INFORMING, EDUCATING, EMPOWERING FAMILIES
617-236-7210 | www.fcsn.org | [email protected]
Residential Education: Working with
Students Who Have Experienced
Complex Developmental Trauma
Maureen McGettigan, LICSW
Clinical Director Southeast Campus
The Home for Little Wanderers
Acknowledgements
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All work in congregate care is done by a team. I appreciate the work of the current and past members
of our clinical team, Julie Cusack, LMHC, Rachel Herman, LICSW, Chris Wong, LMHC, Morgan
Thompson, LICSW, Caitlin Tobias, LICSW, Liz Gillott, LICSW, Dawn DiMartino, LCSW, Alla
Abramov, LCSW, Beck Rothberg, LCSW, Tara Whooley, LCSW and Emily Murray, LCSW.
I want to acknowledge the stellar work of the educational staff with whom I have worked over the
years, particularly Mike Nelson, Adam Marto, Karson Motta, Shannon Sullivan, Susan Mackoul,
Sharon Basso and Brenda Burke, from whom I have learned a great deal.
The hardest work in residential program is done by the direct care staff who are the unsung heroes in
any program. Thank you to the many past and present members of our milieu staff who have taught
me everything I know about congregate care. A few of the many superlative staff I have worked with
are Eric Ohlson, Kevin Laudermilk, Matt Marrano, Mike Lepara, Elyse Morin, Deb Sheehan, Allison
Callahan, John Ryll, Mark Haskell, Carlos Antunes, and Caitlin Tobias.
I began my work in the field of trauma after reading a book by Bessel van der Kolk in 1990. I owe my
passion in the field to him and to the team with whom I worked at the Trauma Clinic.
Complex Trauma
The traumatic stress field has adopted the term “complex trauma”
to describe the experience of multiple, chronic and prolonged,
developmentally adverse traumatic events, most often of an
interpersonal nature (e.g., sexual or physical abuse, war,
community violence) and early life onset.
van der Kolk, 2005
Areas of Functioning Impacted by Exposure to
Complex Trauma
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Attachment
Biology
Affect Regulation
Dissociation
Behavioral Control
Cognition
Self-Concept
Cook et al 2005
Attachment
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Problems with boundaries
Distrust and suspiciousness
Social isolation
Interpersonal difficulties
Difficulty attuning to other people’s emotional states
Difficulty with perspective taking
Biology
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Sensorimotor developmental problems
Analgesia
Problems with coordination, balance, body tone
Somatization
Increased medical problems across a wide span of areas and
issues
Affect Regulation
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Difficulty with emotional self-regulation
Difficulty with labeling and expressing feelings
Problems knowing and describing internal states
Difficulty communicating wishes and needs
Dissociation
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Distinct alterations in states of consciousness
Amnesia
Depersonalization and derealization
Two or more distinct states of consciousness
Impaired memory for state-based events
Behavioral Control
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Poor modulation of impulses
Self-destructive behavior
Aggression toward others
Pathological self-soothing behaviors
Sleep disturbances
Eating disorders
Substance abuse
Excessive compliance
Oppositional behavior
Difficulty understanding and complying with rules
Reenactment of trauma in behavior or play
Cognition
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Difficulties in attention regulation and executive functioning
Lack of sustained curiosity
Problems with processing novel information
Problems focusing on and completing tasks
Problems with object constancy
Difficulty planning and anticipating
Problems understanding responsibility
Learning difficulties
Problems with language development
Problems with orientation in time and space
Self-Concept
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Lack of a continuous, predictable sense of self
Poor sense of separateness
Disturbances of body image
Low self-esteem
Shame and guilt
Components of Residential Congregate
Treatment
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Education
Clinical Services
Milieu Treatment
Ancillary Services
Therapeutic Crisis Intervention
Goals of TCI
Preventing crises from occurring
De-escalating potential crises
Managing acute crises effectively
Reducing injuries to children and staff
Learning constructive ways to handle stressful situations
Developing a learning circle within the organization
Cornell University, 1979
TCI
At TCI’s core lies the principle that successful resolution of the
child’s crisis depends on the environment’s (the organization) and
the individual’s (the care worker) therapeutic and
developmentally appropriate response.
TCI teaches and support workers at all levels of
the organization to:
– Assess children’s aggressive behaviors as expressions of needs
– Monitor their own levels of hyperarousal
– Use non-coercive, non-aggressive environmental and behavioral strategies
that deescalate the crisis and that lead to the child’s own emotional selfregulation and growth
– Use physical interventions only as a safety intervention that contains the
child’s acute aggression and crisis
TCI Stress Model of Crisis
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Baseline or Pre-Crisis
Triggering Event
Escalation Phase
Outburst Crisis
Recovery
TCI Stress Model of Crisis
Behavior Support Techniques
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Manage the Environment
Prompting
Directive Statements
Hurdle Help
Redirection
Caring Statement
Proximity
Planned Ignoring and Positive Attention
Life Space Interview
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Isolate the conversation
Elicit the young person’s point of view
Summarize what the young person has said
Connect the young person’s feelings to the behaviors
Alternative behaviors are discussed
Practice new behaviors
Enter back into the group
Typical Day
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Wake up/Morning ADLs
Off to school
In school
Returning from school
Afternoon activities
Dinner
Evening Activities
Bedtimes
Classroom: Science
Elective: Woodshop
Peace Pond Entrance
Peace Pond
Elective: Culinary
Elective: Equine Science
Therapeutic Horseback Riding
Weekends and Vacations
• First shift
• Second Shift
• Third Shift
Winter
Summer Programming
• Summer school
• Summer activities
Garden
Fishing Dock
Swimming Dock
How it works together
• Treatment Goals
• Behavior Support Plans
• Multi-Disciplinary Team
Challenges in Congregate Care Settings
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Additional Exposure
Distance from Family and Community
Staffing Inconsistencies
Availability of Resources
Factors that Contribute to Successful Outcomes
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Teamwork
Rituals and Routines
Creativity
Solution Focused Goals
Sense of Mastery
Maureen McGettigan, LICSW
[email protected]
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INFORMING, EDUCATING, EMPOWERING FAMILIES
617-236-7210 | www.fcsn.org | [email protected]