard University: Center for the Devel– oping Child, htip.--developingchild:har/ vard:edu- “The results are staggering: More than 60 percent of the children surveyed were ex/ posed to violence in the past year’ either directly or indirectly:” Shocked by this number: these words were uttered by Attorney General Eric Holder in response to the first Naitonal Survey of Children!s Exposure to Violence published in 2009? We know from this study: and others: that far too many children in Pennsylvania and across the naiton are exposed to vio– lence? These exposures include child mal– treatment: witnessing domesitc and community violence: being assaulted in school or as part of criminal acts? Furthermore: we have learned through research that childhood ex– posure to violence can have ex– tremely negaitve effects that can last a lifeitme? An explosion in research on the brain has confirmed that experiences early in life literally shape how the brain develops? Through this neuro– biological research: we have learned that the brain develops like a set of stacked building blocks? The brain stem forms the foundaiton of the block stack and develops first? This lower brain regulates things like breathing: sleeping and eaitng? Next to de– velop is the mid–brain which is the hub for our emoitons and regulates how we re– spond to threats? It is where the “fight: tight or freeze” response lives? Last to de– velop is the neo–cortex: someitmes re– ferred to as the CEO of the brain? The neo–cortex is responsible for execuitve funcitoning and regulates criitcal thinking: impulse control and decision making? We have learned that the neo–cortex is not fully developed unitl age 25’ Each part of the brain: as well as the connecitons among the parts of the brain: is comprised of a series of complex con– necitons called neurons that look almost like electrical wiring circuits? Repeated ex– periences are the process for how these neural connecitons are made and strengthened and are the foundaiton for all learning and behavior? Unfortunately: when children are exposed to repeated early experiences that are negaitve: scary and painful: the part of their brains de– signed to respond to threat can become overdeveloped and can compromise opit– mal development of the “thinking” brain: the neo–cortex? Behavior: learning: and overall funcitoning can be impaired? While many children are very re– silient: many who are exposed to violence suffer deeply? They can have difculites with early attachment and bonding: suffer from anxiety: depression: aggression and conduct problems: have problems learn– ing: be more prone to daitng violence: delinquency: further vicitmizaiton: and in– volvement with the child welfare and juve– nile jusitce systems? Furthermore: exposure to violence can impair a child!s ability to develop healthy trusitng relaiton– ships - especially when the violence is perpetrated by a caregiver? Partnering and parenitng later in life can be affected and can conitnue the cycle of violence into the next generaiton? Fortunately: there is hope? At the same itme we have learned how violence exposure negaitvely affects brain develop– ment we have also learned that the brain has a remarkable capacity to repair and heal itself and the best “medicine” for the brain is to provide children and youth with safe: stable: nurturing relaitonships with caring: responsive adults? To accomplish this: the Mulitplying Connecitons Iniitaitve in Philadelphia has developed tools and resources to help providers who work with children exposed to trauma and adversity recognize the signs and symptoms of trauma? We use a framework called CAPPD to more effecitvely respond to these children? CAPPD is an acronym which stands for stay CALM: be ATTUNED: PRESENT and PREDICTABLE and DON!T es– calate when the child escalates? Of course these skills are good for all children: but consistently employing them with children affected by trauma and adversity is criitcal and can be especially challenging because these children and youth can exhibit ex– tremely difcult behaviors as a result of their exposures? The Mulitplying Connecitons Iniitaitve developed a curriculum: “Becoming Trauma In– formed:” which teaches providers about the impact of trauma: the ben– efits of CAPPD and how to use this model? Addiitonally the Iniitaitve: in partnership with Linda Chamberlain: Ph? D? and the Insittute for Safe Fami– lies and: has developed the Amazing Brain Series: a set of easy–to–read and beauitfully illustrated brochures which make the brain science infor– maiton accessible for providers and caregivers? Many of the resources de– veloped by Mulitplying Connecitons: as well as links to other great websites: can be found online at www:multtplying/ connecttons:org? Lastly: there are a num– ber of very effecitve treatments specifically designed to help children and caregivers heal and recover from violence exposure? You can learn more about “trauma–specific” treatments on the Na– itonal Childhood Traumaitc Stress Network website at www:nctsn:org: Leslie Lieberman’ M:S:W: is director of Multtplying Connecttons Inittattve of the Health Federatton of Philadelphia: page 3 June 2013 Working with Children Exposed to Violence by Leslie Lieberman page 4 June 2013 Jasmine“s Story I am 17 years old? I was born and raised in Philadelphia? My whole life has been shaped by the violence in my neigh– borhood: in my family: and at school? I am currently at North Central Secure Treat– ment Unit•Girl!s Program? I have been in placement here for more than a year? I was released to a step–down program in the community: but I was deeply im– pacted by violence that had happened at home before I was released: and I didn!t last long outside of this placement before I had to come back? On November 2: 2012: my grand– mother called this program to tell me that my dad had been shot seven itmes – one in the neck: two in the chest: one in his leg: one in his back: and one in his shoul– der? He died in the hospital an hour aflffier the shooitng? He was the only parent I knew: even though I had never lived with him? He was shot and killed over an argu– ment about a house and money? My dad was shot six itmes in 2005: on my birth– day? He survived that shooitng? He was shot nine itmes in 2007: also surviving? He was living on borrowed itme? This was not unusual where I grew up? Everybody gets shot? That is what I knew from the beginning? The neighborhood I grew up in was violent: bodies “folding” every other day? Everyone was out for themselves; people didn!t have feelings? Being shot was “nothing” compared to other things going on? Families were torn apart from vio– lence and drugs? I remember when a man was shot and killed because he had [2 in his pocket? Yes: [2? Bodies were oflffien seen lying dead in alleyways? I personally witnessed two shooitngs? A man was dragged out of the car where there were two babies in car seats? He was shot in the head and the little girls were shot in the stomach? I was 15 when I saw that? I also saw my cousin gunned down in a park in front of me? He told me to run and never turn around? I did what he told me to do: and I didn!t look back? I knew they would kill me too? I was shot myself once in the leg: dur– ing a robbery I was commiitfng? I was 14 when I was shot: and I was already deeply involved in crime and violence? I was in a gang at age 13? I was jumped and beaten to force me to join the gang? I did this for proteciton: –proteciton from the streets: for my life: and from other gangs? In addiiton to witnessing violence on the street: I was physically abused by my father and my uncle? My father was ad– dicted to drugs: and my uncle was an alco– holic? They beat me badly seven itmes: busitng my face open? Both my father and uncle are now deceased? Where I grew up: nobody really seemed to noitce what was happening to me? I was raised by my grandmother: and I am proud to say that she was not a violent woman? She is a lov– ing and caring woman: all of the itme: so I did have a safe place to go? I have been in seven placements: in– cluding this one? This is my second secure placement? I was violent: I assaulted staff: I just didn!t care: and I ran away in all of my placements – unitl now? I was asked why I am not violent here: what is differ– ent: and what has helped me to heal the pain that caused my anger and violence? This is what I think, I believe that what has helped me most here is the support from the staff? Nobody gave up on me: even when I came back aflffier a short itme out in the commu– nity? The staff come back here every day to help us; they don!t quit or give up? I have been in gun violence: post–traumaitc stress disorder (PTSD) and drug and alco– hol groups? If you want to change: these groups help a lot? It also helps just to talk? I have also been assisitng the unit therapist with the PTSD group for at least four cycles of the group? I would say that it is just as good for me to help a group as being in the group myself? I never believed I had trauma; I don!t even think I believed it aflffier I completed the group? Now I un– derstand how trauma has shaped my life: how it has led to me being locked up? Honestly: if anybody had noitced when I was younger that I was in trouble: stepped in: mentored me: cared about what happened to me: I may not be here right now? If my parents had been there for me: life may have turned out differ– ently? The Provider“s Perspecttve When Jasmine (not her real name) was 12 years old: the Department of Human Services (DHS) was involved with her family? They became involved because a report was called in by a neighbor claim– ing that a foster brother was sexually abusing her? DHS acted quickly and she was removed from her grandmother!s res– idence to ensure her safety? Unfortu– nately: at the age of 12: she did not understand why she couldn!t go home? This was the beginning of her own cycle of anger and violence: in addiiton to the be– ginning of her experience of being in out– of–home placements? She went to live with her aunt for one year? Her aunt was unable to manage this very angry young teenager: and she was moved to a foster family: where she remained for three months? They were also unable to deal It“s a Hard Knock Life by Jasmine with Dana Lockridge page 5 June 2013 Defending Childhood with her behaviors: and she returned to her grandmother!s home? She stayed with her grandmother unitl she began her cycle of placements? At the same age: 12: she was sent to her first placement for taking a knife to school? She had the knife to protect herself from girls who were threatening to “jump” her? Jasmine!s story is not unusual for the youth in the Youth Development Center system; it is just a bit more severe than some others? One hundred percent of our young ladies have witnessed or been a vicitm of violence? Most become violent as a result? As Jasmine stated: the most impor– tant factor in her success is feeling that people care: that they won!t give up: that they won!t quit: even when it is difcult? I believe in treatment programs: educa– iton: psychiatric medicaiton when appro– priate? But her words really sum it up, it is all about the relaitonships that are built? She may remember 10 percent of what she is taught: but she will never for– get that she felt safe here: that people cared and didn!t quit on her: and she will remember how she felt when she walked out of the front gate? I believe it is essen– ital to provide a good foundaiton of val– ues to our youth who don!t grow up with this: and this is done with the Sanctuary] Model we use here $see page 7 for more informaiton about Sanctuary] in Pennsyl– vania®? I believe that the enitre treatment team plays an essenital role? But mostly I believe that the key to change for our youth who have lived in these violent: un– safe situaitons is providing a safe environ– ment and showing genuine love and caring? This is done every day by our staff? This is where the growth and change process starts? Then the youth are open to learning concepts: examining how their criminal thinking had contributed to their current situaiton: and considering an– other life that does not involve harming others and being dangerous individuals? Clearly: early interveniton is criitcal: earlier than age 12? Also: not geitfng shuf– ted around in the system is another im– portant factor in predicitng future success? Many of our young ladies would not have made it into this system if some– one had noitced earlier in their lives that they were being beaten: abused: or ex– posed to daily violence? Early interveniton is definitely a key: as the older our girls get: the more difcult it becomes to change their minds: for them to be open to a different way of living? In Jasmine!s case: interveniton arrived at the age of 12: but it wasn!t the most helpful inter– veniton: and resulted in a string of place– ments that increased the anger and violence for this young lady? She can now look back and examine what happened: and think differently about her future and the choices she makes? She is sitll working hard: she no longer harms others: she fully examines her life of violence: what she has witnessed: and what she had done: and she makes better choices today? Her story is not ending; it!s just be– ginning? Jasmine is a resident in the North Central Secure Treatment Unit Girls Program’ and Dana Lockridge’ P:S:A:/M:H: is a staff member: In 2010: the federal Department of Jusitce launched the ’Defending Child. hood Inittattve-The iniitaitve has three goals, / Prevent children!s exposure to violence / Miitgate the negaitve impact of chil– dren!s expsoure to violence when it does occur / Develop knowledge and spread aware– ness about children!s expsoure to viol– nce As part of the iniitaitve: the U?S? At– torney General created a Naitonal Task Force on Children Exposed to Violence in 2011? In December 2012: the task force is– sued its report: which detailed recom– mendaitons in the following categories, 1? Ending the epidemic of children ex– posed to violence: including, / Ensure universal public awareness of the crisis of children exposed to viole– bce and change social norms to pro– tect children from violence and its harmful effects 2? Idenitfying children exposed to vio– lence: including, / Galvanize the public to idenitfy and respond to children exposed to vio– lence / Include curricula in all university un– dergraduate and graduate programs to ensure than professionals receive training for idenitfyng and screening children for exposure to violence 3? Treatment and healing of exposure to violence: including, / Provide all children exposed to vio– lence access to trauma–informed services and evidence–based trauma– specific treatment 4: Creaitng safe and nurturing homes: in– cluding, / Provide families affected by sexual abuse: physical abuse: and domesitc violence with educaiton and services to prevent further abuse: to respond to adverse effects on the family: and to enable the children to recover 5? Communiites rising up out of violence: including, / Provide schools with the resources they need to create and sustain safe places where children exposed to vio– lence can get help / Support community programs that provide youth with mentoring as an interveniton and as a preveniton strategy: to reduce vicitmizaiton by and involvement in violence and to promote healthy development by youth 6? Rethinking our juvenile jusitce system: including, / Make trauma–informed screening: as– sessment: and care the standard for juvenile jusitce services / Develop and implement policies in every school system across the coun– try that aim to keep children in school rather than relying on policies that lead to suspension and expulsion and ulitmately drive children into the juvenile system? Read the full report and find out more about the Defending Childhood Inittattve at www-justtce-gov’defendingchild. hood’index-html page 6 June 2013 “No one starts out planning to abuse their kids or take drugs?” So says Darlene from her vantage point as a parent am– bassador at a training center for child wel– fare workers where she advocates for a voice at the table in the child welfare sys– tem for families and children? When she!s working with child welfare system staff and parents across Pennsylvania!s 67 counites: she is someitmes overwhelmed by her own memories of what it!s like to be in the system? She also remembers her mother!s circumstances: knowing that she didn!t set out to be a parent who neg– lected her children or allowed them to be abused but was a vicitm herself? Darlene is the oldest of four children; she has one sister and two brothers? Her family moved around a lot: and it seemed like she was always geitfng used to a new school? Her father physically abused her and her brother? He beat her badly: and she remembers curling up in a ball as he kicked her? When she went to school: she was told she had to say she fell down the steps if anyone asked her about all the bruises? Her father also abused her mother: who had in turn been abused by her father? Darlene!s father leflffi right before her 12th birthday? She was home sick that day and heard the zipper to the suitcase as he packed up and leflffi? She never saw or heard from him again: even though she tried to contact him later in life? Her mother lost the house because she wasn!t able to pay the bills: and things declined from there? They were always moving be– cause they couldn!t pay the rent? Her mother started going out with different men: and their home became what Dar– lene describes as a “top house?” She was sexually abused during this itme? Fre– quently: she was leflffi at home to take care of her siblings where there was oflffien no food or electricity? The neighbors knew what was going on; however: while they would bring food to the children: no one ever reported the situaiton to the authori– ites? Darlene met an older guy who later became her first husband and she would run away to him someitmes? Her mother went to live with her brother and eventu– ally simply leflffi the kids with him? He fi– nally called the children and youth agency and Darlene!s siblings went into foster care? Her mother signed emancipaiton pa– pers for her: and her boyfriend became her legal guardian when she was 16? Darlene tried to do things regularly with her siblings? At first they were all placed in the same home along with her sister!s baby who she eventually gave up for adopiton? The children and youth agency checked in with Darlene every month? Her brothers went to live with an aunt and uncle: then back to foster care: where they stayed unitl they were 18 and came to live with her? Her sister lived with one aunt and uncle: then went back to foster care? Finally: she went to live with a great–aunt and uncle unitl she was 18; they were very good to her and Darlene remembers feeling jealous of her good sit– uaiton? The sister became pregnant again: and again gave up the baby for adopiton? Life has been rough for all four sib– lings as adults? Darlene!s sister has been married and divorced twice? All of her children have different fathers and she didn!t raise any of them? She!s written bad checks and spent itme in jail? She!s stable now: married to a nice guy and has a good relaitonship with her daughter? One of Darlene!s brothers is very much like their dad? He physically abused his wife and kids and has had drug issues? He is in jail for an inappropriate sexual relaitonship with a 14–year–old girl? Her other brother: the youngest in the family: is doing okay now: although he!s had employment prob– lems and strained relaitonships? He was married and had two children to two dif– ferent women? As for herself: Darlene is married for the third itme? She has two children and one grandchild? She has always cared for her own kids and feels like the cycle of abuse has ended for them? It!s especially graitfying when she receives a Mother!s Day card that says she!s the “best mom?” She and her husband host exchange stu– dents; they!ve had students from such countries as Germany: Denmark and Chile? In fact: a former student from Chile will attend a local college this fall and live with Darlene and her husband? She also has a relaitonship with her mother now: and has tried to forgive her because she needs to do this for herself: but she doesn!t for– get what happened? She and her mother have never really been able to talk about what happened: and her mother has never been able to tell Darlene she!s sorry? Darlene always felt like she needed to be the caretaker in the family? When Darlene thinks about the im– pact of the violence she witnessed and ex– perienced in her family: she lists things like her drug abuse: her inability to sustain relaitonships: and issues with trust and self–esteem? But she!s able to say with confidence and a smile on her face: “I!m a good person:” and she feels like her cur– rent job helps her process things: be a stronger person and give back to a system that helped her (she had a good case– worker who kept in touch with her)? She believes family engagement is really im– portant because kids want to make and keep connecitons with their own families? She also knows that single mothers oflffien have no support system and easily get caught up in making bad choices: like sub– stance abuse? So when she talks to child welfare workers as part of their training regarding out–of–home placement: she tries to make sure they understand that regardless of the many bad things that have happened: more oflffien than not: par– ents love their kids? It!s important to oper– ate within that framework and work to strengthen rather than sever those family bonds? This arttcle is based on an interview by the editor with Darlene’ parent ambassador for a statewide child welfare training cen/ ter: Using the Experience of Violence to Help Others cal and cogniitve behavior therapy were used to assist Karen in reframing her thoughts in a more producitve way that didn!t include aggression? Karen was successfully discharged from treatment to a maternal aunt who– had been working closely with the team throughout Karen!s stay? Since that itme: she has been able to reintegrate back into the community: return to public school and most recently: she became a cheer– leader for her school? Karen is a perfect example of a child who experienced ex– tensive trauma: but was able to move be– yond the hopelessness of those experiences to become a confident and focused adolescent? Lisa Fox is chief executtve oflcer’ Chuck Lord is clinical liaison’ and Craig Taylor is chief medical oflcer at The Bradley Cen/ ter’ Pitisburgh: The Pennsylvania State Sanctuary Provider Collaboraitve was developed to conitnue to foster and develop the Sanc– tuary] Model across the state to share networking ideas: concepts and strate– gies? The iniital group of agencies was trained through a grant from the Pennsyl– vania Department of Public Welfare and currently has 25 ceritfied agencies with three awaiitng ceritficaiton? The group is divided up into three regions: Northwest: West: and Southeast: and has worked on numerous projects including, / Vision•mission statement / Peer process re–ceritficaiton / Sharing strategies across agencies / A project with the University of Maine to idenitfy benefits of gains within the Model? The Steering Committee is comprised of representaitves from provider agencies: the Department of Public Welfare: includ– ing the Ofce of Mental Health and Sub– stance Abuse Services: and managed care organizaitons? Most recently the group met to discuss current regional updates and state and managed care expectaitons? Future plans include the final evaluaiton from the University of Maine: conitnued sharing of organizaitonal adaptaiton of the Model: and ongoing communicaiton within the network? The Sanctuary] Model has been helpful to organizaitons by focusing on the Seven Commitments, ? nonviolence: emoitonal intelligence: so– cial learning: shared governance: open communicaiton: social responsibility: and growth and change? In Northwest Pennsylvania five providers have been trained and ceritfied in the model, Perseus House: Inc?: Sarah Reed Children!s Center: Vision Quest: Gan– nondale and Harborcreek Youth Services? This collaboraitve meets regularly to share adaptaitons and uses of the model? Perseus House conitnues to use the Sanctuary] Model as the over–aching framework for its trauma–informed care applicaiton to assist youth with the ability to heal from early childhood trauma events? However to complete the total treatment experience we use addiitonal evidence–based pracitces, Aggression Replacement Training: A structured learning group model that teaches social skills: anger control training and moral reasoning: this ap– proach helps youth idenitfy and express their feelings? The anger control training component focuses on physical cues and helping youth idenitfy the external and in– ternal triggers for their anger? Youth who have been traumaitzed typically have a difculty assessing environmental risk and they need this assistance? Trauma.Focused Cognittve Behavioral Therapy This conjoint individual and family therapy model teaches youth how to heal from their trauma by giving them coping skills to deal with daily stress? Life Space Crisis Interventton This staff interveniton model teaches adults how to address explosive incidents with youth and use those incidents as op– portuniites for skill building? Both parents and children report the ability to better express their feelings and emoitons and regulate their own behav– ior? In addiiton: it is evident that the inte– graiton of skill–building evidence–based programs and trauma–focused cogniitve behavioral therapy within the framework of Sanctuary enhance the intervenitons? It also helps with restoring dignity: teaches young people to take responsibility for their behavior: and builds respecttul inter– personal relaitonships? Mark Amendola is executtve director at Perseus House’ Inc:’ Erie: More informa/ tton about the Sanctuary@ Model is at www-sanctuaryweb-com- page 7 June 2013 The Impact of Trauma on the Brain The brain undergoes significant growth in infancy and childhood? Neu– ronal connecitons are bourgeoning throughout the brain: establishing im– portant pathways that are further de– fined in adolescence through a process of pruning? Early exposure to trauma: no mat– ter the kind: leads to a significant stress response by the body? The stress re– sponse acitvates hormones: and corit– sol and coritcotropin release hormones that can alter neuronal growth and dif– ferenitaiton in the young brain? This can lead to permanent changes in neuronal connecitons that help to control emo– itons: impulses: and anger: leading to difculites in affected individuals with mood regulaiton: aggression: and poor impulse control? These changes can be permanent and have enduring impact on adults: leading to psychiatric disabil– iites and other issues? / Lisa Fox conttnued from page 1 The Sanctuary Model in Northwest Pennsylvania by Mark Amendola page 8 June 2013 PA CAWWP Newsletier published by Pennsylvania Department of Public Selfare Office of Mental Health and Wubstance Abuse Wervices Bureau of Children/s Behavioral Health Wervices When Robert Manriquez shares his story with the youth he!s helping through the High Fidelity Wraparound process: he can see their eyes light up as they realize they!re not alone and a staff person un– derstands them from his own personal ex– perience? He says he can someitmes be overly passionate and has to guard against geitfng emoitonally involved with some youth because he knows so well what they!re going through? Robert: age 27: is now a Youth Support Partner in Chester County? He also at– tends Delaware County Community College and is studying psychology? He was born in Maryland and moved to Chester County during high school? Soon aflffier his birth his father went to jail on a drug–re– lated charge: and so he lived with his birth mother and her boyfriend? They were both alcoholics: and the boyfriend was physi– cally abusive to Robert: threatening him and throw– ing him up against the wall? When Robert was 6 years old: his father obtained full custody of him and his mother disap– peared from his life unitl he was 18? Life with his father became difcult as well? He had been in Alcoholics Anony– mous: but aflffier he hurt his back and was on disability: he became addicted to pain pills and stopped going to meeitngs? He was emoitonally and physically abusive to Robert? One itme he twisted his ankle and cut his head when his father dragged him out of bed? When Robert was in tenth grade: he moved out? His father had been trying to convince him to quit school and get a job: and for Robert the final straw came when one day his father dragged him into the bathroom and forced him to cut his hair and shave? At the itme: he was already two years older than his class– mates; he had also been in a drug rehabil– itaiton center for alcohol: cocaine and heroin addiciton? He lived with a friend!s family and was able to complete his GED? He joined the service: but then got in– volved with drugs again and was thrown out of the service for selling and using? Throughout high school: Robert was always angry and he knew others who were vicitms of violence? One friend was shot 27 itmes by police and killed when he was teeing police and pinned some– one against a wall? Another friend who he had known since second grade and to whom he could always go when he was having problems with his father was also shot and killed by police? Robert fre– quently got into fights: mostly to prove he was a tough guy and because it was the only way he knew to solve problems? For– tunately: he was never arrested? When he got into heroin: he realized he was be– coming like his father and he didn!t want that: so he went into rehab again? Today Robert has no contact with his father and no real mother–son relaiton– ship? He stays in touch with his siblings and has a good relaitonship with his twin half–sisters? While he doesn!t want to place blame: knowing that he is responsi– ble for himself: he believes that his home situaiton when he was growing up con– tributed to the bad choices he made in his own life? He oflffien felt lonely and isolated and didn!t feel like he could trust anyone? He felt helpless and con– fused when he was being abused and when he watched his mother being abused by her boyfriend? He sitll finds it hard to trust other people: although he has been in a relaitonship with a girl for four years? Most of his friends from his earlier years are either dead or in prison: and his closest friend died of a drug over– dose? As a High Fidelity Wrap– around youth support partner: Robert feels good about helping other kids who come from difcult situaitons become successful? It!s his way of transferring the life skills he!s learned to others: hoping to help them break the cycle and start a bet– ter life for themselves? This arttcle was based on a telephone in/ terview by the editor with Robert Man/ riquez’ High FidelityWraparound youth support partner at Child and Family Focus in Chester County: Breaking the Cycle