by Julia Steiny
Today we're at a training in Trauma-Informed Care for Children and Adolescents. Hosted by Bradley Hospital, the oldest pediatric mental-health facility in the country, our teacher is Margaret Paccione-Dyszlewski, PhD. The hosts know I'm there partly as a journalist and partly as a restorative practitioner working with a lot of core-urban kids who are awash with trauma.
Paccione-Dyszlewski emphasizes that "trauma is extreme stress that affects a person's ability to cope." And that "the trauma of children has an impact on everyone around them. So kids with a significant history of trauma get a reputation for being bad kids, which only makes things worse."
Trauma-informed care is essentially a shift in philosophy that emphasizes exploring the trauma driving unwanted behavior. There usually is trauma, after all. It runs a wide gamut from mild to severe — from a bout of anxiety after a bad fender-bender to violent acting out as a result of prolonged sexual abuse. The younger a person is when the trauma takes root, the harder it is to heal.
The good doctor apologizes for what she's about to do. Then, on a large screen flash some of the most famous of the photographs of the 911 attack on the Twin Towers. Shoulders droop; smiles fade; people look away. You could hear a pin drop, but the discomfort was palpable.
She allowed some aggrieved complaint from her audience, most of whom work on the exhausting front lines dealing with distressed kids. They hadn't anticipated a super-yucky emotional experience in what they thought would be a refreshing, intellectually-nourishing day off from stress.
The point is that everyone experiences trauma at some point.
Paccione-Dyszlewski tells us its defining feature is the "disregulation of emotional states." Trauma is not itself a discrete emotion, like joy or rage, but a roller coaster of all kinds of feelings that can be triggered by just about anything, including mere photographs of the national trauma we all lived through.
Those of us in the audience bounce back from our irritations, sweaty palms and nervous stomach brought on by the 911 trigger. She says, "Because we're relatively mature, well-regulated adults, we cope."
She made her point. We were upset, but we certainly had not watched Mom get beaten up by the boyfriend or our beloved older brother get shot in a drive-by. The photos didn't seriously challenge our ability to cope. We don't have an emotional water table already so full of trauma that one more drop — a perceived insult, someone yelling — is enough to make the emotions come spilling over. Okay, then how do we help kids whose out-of-control behavior is driving everyone nuts to learn to cope in community-appropriate ways?
Let's back up to what mentally healthy looks like.
No one can protect kids from adversity. Adversity lies in wait. That's life. But kids who have strong relationships can be protected from its long-lasting, toxic effects. As soon as they're mobile, kids crawl, toddle or run into their worlds to do what their brain is designed to do: explore and learn. Inevitably they fall-down-go-boom, encounter hot, loud, scary, or mean. But healthy kids bee-line back to their secure relationship. They cry, rock, receive comfort, regroup, and are off again. They trust that someone will respond promptly, regularly and with empathy. Eventually they learn to soothe themselves and to regulate their own emotions. Managing adversity without its becoming traumatic enhances learning.
Strong connections are the way humans gain mental health, but also recover it. Brain researchers argue that the way to heal trauma starts with establishing consistent, warm, caring relationships that many kids never had in the first place. In fact, unless a kid can develop a relationship with someone whom she values and trusts, she may never give a fig about how her wretched behavior affects others. Helping traumatized kids care for someone is the only way to turn the Titanic of deep-rooted, anti-social behavior.
But how labor-intensive is that? Totally. Making relationships can take frustrating amounts of time. It's hard for healthy adults to make friends in a new city, never mind for a truly traumatized child to learn to trust someone. So time will be a factor in changing these maddening kids' behavior.
Yet, "Every time there's an opportunity to show concern, it starts to promote the corrective experience and undo the worst of the trauma," says Paccione-Dyszlewski.
Of course, a school, a medical practice, or any institution that works with kids usually has other important work it's trying to get done. Who's got time to fuss about building strong relationships in the short school day that's crammed with so much else?
Next week Paccione-Dyszlewski will help us see how such institutions could become "trauma-informed" and thus more effective. She didn't call her techniques "Restorative." But I would.