Assessment
What is a survival-in-the-moment state?
An individual's experience of the present environment as threatening to his/her survival, with corresponding thoughts, emotions, behaviors and neurochemical and neurophysiological responses.
What is needed in order to create a priority problem?
There must be a pattern of behavior (3 A's & 4 R's) based off at least 3 moment-by-moment assessments. This must be related to their past trauma environment.
What is the primary goal of safety-focused treatment?
Establish and maintain safety and stability in the child's social environment and to minimize risk to the child and to others, based on his/her difficulty with survival-in-the-moment states.
What is the primary goal of regulation-focused treatment?
Give the child sufficient skills to manage emotional states when triggered by perceived threats.
What is the primary goal of beyond trauma treatment?
Work with child and family to gain sufficient perspective on the trauma experience so that the trauma no longer defines the child's view of the self, world and future
What type of child can benefit from TST treatment?
A child with a plausible trauma history and a child who has difficulty regulating emotional states that are related to trauma history.
How do you identify what phase of treatment to begin with?
Determining the child's survival states and environment (see chart in book on page 205).
True or False: You must complete the assessment and treatment plan before moving into safety-focused treatment.
False. You should begin safety-focused treatment as soon as you see a child in a harmful environment or have caregivers who are insufficiently helpful and protective while child is having dangerous survival states.
What is the caregiver's role in regulation-focused treatment?
Help and protect their children and building awareness alongside the child in order to help regulate their emotions.
What is the first step of beyond trauma treatment?
Strengthening Cognitive Skills: cognitive awareness, thought stopping, positive thinking and catching, calling and changing unhelpful thoughts
What are the 3 A's and 4 R's?
Awareness (consciousness): attention, orientation and sense of self
Affect (emotion): produce a specific reaction to a stimuli and help regulate the internal state of the individual.
Action (behavior): physical things child is doing
Regulating: usual state of being, calmness, control over emotions and behaviors
Revving: child experiences change in the environment and identify that a threat is present
Reexperiencing: child is flooded with feelings that remind them of the trauma
Reconstituting: transition back to regulated state
Ask yourself: What will be your overall approach to addressing the child's problems within that first phase of treatment? How will you address the threats you have identified in the environment? How will you enhance the child's capacity to regulate their emotions?
How do you define a safe-enough environment?
Caregivers are able to protect their child from actual threats and caregivers are able to help their child regulate dangerous survival states and protect their child from stimuli that provoke dangerous survival states.
What is the Managing Emotions Guide?
An individualized worksheet that identifies the way the child switches from his/her usual state to survival states and appropriate interventions for various stages of escalation and traumatic states. The goal is for the child and caregiver to learn to identify triggers and patterns of escalation, and be able to intervene early in the cycle of survival states
What is the Cognitive Awareness Log?
An individualized worksheet that identifies thoughts, feelings and behaviors associated with negative emotions as well as adaptive, alternative thoughts. The goal is for the child and caregiver to learn to identify links between the child's thoughts, feelings and behaviors as well as adaptive ways of countering automatic thoughts
Define a child's "cat hair"
A child's triggers/stressor presented in their current environment
What is the process of creating a Treatment Agreement Letter?
1. Complete the treatment planning form
2. Create a draft of the Treatment Agreement Letter and share with supervisor
3. Once approved by supervisor, share Treatment Agreement Letter with the family and ask for their feedback
4. Make any necessary edits
5. Bring Treatment Agreement Letter back to the family once edited and have them sign and keep a copy and you keep a signed copy in the binder
What does it look like to "clean out the cat hair"?
Make sure "cat" stays away from the child, make sure the "cat hair" that provokes dangerous survival states also stays away and make sure other sorts of "cat hair" are also removed when therapeutically indicated and when possible.
What is the Earliest Detectable Warning Signal?
Signal that indicates the child has left the regulating state and is starting to rev into a survival-in-the-moment state.
Help child develop trauma narrative using the prompts on the beyond trauma guide, process any negative thoughts that arise while writing the narrative (cognitive restructuring), re-evaluate the child's needs as you process through the narrative, focus on the child's future using the narrative, determine if the caregiver is ready to hear the narrative and work with child to read the narrative to the caregiver
What are the three types of environments that the child may be experiencing?
Helpful and protective: those around the child are available to apply sufficient competence and support the child's maintenance of regulation and support child's return to regulation when survival-in-the-moment occurs
Insufficiently helpful and protective: those around the child are either not sufficiently available or not sufficiently competent to support the child's maintenance of regulation and return to regulation
Harmful: those around the child are not sufficiently available enough or have not applied sufficient competence toward protecting the child from exposure to a true threat of harm
What are potential barriers to treatment?
Scheduling, transportation, Child care, parent limitations, stigma of mental health services, fear of social services
What are the three categories of "cat hair"?
1. Triggers/stressors that are unnecessary, unhelpful or downright damaging parts of life that ideally would be reduced or eliminated
2. Triggers/stressors that are a necessary part of life but could be temporarily reduced or eliminated until better regulation skills are learned
3. Triggers/stressors that are a necessary part of life and cannot or should not be removed and instead must be learned to be tolerated
What must be accomplished in order to complete regulation-focused treatment?
The child no longer enters survival states people around them no longer walk on eggshells and they can better regulate themselves and their caregivers help keep them regulated.
What should be final steps of treatment before termination?
Any necessary referrals, process through termination with the family by anticipating the goodbye early, acknowledge the meaning of the work and of the relationship. Identify people and places that support child in life goals and any barriers and how to overcome them