Children in Crisis
Published in Aspects Magazine, Autumn 2016 | Vol. 39 No. 4
Fourteen-year-old Alyssa* is no ordinary teenager; she has dealt with more trauma in three years than many people will experience in a lifetime.
At age 11, Alyssa lost her father after a long battle with cancer. Just a year later, she was sexually abused by her mother’s first love interest since losing her husband; and at 13, the young girl’s trauma was magnified when her mother was diagnosed with breast cancer. She developed a fear of strangers and men, withdrew from her friends and experienced extreme anxiety.
To help, Alyssa and her family sought a new type of therapy – trauma focused cognitive behavioral therapy – newly available through the Children’s Medical and Mental Health Resource Network (CMMHRN), a program of Southern Illinois University School of Medicine.
Alyssa is one of more than 175 children and teens who have received trauma focused cognitive behavioral therapy through the Trauma Informed System of Care Learning Collaborative, an effort made possible by a $100,000 donation from The Poshard Foundation and an $80,000 grant from the SIU School of Medicine Rural Health Initiative.
The Learning Collaborative, launched in February 2015, serves 23 counties in southern Illinois. It is comprised of health care providers, social workers, law enforcement officials and representatives from child advocacy centers, the Department of Child and Family Services, state attorney offices, women’s centers and other social service agencies.
According to CMMHRN clinical director Ginger Meyer, MSW, LCSW, abused children referred to the program, on average, experience more than three different types of trauma, most often sexual and emotional abuse, before receiving help. Nearly two-thirds of these children, ages 3 to 18, experience some form of post-traumatic stress. Meyer helped found the CMMHRN in 2002 with a Children’s Justice Federal Grant from the Illinois Department of Child and Family Services.
The short-term treatment model consists of 8-25 sessions with the child/adolescent and caregiver. The therapy assists youth and parents in learning new skills to help process thoughts and feelings related to traumatic life events; managing and resolving distressing thoughts, feelings, and behaviors related traumatic life events; and enhancing safety, awareness, parenting skills and family communication.
Part of the innovative therapy involves the child creating a "trauma narrative." A trauma narrative serves as a method for the child to learn to tolerate remembering without significant distress and to arrive at a true and helpful way of understanding what the trauma means in their life so that it can be put in the past.
When children can’t yet find the words to express their trauma, therapists encourage them to draw or paint. "Implementing play therapy and art therapy into their sessions can really amplify the positive effects of the trauma therapy," Kim Honey, LCSW, a member of the Collaborative who is trained to provide the trauma-focused therapy.
Trained to Intervene
To help children and teens like Alyssa, the CMMHRN and partner agencies formed 19 care teams that trained 65 clinicians on Trauma Focused Cognitive Behavioral Therapy. "This treatment is not just a model of therapy but a unique process of maintaining hope for many kids who may have lost hope due to childhood trauma," says Honey.
Forty-six of these providers are on track to become nationally certified Trauma Focused Cognitive Behavioral Therapy clinicians. "This is a significant accomplishment," Meyer stresses. "Only 14 clinicians in Illinois are certified, and currently only one of them is in the southern region."
The southern Illinois collaboration is earning national recognition for its work. In September 2016, the Substance Abuse and Mental Health Services Administration awarded the Learning Collaborative with gold-level Excellence in Communications and Outreach (ECCO) awards in two categories: communication and outreach to a professional audience and partnership development strategy.
Educating the Next Generation
A federal grant has also funded a 30-week, Trauma Based Behavioral Fellowship at the SIU School of Social Work. The fellowship trains students to recognize behavioral changes that may occur following trauma, use group treatment approaches with teens and children, address youth addiction, use play therapy and practice parent-child interaction therapy. The fellowship began in January 2015 as a partnership of the Network, the SIU Center for Rural Health and Social Service Development and the SIU School of Social Work.
"New research increasingly calls for therapists to be trauma informed and trauma trained," says Associate Professor Dhrubodhi Mukherjee, PhD, MSW, director of the Trauma Based Behavioral Health Fellowship at the SIU School of Social Work. "Our goal is that our fellows use their training to contribute back to the community and help children in rural communities like southern Illinois to have a better quality of life."
The program is funded through 2017 and will graduate more than 70 fellows over the three year period.
After completing therapy this past spring, Alyssa says she’s ready for the challenges of high school. Her therapist in the Learning Collaborative agrees. "I saw for the first time, a child who felt very small and defeated due to her sexual abuse, take control of her story and make it into an empowering story of perseverance," says her therapist.
In May 2016, Alyssa was a top student in her 8th grade class. According to her therapist, the freshman made the high school cheerleading squad, started dating her first boyfriend and is a giggly teenager, which, her mother reports, is something she hasn’t "seen in many years."
Like Alyssa, 14-year-old Adam has struggled with years of trauma and abuse. He showed signs of post-traumatic stress: anger, irritability, difficulty sleeping, nightmares and trouble paying attention. As a child, he witnessed drug use and domestic violence and was removed from the care of his mother and placed into foster care.
Since coming into the foster care system, Adam had been "shuffled around to numerous foster homes, removed for either chronic homelessness or the inability of his caregivers to follow DCFS regulations," explains Kerie Moore, MSW, QMHP, Adam’s social worker and a member of the Learning Collaborative at SIU School of Medicine.
Adam is also making great strides. "At Adam’s first therapy session with his trauma-focused clinician, he was so resistant he would barely engage, telling his female counselor he didn’t like therapy or females and wouldn’t be participating in the sessions" says Moore.
"After nearly a year of living with his foster family, he hugged his foster mother for the first time," says Moore. "Adam read his trauma narrative to his foster mother and father and was even able to tell them what it meant to him to have them love and care for him." After completing the therapy, Adam’s foster family invited him to become a permanent member of their family by adopting him.
"Stories like Adam’s and Alyssa’s make all the work worth it," says Meyer.
Planning for the Greater Community
As the CMMHRN continues to train fellows and identify cases of child abuse, it aims to expand its reach and add new resources for families and providers, says Meyer. "We want to have an ongoing training curriculum for multiple disciplines regarding trauma-informed care, trauma-informed practice and evidence-based trauma interventions. In the future, we would like to create a national trauma center in collaboration with our partners that would focus on training and educating providers on trauma focused therapy."
The CMMHRN is also in the process of creating a new online database that will allow parents to easily locate a trauma focused therapist.
For children and teens like Alyssa and Adam, these resources can’t come soon enough, Meyer says. "When you know you can help those children, it feels really good. The medical care and therapy the Network provides is one of the first steps to healing."