Residential schools serve as a viable alternative for children with behavioral and emotional issues not adequately addressed in a traditional academic setting. Students present with a variety of issues that range from depression and anxiety to attention deficit disorder and substance abuse and many others in between.
In recent years, research and clinical care has shifted away from treating just the diagnosis and now address the underlying trauma that might be at the heart of the child’s problems.
Joseph Spinazzola, Ph.D., vice president, Behavioral Health and Trauma Services at the Justice Resource Institute, professor of practice in the department of psychology at Suffolk University and executive director of the Trauma Center at JRI, indicated that state-wide and nationally, there is growing recognition that chronic early trauma can lead to a host of psychiatric problems.
Trauma shapes behavior, so focusing on a diagnosis, for instance eating disorders, can be a “false target,” according to Spinazzola.
He explained that you have to “get to the source of the problem” and figure out how trauma affects the person physiologically. “We focus on cultivating alternate [treatments],” he said.
When you consider behaviors such as cutting, eating issues or risky sexual activities, “the coping skills presented in past programs pale in comparison,” he said. “Why shift from using cocaine to using a stress ball or guided imagery?”
Spinazzola noted that a “coinciding array of deficits and delays” because of a family history of mental illness makes an individual more vulnerable. “In the past, trauma was falsely equated with PTSD,” he said, pointing out that children often present with attentional or attachment difficulties and other problems, with or without PTSD.
“Complex trauma has multi-faceted effects. Placement disruptions, chronic neglect, abuse, re-victimization, and academic and behavioral adaptation can become psychologically layered,” Spinazzola said.
Kari Besarra, LICSW, senior vice president at JRI, reported that care goes beyond symptoms and figuring out evidence-based treatment. “Such models have to have long-term supports,” she said. An integrated continuum of care that involves residential and inpatient care, a case manager and community support helps to ensure the patient “doesn’t get lost.”
Spinazzola pointed out that staff orientation and training is critical to delivering trauma-informed services. “They learn how trauma shapes development, how it affects the provider and how to better manage the effects of exposure to a child with trauma. The entire trauma-informed program requires ongoing training,” he said, noting that JRI uses the ARC (Attachment, Regulation, Competency) model, which helps get everyone across the milieu on the same page.
Treatment options for students are trauma-focused and range from dialectical behavior therapy and cognitive behavioral therapy to biofeedback and yoga.
“Trauma-informed therapy is retooled behavior management. Our current program is Building Communities of Care, based on Cornell’s Care Model. This draws from other risk management strategies and prevents/reduces restraint and seclusion,” said Spinazzola.
Wediko Children’s Services, headquartered in Boston and with locations in New Hampshire and New York, has also adopted a trauma-informed approach in both its summer and school programs.
Katherine Patton Regal, LICSW, director of public relations, reported that youth come to Wediko with a host of diagnoses, but that therapy is trauma-informed and focuses on the individual’s strengths. “We put less stock in diagnoses,” said Regal. “It’s important to focus on trauma and how the child presents.”
All staff at Wediko is trained in trauma-informed therapy. They understand that these students have faced chronic adversity and not only one traumatic event, Regal pointed out. “We build capacity to help them cope with what’s going on in their lives. We make all kids feel supported and safe,” she said. “We look to identify strengths and use them to build upon. The why is important, but we definitely want to know more about the what.”
For instance, a child that enters with an eating disorder is treated holistically. Regal said, “The eating disorder could be a manifestation of anxiety or something else. We develop ways of coping with bad habits and replace them with healthy habits,” she added. “Whether the child is overly sexualized, has an eating disorder, is a fire setter or self-cutter, we know there are layers underneath.”
Wediko’s summer program is structured much like a traditional camp, but is “therapeutically structured for kids who struggle with relationships with peers, teachers and parents and for those who have experienced failure because of social and emotional needs,” Regal said.
In addition to art, theatre, music, yoga, fishing, swimming and other activities typically found at summer camp, students attend classes for two hours a day to prevent regression over the summer.
“The classrooms are centered around developmental level and the work is engaging, centered on math and language arts. We build momentum for school in the fall,” she added.
The residential school setting is structured in a similar manner to the summer program but is more intensive. Students require a “higher degree of service needs,” according to Regal.
Devereux in Rutland, Mass. follows Positive Behavioral Intervention and Supports (PBIS), a “trauma-informed ecological model,” according to Kerry Ann Goldsmith, LMHC, assistant executive director, Devereux Massachusetts.
“Under this umbrella, we blend family engagement activities, function-based assessment and interventions, trauma-informed care, and positive behavior support with Devereux’s philosophy of care, which includes individualized approaches,” she said.
“We start with assessments such as the ACES (Adverse Childhood Experiences Survey), which help to build an understanding of the student’s trauma history and a thorough biopsychosocial assessment.”
Goldsmith explained that Devereux staff is trained in Risking Connection, a curriculum for milieu-based, trauma-informed care that helps them understand trauma, how to respond to those who have experienced trauma and emphasizes self-care for caregivers.
“Clinical interventions include Trauma-Focused Cognitive Behavioral Therapy as well as Cognitive Behavioral Intervention for Trauma in Schools, which we are currently in the process of implementing in our Day School program,” she said.
While many of Devereux’s students have trauma histories, they also present with a variety of mental and behavioral health challenges, noted Goldsmith.
Devereux treats these students with other evidence-based interventions that have been shown effective for particular symptoms, behaviors and diagnoses, such as Dialectical Behavior Therapy and Applied Behavior Analysis.
By Phyllis Hanlon