healing trauma through relationships and occupations · ma’s restraint & seclusion reduction...
TRANSCRIPT
Healing Trauma through
Relationships and OccupationsATTACh 2018: Virginia Beach, VA
Miranda Wilson, MS, OTR/L & Romeissa Selmane, MS, OTR/L
Learning Objectives
• Describe how occupational therapy (OT) aligns with and compliments ‘big picture’
trauma treatment• Integrative Treatment of Complex Trauma (ITCT), current trends in neuroscience, and
developmental impacts of trauma
• Select and plan interventions to enhance function of clients who have experienced
complex trauma and attachment disruptions
• Utilize strategies to enhance collaboration with a multi-disciplinary treatment team
while maintaining the distinct role of occupational therapy
• Anticipate and plan for potential challenges in developing a new OT program in the
group home level of care
Agenda
OT assessments & interventions
Creating an OT department
Trauma treatment (ITCT)
Trauma's impact on the brain
Who we are
Stretch Breaks
Every 45 minutes, we will take a 2-minute stretch break.
What is Occupational
Therapy?
Occupations = anything that occupies your time
Who do we serve?
Harrington House1:3 co-ed Intensive Group Home (IGH) for youth 8-14
Children's Community
Support CollaborativeBoston's Continuum: Community-based wrap-around services
Meet Sam
How does
trauma impact
the developing
brain?
How Trauma Impacts the Developing Brain
(Scopeconsultancy, 2017)
How are occupations
affected by trauma?
How do we provide treatment to
individuals experiencing
complex trauma?
Integrative Treatment of
Complex Trauma (ITCT)
Dialectic Behavior
Therapy (DBT)
Trauma Sensitive
YogaSubstance Abuse Treatment
(e.g. “Seeking Safety” model)
Motivational
Interviewing
Restorative Practices/
Circle Keeping
Cognitive Behavior
Therapy (CBT)Therapeutic Crisis
Intervention (TCI)
OT Frameworks
Permanency
Planning
How was OT introduced?
How to develop a well-integrated OT department
✓ Immerse self in culture and routine of program
✓ Understand agency values, philosophies and policies, as well as how
they are applied at the program
✓ Program-Wide Needs Assessment
✓ Form relational connection with all departments
✓ Integrate experiences, relationships and observations, with a trauma,
attachment and occupation-informed lens to complete needs assessment
✓ Identify strengths, areas of improvement, opportunities
and threats (SWOT analysis)
✓ Prioritize needs and create an action plan
✓ Continuously strengthen and empower interdepartmental
relationships and collaboration in all aspects of OT 3-tier model
Tier 1: Universal Promotion
and Prevention Services
Tier 2: Targeted Services
Tier 3: Intensive
Services
OT 3-Tier Model
Where No OT Had Gone Before...Challenges
● Pre-conceived notions
○ “Oh my ____ had OT but our youth don’t need to
work on ____”
○ Pigeon-holing OT as only ‘sensory’ or only ADLs
● No precedent
○ Cultural change can be very slow!
● Keeping OT’s role as distinct while also
maintaining its wide scope
○ Avoiding ‘turf battles’
○ Highlighting OT’s unique value
Where No OT Had Gone Before...Strengths
● Wide/Diverse knowledge base that OT’s carry
○ ‘Speaking the same language’ as other team members
○ Framing formulations and interventions in language
that emphasizes: attachment, typical development,
neurobiology, education or medical models
● Advocates/Champions within our agency
● Agency/Program Philosophies & Values
● MA’s Restraint & Seclusion Reduction
Initiative
How does an OT provide
trauma- and attachment-
informed interventions?
Theory & Framework Driven
Assessment Driven
Trauma- and Attachment-Informed OT Interventions● Therapeutic use of self
● Collaborative assessment process & goal
setting
● Highly Individualized
● Occupation-driven interventions
● Activity analysis
● Sensory modulation and processing
● Environmental adaptations
● Motivational interviewing
● Cultural and developmental sensitive
● Avoid judgment and power struggles
● Increase internal awareness/internal locus of
control
● Increase internal sense of safety
● Understand the meaning behind behaviors
Complex trauma occurs in relationships so healings needs to occur in relationships.
Occupations are situated in relationships and are used as a means and end to help in the
healing journey.
Thank you!
Questions?
Learn More about ITCT
ITCT Website:
https://keck.usc.edu/adolescent-trauma-training-center/
Karianne Chen
USC-ATTC Training Director
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd
ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48
Appendix III of J. Briere and C. Lanktree (2011), Treating Complex Trauma in Adolescents and Young Adults. Thousand
Oaks, CA: SAGE Publications.
Bazyk, S., Arbesman, M. (2013). Occupational therapy practice guidelines for mental health promotion, prevention, and
intervention for children and youth. Bethesda, MD: American Occupational Therapy Association, Inc.
Briere, J. B., & Lanktree, C. B. (2013). Integrative Treatment of Complex Trauma for Adolescents (ITCT-A) Treatment
Guide, 2nd Ed. Los Angeles, CA: USC Adolescent Trauma Training Center.
Children’s Behavioral Health Knowledge Center. (n.d.). Caring Together Continuum Practice Profile: Overview.
Retrieved August 6, 2018, from http://www.cbhknowledge.center/caringtogethercontinuumoverview/
National Child Traumatic Stress Network (n.d.). What is a trauma-informed child and family service system? Retrieved
from http://www.nctsn.org/resources/topics/creating-trauma-informed-systems.
Petrenchik, T. (2015). Childhood Trauma: Occupational Therapy’s Role in Mental Health Promotion, Prevention, &
Intervention With Children & Youth. Bethesda, MD: American Occupational Therapy Association, Inc.
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