EXTENDED DAY TREATMENT...a Creative Alternative for Traumatized Children and Caregivers
by Marilyn E. Cloud, LCSW, ACSW; Sarah Lockery, LMFT; Lucy McClellan, RDT-BCT, LCAT
Most children and youth involved with child welfare and juvenile justice systems have been exposed to physical and sexual abuse and other types of trauma-inducing experiences. These experiences often lead to psychiatric and/or co-occurring disorders and medical conditions that are likely to continue into adulthood unless there is a trauma-informed system of care with a trained, skilled workforce and an array of trauma-specific interventions and treatments. DCF has assumed a leadership role in creating an organization where the workforce understands and responds to the varying impact of traumatic stress on children and caregivers. This is evidenced by the adoption of trauma-informed care as a cross-cutting theme and core component of the Strengthening Families Practice Model, trauma training for the entire workforce, introduction of trauma screening and referral, trauma champions at each work site, and efforts to disseminate evidence-based, trauma-specific interventions and treatments. One of the most significantly transformed behavioral health services is the statewide system of nineteen DCF-funded Extended Day Treatment (EDT) programs. Were YOU aware of this resource, and have YOU referred any traumatized children and families?
EDT programs offer a structured, intensive, therapeutic milieu for children and youth, ages 5 to 17 and their caregivers (www.ct.gov/dcf
, then "About DCF" then "Extended Day Treatment", or go here
). A team of multi-disciplinary staff including psychiatrists, advanced registered nurse practitioners, master's level clinicians, and para-professional direct care staff offer a broad range of treatment services and psychosocial interventions. The goal is to assess, treat and stabilize children who are experiencing a moderate level of emotional disturbance and behavioral dyscontrol. The programs operate 5 days per week, 52 weeks per year, and are open during school vacations. The average length of stay is 6 months. Priority access is afforded for children who have returned home from out-of-home care or are at risk of placement due to mental health issues. The intent is to provide the support necessary for the family to maintain the child in his/her own home.
Connecticut's EDT programs are unique in several ways. First, while a range of trauma-informed treatments are available, including statewide implementation of Trauma-Focused Cognitive Behavioral Therapy, a limited few are milieu-based and even fewer offer a comprehensive, integrated array of clinical treatment and rehabilitative services. The child and family-based EDT model consists of: comprehensive assessment that includes history of trauma exposure and current trauma symptoms; psychiatric evaluation and medication management if indicated; treatment planning; 24 hour crisis services; individual/group/family therapies; and discharge planning. EDT providers offer alternatives to traditional therapies including expressive modalities such as therapeutic drama play. Supervised community outings occur on a regular basis to enable children/youth to "practice" social skills that are learned within the milieu. Many sites offer "family meals" and other positive reinforcements. Transportation resources are available.
Similar to DCF, the EDT provider network has taken multiple steps to develop a more trauma-informed treatment team that now offers trauma-focused interventions and treatments. These include:
- Foundational Trauma Training (Risking Connection): All staff is trained to frame common symptoms and behaviors as adaptations to traumatic life events, using a strength-based, present-focused relationship as the primary change agent to support healing (www.riskingconnection.com).
- Family Engagement Skills Training: Treatment teams have been trained to identify and address barriers to treatment, clarify the presenting needs of children and families, establish a collaborative, empowering relationship, and apply problem-solving techniques.
- Trauma-Focused Cognitive Behavior Therapy (TF-CBT) - PRAC Components: Clinical staff has been trained to offer the skills-building components (PRAC) of TF-CBT. These include:
- Psychoeducation and Parenting Skills - General education for parents about child abuse and the typical emotional and behavioral reactions as well as training for parents regarding child behavior management strategies and effective communication;
- Relaxation Techniques - Teaching relaxation methods such as focused breathing, progressive muscle relaxation and thought stopping;
- Affect Expression and Regulation - Helping the child and parent manage their emotional reactions to reminders of the traumatic event, improve their ability to express emotions and participate in self-soothing activities; and
- Cognitive Coping and Processing - Exploring and correcting inaccurate attributions about the cause of, responsibility for, and results of the abusive experiences (http://www.tfcbt.musc.edu).
- Therapeutic Drama: Eight programs (Mid-Fairfield Child Guidance Clinic; Children's Center of Hamden; Community Mental Health Affiliates - Waterbury and New Britain; Klingberg; and The Village for Families and Children - Hartford, Manchester and Meriden sites) plus Clifford Beers Clinic and Lower Naugatuck Valley Parent Child Resource Center -IOP offer therapeutic drama. Clinicians participated in a year-long learning collaborative offered by Creative Alternatives of New York (CANY) with generous support by the TOW Foundation. The CANY model of drama therapy utilizes the group process as a therapeutic agent of transformation and healing. The creation of fictional narratives and roles, referred to as metaphorical devices, serve as protective factors, allowing for real life experiences to be explored and embodied within a parallel realm, thereby reducing the risk of re-traumatization. Children are free to engage their imagination, envisioning and enhancing future goals, roles and behaviors, gradually informing their sense of self. Julie Nesteruk, Program Director at The Children's Center summarized the value of the CANY model:
One of the most elegant parts of the CANY process of therapeutic drama is that, regardless of the age, verbal skill, or maturity of the children and youth, each individual child benefits within the context of the group. There are not many group therapy approaches that are able to impact individuals in such a definitive therapeutic manner. There are no outsiders in a CANY therapeutic drama group. As you may recall, we have also used the approach in our multi-family therapy groups with much success. (For more information on CANY, visit: http://www.cany.org).
- Psycho-education and Social Skills Groups: An array of psycho-education and social skills groups are offered weekly in the milieu setting. Examples include: problem-solving skills training; communication skills; feelings identification and management; grief and loss; bullying; and enhancing personal safety.
- Life is Good Therapuetic Activity/Play Groups: A clinician, paired with a direct care worker co-lead these groups, using the power of transformative play activities to help children actively engage, gain internal control, experience joyfulness and hope, and improve social connections. Through structured play activities, children learn appropriate social skills and feelings modulation (www.lifeisgood.com/playmakers).
- Multiple Family Groups to Reduce Youth Behavioral Difficulties: EDT providers offer a 16 session multi-family group curriculum to teach families how to apply the 4 R's (rules, responsibilities, relationships and respectful communication) to build a stronger, well-functioning family system.
- Other: Many providers use family partners who have utilized EDT services in the past to assist with outreach and engagement with new families. Family partners also provide the "consumer's voice" regarding program enhancements and service delivery. Some providers offer art therapy, crafts, music and additional evidence-based treatments, such as dialectical behavior therapy that is offered for the adolescent groups at Wheeler Clinic.
Counteract the impact of violence, abuse and neglect;
Focus on helping children/youth move beyond a traumatized past; and
Build the personal resources and skills needed for youth to engage in their communities in healthy ways.
EXTENDED DAY TREATMENT PROGRAMS
NOW is the time to consider a child and family that YOU might refer...
Content Last Modified on 8/28/2013 3:08:46 PM