Interventions that Work

Jasper Mountain has always had an influx of new employees who understandably want to know how to successfully work with our challenging children.  We have learned over the years that there is no substitute for experience with this population because employees universally say that six months after starting, they have a deeper understanding of the children and how to work with them. Then after a year it becomes even clearer, and after two years yet an even better understanding of what works and why it works.  However, the road to successfully helping our population can have either a solid or shaky beginning and everyone wants to have the former.  The purpose of this training is to provide a brief overview of some of the approaches that will overtime form the basis for successful interventions.  In the beginning a new staff person many not fully understand the complexity or nuances of the approaches mentioned, but the following can provide a framework that can lead to avoiding some mistakes and speeding up the process of being successful in helping our difficult population.  This overview breaks down successful interventions into ten areas.

1. Work to Change Internal Perceptions

You likely have heard this statement since joining the team at Jasper Mountain, but it is difficult to stress how important it is to facilitate change within the child.  As you have undoubtedly noticed, regardless of the facts our children see the world from their distorted perceptions.  We all live in the world that we perceive, and that is not a positive world for our children.

Although our children are young, most have had an unending series of adults telling them something is very wrong with them.  This message of being broken forms their self-perception and children who think they are bad or broken act consistent with this perception.

The quickest way to change behavior is not behavior modification, consequences or collaborative problem solving.  The quickest way is to change the child’s perceptions of self, others and the world around them.  Change their perceptions and you change the world they live in.

2. Disconfirm Past Negative Messages

This is closely related to perceptions because a young child’s inner world is defined by their experience and what they are told.  Unfortunately, our children have received far too many negative messages resulting in a scarcity of self-worth and positive dispositions. Consistent with the Hippocratic Oath—first do no harm—with our population this means do not let our children get you to treat them badly. The child may be more familiar and confrontable with being mistreated and may know how to act to continue this pattern, but don’t let this happen.

While negative messages impact the child, fortunately positive messages and positive experiences likewise have an impact on the developing brain. It may take multiple positives to override past negatives, but it can be done.

We must ensure that we do not add to the negative messages unintentionally.  With all your interventions ask yourself if you are confirming or disconfirming what the child believes.  Clearly you must correct inappropriate behavior but make sure with each correction you add the message that you believe the child can do better.  What is going on inside the child is much more important than the rule you may be enforcing, so enforce the rule but disconfirm the child’s negative self-perception.

The only way to override the negative past is to build a positive present.  We can’t just tell children they are capable and lovable rather than broken and a disappointment, we must provide opportunities where the children can have positive experiences of self and others.  Do not gauge your success in doing so based upon what the child says. Like planting seeds in a garden, you may not see the results of your work for some time, and sometimes the results of your hard work you will never get to see.

3. Teaching Regulation through all forms of Relaxation

The importance of learning to relax may sound obvious and perhaps simplistic, but neither are the case.  To a child whose inner world is chaotic and a continuing crisis, the goal is survival through hyperarousal and not relaxation.  However, we must teach these children that the only healthy way to thrive with stress is to learn how to relax and manage stress. It may also be the case that a state of relaxation may be an entirely new experience for the child.

Relaxation has been called the single most important component of brain health.  Without the ability to manage stress, the brain signals production of stress hormones (cortisol, adrenaline, epinephrine) that produce activation of the nervous system but overtime they also damage bodily systems.

Any children who have grown up without a supportive and loving parent will lack the ability to relax.  Like many other health habits, relaxation must be specifically taught.  At Jasper Mountain this can be done in groups (quiet time and meditation) or individually in therapy or on the porch after a child has finished venting.

Remember the best way an adult can teach a child is through example.  Assess your ability to relax and use these skills in stressful situations.  While you are learning relaxation skills, you are modeling for the children and everyone comes out ahead!

4. Promote Positive Play

Play is an essential element in a healthy child’s life.  Play is involved in physical activity building coordination, important in developing imagination, learning social skills with peers and in recreation which is a component of stress reduction.  With so many advantages of play and its role in positive activity and having fun, play and health go together.

But childhood play is not always understood by adults.  It is not about strategies toward winning and losing, true play is immersing yourself into an enjoyable pursuit.  There is no goal in childlike play, it is its own goal. Play has healing qualities because while reducing stress levels it promotes joy, a healthy aspect of a child’s life.

Most of the time adults need not focus on the importance of play for a child because play is a natural activity.  However, trauma impacts a child’s desire for and ability to engage in childlike play.  What types of play these children do engage in is competitive (there are winners and losers) such as sports or video games.  But trauma generally robes a child of play for play sake.  Therefor play should be an aspect of every traumatized child’s treatment plan.  At Jasper Mountain positive play needs to be a daily aspect of the child’s routine.  

Making time for play is not enough, we must teach and encourage traumatized children childlike play.  When our children ‘play’ you will notice that they often become aggressive, seek to gain control over peers and end up in anger or tears frequently—this is not consistent with childlike play. It takes time but traumatized children can learn to enjoy activity, enjoy a game and overtime learn to lose themselves in recreation (re-creating).

For all of the above reasons, play needs to be a component of treatment but also present in the residence and our school. If we do not assist a child who has lost the ability to play, where will they learn to do so?

5. Become an Attachment Figure

Many experts believe that teaching a traumatized child to bond and attach to a caring adult may be the most important element of successful therapy.  In part this is due to the role connection with the source of social support aids in coping with the stress of living.  For most of our children our goal is to aid them in learning bonding and attachment skills.  

The ability of children who have experienced trauma to connect with another person is essential for social success.  The most important success in life is not determined by money, education or social status, it is determined by the support and love a person has.  Few of our children have ever been successful in homes, or schools or with care providers.  We must change this pattern for the child’s long-term chanced at a lifetime of social success.

One of the many advantages of connecting with others is that it is cumulative, and each healthy attachment builds upon the last and improves emotional health.  Attachment is an element in most of the other areas of developing health in this training—it changes perceptions, disconfirms a negative past, enhances play, aids relaxation and more.

A child’s attachment with others is often misunderstood with the thinking that attachment should only develop with a primary care provider.  However the more honest, supportive and genuine attachments the child has the better because bonding skills are learned and reinforced with each bond and the child more easily bonds at the next opportunity with teachers, family members, and friends.

6. Translate the Meaning of Behavior

The cornerstone of our work at Jasper Mountain is to first understand the children we work with.  In the process of doing so, we must understand their background, understand their inner world that forms their perceptions and interpret what the child’s emotions and behaviors are telling us.  To do this we use the concept of translating what the child is communicating to us.  Much of the time their words are of little use to accurately understand where the child is coming from but translating the true meaning of their energy and behavior will give us the most accurate results.

All behavior has meaning, but it may be very different than it appears.  The meaning we are looking for is the meaning to the child, not to us.  For example, violence toward a particular staff person may not mean the child dislikes the staff member but instead may mean the opposite that the child is feeling vulnerable due to liking the individual.  But how do we know whether to take words or actions at face value or consider an entirely different message?  The answer is a combination of experience and using other tools such as the NRT protocol to arrive at the answer.  It can also be helpful to respond to the true message you believe the child is sending and observe the response.

Becoming proficient at translating may be the most important skill you can learn to be successful.  Unless you accurately understand the child’s true message you will be unable to know how to respond effectively. For example, with the case mentioned above, if aggressive acting out toward a particular staff member is caused by fear of vulnerability, it will not help to simply stress the importance of avoiding violence.  If we cannot correctly translate the message of the child, we have not understood the child.

7. Work at the Emotional Age of the Child

Trauma most often impacts the Limbic region of the brain, where emotional development is based. Because of this, maturation of emotional growth can be severely restricted at the time of a traumatic experience.  While emotional expression may continue to mature, when the individual is under significant stress the result is often a return to the Limbic emotional age or the age when the trauma occurred.  Becoming emotionally stuck at a young age may cause a twelve-year-old adolescent while experiencing stress to act like a three-year-old. When this takes place, it is a good idea to match your interventions with the emotional age you are working with.  It will not work to ask the child to act their age because in a real way they already are.  This is an important aspect of understanding the child to be able to be a successful helper.

8. Provide Executive Functions for the Child

The brain has areas that allow both primitive functions as well as higher order reasoning.  You will notice that trauma often produces highly reactive and primitive responses from Jasper Mountain children.  The primary reason for this is the sensory input coming into the child’s brain being processed by the Limbic region along with the autonomic nervous system.  The result is some combination of fight or flight.

Trauma changes the brain in order to better prepare for further threats and to help with survival.  However this is not very useful when there is no real threat although the child may perceive that there is.  Survival places the focus on reacting to threats and away from executive functions.  When this takes place, it is important that the child receives your help to deactivate reactivity and high order reasoning will need to come from you to help the child think through the situation.  At such times cognitive restructuring can help by encouraging the child to relax, rethink and respond to the situation.  However, you will have to initiate this process until the child gains the skills to be able to do so without help.

Neuro-pathways in the brain are strengthened with use and many children automatically react to most all sensory input.  The brain forms neuro-pathways over time so it is important to build in repetition into effective interventions.  For example, helping a child relax and rethink a situation when not under stress. 

The brain is constantly changing at all periods of life.  With every experience the makeup of neurons acts similar to muscle cells where the more they are used the stronger and more efficient they become.  The reverse is also true—less use and cells atrophy.  When you provide executive functions for the child, you are actually making positive changes to the child’s brain.  But this takes time and although you would like a child to learn from one or several experiences, it may take time to override the impact of early trauma, so be persistent and be patient.

9. Know the Right Problem before Seeking Solutions

Adults are often experts at rapid responses to childhood problems and in doing so missing the point entirely.  A child may tell a lie and the adult provides a mini-lecture in honesty, when the child is actually concerned about disappointing the adult.  If we are to develop successful interventions, we must first understand what the real problem is that needs to be addressed.

The first step with unwanted behavior is to separate the symptom from the problem since they may be very different.  Symptoms are what we can see, but actual problems that caused the symptom may be elusive. A quick but inefficient way to know if you focused on the wrong issue is your intervention will be unsuccessful.  But when an intervention consistently does not work, discontinue it because you likely are addressing the wrong problem.  A better method is to follow the NRT protocol to first identify the symptom, then translate the child’s message to get to the real issue, and only then come up with an intervention and see if you are on target.  Using the NRT process there are four steps–what you see (symptom), what it means (translation), what caused it (child’s history) and interventions to promote change.

10. Take the Long-Range View

Too many treatment programs put the focus on the here and now and seldom consider the future.  Our programs are less concerned with immediate gains and instead our goal is helping a child have a successful and happy life.  Short-term and long-term improvements are not incompatible, but only focusing on the immediate can make adults impatient to see progress.  Positive brain change is more of a long-term than immediate task.  Therefore with all your work with children keep your focus on the long-term and building skills for the future.

It is not surprising that most adults want to see immediate improvement in children.  One reason for this is that challenging children have an exclusive focus on the immediate.  Be aware that these children can train us to focus only on immediate issues. A long-term focus is asking yourself what the child can learn in the present that will be helpful in the future.  Will the child learn from you today what will help them be successful ten years from now?

Some interventions may produce immediate gains but hamper long-term improvement and they should be avoided.  Many adults rely on these short-term interventions such as: rewards that are actually bribes, any type of threat of punishment, and incentives that are the only reason a child complies.  A child may do their chores for a cookie, but what has been learned? In the future the young person will not be immediately rewarded for prosocial behavior, the motivation must be internal. Adults are not given an immediate reward for arriving at work on time, paying taxes or stopping at stop signs.  Help a child see the importance of doing the chore and a cookie is not it.

We must focus on the future because with our children the odds are stacked against a successful and happy future. Childhoods of trauma are common in our prisons, mental institutions, addiction programs and produce teens and adults who self-harm and react to the stress of life with fight (antisocial anger) or flight (suicide).

There is nothing simple, quick or easy about helping traumatized children navigate the stress of life in a successful way.  However we have learned over the past decades that success and happiness are obtainable to our children if we do our best to prepare them with skills, hope and confidence that they can achieve their dreams.  Your hard work today can turn our children into successful and happy individuals in the years to come.  Being a part of this process is the greatest reward for the job you do. 

Test

1. One of the primary reasons Jasper Mountain children feel constant negative stress and unhappiness is their faulty perceptions.  T or F
2. Circle all the ways staff can disconfirm negative message from the past:

1. Tell them their parents were wrong in what they said and did.
2. Have the child experience their strengths and abilities.
3. With each correction give the child the message you believe he or she is capable of doing better.
4. Stress what is right with the child rather than focus on what is wrong.

3. Our program must enhance both activating parts of the day and also calm and relaxing parts of the day to teach a balance and skills to do both.    T or F 
4. Childlike play is easy to promote because children with abusive pasts gravitate to such play.  T or F
5. Circle the statement that is not true about the teaching bonding and attachment skills with our children.
   1. Learning to attach with adults promotes future social success in life.
   2. The more attachments the better for our children.
   3. Bonding should be reserved for a parent or primary care provider.
   4. Staff should work to be attachment figures for our children.
6. Translating a child’s message includes (circle all that apply):
   1. Considering whether the child is speaking in opposites.
   2. Considering whether the child has learned to be truthful with their words.
   3. Helps to learn the most accurate message the child is sending.
   4. Helps to understand speech problems the child has.
7. Because the Limbic region of the brain is the emotional center, traumatized children have highly evolved emotional development.  T or F
8. Providing executive functions for the child actually delays the child’s ability to develop these skills.  T or F
9. Identify the common mistakes adults make with our population:
   1. Children lack the sophistication to be hard to read.
   2. Interventions need to be clear, immediate and uncompromising to produce quick results.
   3. Slow down and make sure you understand the problem before working toward a solution.
   4. Traumatized children need a friend more than they need a parent figure.
10. Which of the following represents the primary goal of our treatment at Jasper Mountain:
    1. Improved behavior
    2. Learning to get along with peers and adults
    3. Calm shifts that are a joy to work in
    4. Long-term success and happiness in life