HELPING HAND HOME FOR CHILDREN

A Model for Healing - Interventions for Traumatized Children

Who Are We?

Our residential program cares for up to forty-one

children at a time, ages four to thirteen, who have

suffered abuse and neglect.

Our Foster Care and Adoption Program currently cares for fifty-one children

and has 50 families, who are all trained in TBRI.

Residential Care: Foster and Adoption:

Helping Hand Home for Children is a Residential Treatment Center

and Foster Care and Adoption Program.

Our mission: To provide a nurturing and therapeutic home for children

and to restore each child to a healthy family setting.

For information on our Foster Care and Adoption Program: kduck@helpinghandhome.org

Who Do We Serve?

Our children come from the foster care system in the state of Texas and are

assessed as specialized, intensive, and intense plus, under that system.

We care for the children that many others do not endeavor to due to the intensity of

their behaviors. We know that their behaviors are a manifestation of the

trauma they are experiencing from their abusive and neglectful pasts.

Who Do We Serve?

Common behaviors we help the

children with are high rates of

aggression towards themselves or

others, running away, property

damage, and lengthy crying,

screaming, and yelling episodes

where their bodies are out of

control, also known as tantrums.

Interventions

The types of interventions we use with our children are

determined by the view we have of our children.

Impact of Trauma

Neuroscience shows us that trauma impacts healthy brain development

by causing imbalances in levels and expressions of key

neurotransmitters, chemicals, and hormones in the Central Nervous

System.

These imbalances lead to the aberrant behaviors previously

mentioned that our society labels as mental illness: Conduct Disorder,

Oppositional Defiance Disorder, ADHD, Reactive Attachment Disorder,

etc.

EXCITATORY

Respond to stressor stimuli in the environment and keep the brain focused on survival.

Focused on keeping

the brain and body in a

state of calm, help with

sleep, and determine

mood regulation.

INHIBITORY

Two Types of Neurotransmitters:

Trauma causes an increase, and quite often, a flood of excitatory neurotransmitters. Flooding may

produce a “neurotoxic wash” on the brain, similar to diluted bleach. This wash further suppresses

inhibitory neurotransmitters.

“Neurotransmitter Patterns and

Behavioral Correlates”

What do we know about our children?

Neurochemical impact of abuse & neglect: Living in a perpetual state of fear

Unable to adapt and adjust to their environment.

Low frustration tolerance and impaired communication skills.

Unable to problem solve, build relationships, and exhibit maladaptive behavioral responses.

They have very low self-esteem and minimal sense of self-worth.

They are responsive to and need kindness.

What do we know about their neurochemical

potential?

What do we know about their neurochemical potential?

The human brain can change throughout life given the right stimuli. By exposing

our children to new experiences we facilitate the development of new neural pathways. These pathways aid in self-

regulation, emotional IQ, and appropriate behavioral responses.

Experiential learning followed by effective praise is the key to successful rewiring.

Interventions

Motivation vs Capability to Self-Regulate

Reward/Consequence vs Relationship/Felt Safety/Trust

Behavior = Communication

Anger = Fear/ Loss of Power or Control

We understand that the

behaviors previously

listed are symptoms for

our children of deeper

emotional, psychological,

and physical needs that

were never met or even

damaged.

Interventions

Trust Based Relational Intervention (TBRI)

Empowering, Connecting, & Correcting

Trust Based Relational Interventions

TBRI is designed to meet the basic relationship and developmental needs of children and youth from “hard places”, as well as the needs of the adults who seek

to help them heal learn and grow.

Principles of TBRI

Connecting Principles: Create connections that disarm fear, gain trust, and enhance learning.

Empowering Principles: Empower learning and regulation by meeting physical and environmental needs.

Correcting Principles: Shape beliefs and behaviors, are dramatically effective because kids feel safe, connected, and empowered!

To build trusting relationships that help children feel valued, cared for,

safe, and connected. Disarming fear and building trust greatly increases

the capacity for connection, growth, and learning.

Connecting Principles

Connecting Principles: Mindfulness

What do I bring to this interaction from my

own history?

Be Flexible: adjust interactions based on the child's needs.

Be Aware: of the child's perception of your voice, presence, &

interactions.

Connecting Principles: Giving Voice

Our children are more likely to use aggression, violence, manipulation, & triangulation to deal with adults and other

children. Connecting strategies are dynamic in beginning to teach trust and disarm fear.

Give full attention: A child feels heard and valued when an adult gives full attention and eye contact -even briefly.

Offer Choices: When possible offer choices about activities during the day. This greatly enhances trust.

Offer Compromises: When possible, offer compromises about activities, events, etc. Again this greatly enhances trust, connection, and learning.

Share Power: allowing children to help make some decisions is called sharing power. Sharing power reinforces the adult's authority and at the same time creates connections and trust.

To prepare bodies and brains for success by providing an environment that meets the physical needs of children and youth.

Empowering Principles

Empowering Principles: Physical & Internal

Physiological Strategies:

Have the child's physical needs been met?

Provide hydration: encourage water consumption

Regulate Blood Sugar: healthy food every two hours.

Meet Sensory Needs: physical activity at least every two hours

Model Self-Regulation: teach and practice self-regulation skills, provide physical activities, and provide nurturing interaction throughout the day

Empowering Principles: Environmental & External

Ecological Strategies:

How is the environment affecting this child? How can we impact that?

Schedules & Daily Rituals: daily schedules, morning routine, & evening routine.

Pre-Planned Transitions: minimal abrupt transitions

Awareness of Sensory Input:smell, sight, sound, & touch sensitivities.

Empowering Principle: Self-Regulating

Sample Activities:

Deep Breathing

Magic Moustache

Cooling Your Soup

Chair Sit Ups & Push

Ups

How’s your engine

running?

One of the most important Empowering

Principles is the capacity to teach self-

regulation. These skills can be taught as

part of physical exercises, daily

routines, and/or nurturing activities.

Self-Regulating: Deep Breathing

Because ⅔ of our oxygen

sacks are in the bottom ⅓

of the lung, breathing

deeply will oxygenate

the body and brain,

helping children and

youth think more clearly,

learn more easily, and

make batter behavioral

choices.

Self-Regulating: Magic Moustache

Pressing the

parasympathetic pressure

point just above the center

of the upper lip creates a

calming influence. Most kids

love to make the

“mustache”!

Self-Regulating: Cooling Your Soup

Pretend to hold a bowl

of soup and blow on it

to cool it off. Let

children choose the

type of soup they are

cooling.

Self-Regulating: Chair Sit Ups & Push Ups

These are calming and can be done anytime a child is feeling overwhelmed. An advantage of this activity is that it can be done anytime without creating distractions for other people.

Self-Regulating: How’s Your Engine Running?

This quick

question can

guide a child

quickly back on

track simply by

increasing

awareness.

To help children learn appropriate strategies for getting

their needs met and to learn to navigate successful

interactions day-to-day.

Correcting Principles

Correcting Principles

Proactive Strategies:

Teach Social Skills: teach during calm/alert

times.

Engage Through Play: utilize playful activities

and nurturing games to enhance children’s

awareness of appropriate social, problem-

solving skills, and self regulation strategies.

NOTE: when skills are taught proactively, the need for

responsive strategies is greatly reduced.

Responsive Strategies:

Tools to be used for responding to

challenging behaviors:

IDEAL Response

4 Levels of Response.

Highly effective when adults have

connected and empowered during

calm times.

Capitalize on and create learning

opportunities so that the child sees

you as the “coach” not the

“warden.”

Correcting Principles: IDEAL Response

Immediate: Respond immediately (within seconds when possible)

Direct: Engage directly (with eyes, proximity, and touch when possible)

Efficient: Maximize playfulness when possible and use ONLY the Level

of Response that is essential for addressing the challenge(more on

Levels of Response to follow)

Action-Based: Give the child a chance for a “re-do.” Maximize

learning by creating body memory for “the good stuff!”

Leveled at the Behavior: not the child. Make it clear that you are their

advocate, not their adversary

Correcting Principles: Levels of Response

When a child becomes dysregulated and exhibits behaviors, caregivers should ask themselves these questions:

What is the behavior really saying?

What does this child really need?

How can I teach the child to get their needs met?

How can I teach this skill at a calmer time?

It is helpful to ask a child questions like:

Can you tell me what you need?

How can I help you get what you need?

Helping a child label what they are feeling can help them calm and raise self-awareness, (this is done by asking and not telling them what they are feeling).

Levels of Response

Level I: Playful Engagement

Redirect Child without breaking stride

Give them a chance to correct their behavior without punishing them

E.g., “would you like to try it again with respect?” or “Are you asking or

telling?” in a playful tone

Use consistently – playful engagement reduces misbehavior dramatically

over time because it strengthens the relationship between children and

caregivers

Levels of Response

Level II: Structured Engagement

Pause the situation and use a more regulated voice

Offer two choices – this provides a concrete, quick way to get children back

on track

Ask them to use their words and ask with respect if they are requesting a

compromise

Use behavioral “re-dos” to help children feel more successful. Walking

through the motions of the right behavior is good for motor memory

Levels of Response

Level III: Calming Engagement

Allow children to regulate with adult assistance

Use a time-in and keep children close rather than sending them away (as in

a time-out). This lets them know that they are not alone, that you are there

to offer support and guidance

Work out a predetermined ‘quiet’ or ‘calm’ place adolescents can go when

overwhelmed, (their choice)

Levels of Response

Level IV: Protective Engagement

At HHH we utilize SAMA containments

Reserve use of this level for violence or aggression

The most powerful message an adult can give a dysregulated child is the knowledge that the adult can keep them both safe, and that the adult still knows that the child's behavior is not what defines him or her.

When the child is coherent again, the adult asks them to sit and talk. Looking into the child's eyes, the adult asks, “(child's name) can you tell me what you need?“◼ Based on the belief that an unmet need or fear drives most

aberrations in behavior, this question disarms the child and helps them begin to problem-solve with the adult.

Helping Hand Home for Children: Core Skills

Observing & Describing Behavior

Rationales

Teaching Interaction

Preparing Children for Success

SAMA Assisting Process

Daily Treatment Program Culture

Enrichment Activities – Children

Learn by Doing

Always offer the chance for

experiential learning

Enrichment Activities –

Therapeutic Value vs. Privilege

Shaping beliefs by teaching

rather than taking away

Daily Treatment Program Culture

Language creates perception creates response/behavior/action.

What we say and how we say it, (spoken or written), are equally

important.

The terms we think and speak in have a direct impact on our actions.

What practices do we avoid?

What Practices Do We Avoid?

Any practice that would harm, shame, isolate, or trigger a child.

Time Out

Power Struggles

Shaming or Caustic Language

Elevated Tone of Voice

Reactive Behavior

Physical Isolation