Reaching the Caregiver

I have been thinking about ACEs lately. Not the 4-of-a-kind, win-big-in-poker aces, but those pesky Adverse Childhood Experiences ACEs. As the opioid epidemic in our communities brings death and misery to our families, we have amassed resources in response. Adult recovery agencies and hospitals provide medical withdrawal and ongoing support for recovery. Law enforcement, hospital emergency departments and recovery services create coordinated plans for immediate outreach to overdose victims. Naloxone has been distributed far and wide to reverse the effects of overdose. Slowly, the number of deaths by caused by opioids in our area are stabilizing and even receding.

But what about the children? One parental overdose can cause a cavalcade of problems for children. The pivotal 1990’s CDC-Kaiser Permanente Adverse Childhood Experiences study showed strong correlations between childhood trauma and development of risk factors for disease throughout life. Children presented for assessment at our outpatient mental health clinic tell their stories of ACEs: a parent using drugs brings chaos and abuse into the family, spirals out of control into overdose, jail or death and the children and their caregivers are left to pick up the pieces. Treatment needs to include caregivers as well as the children affected by such loss and trauma. Here are some important issues to consider when working with families affected by the opioid epidemic:

  • Assessment for trauma is a family affair. The effects of trauma reverberate throughout the family. Just when children are most vulnerable and need the most support of extended family, their caregivers may find themselves depleted of the ability to regulate and promote emotional safety. When children are the identified client, we need to explore deeper than the child’s behaviors to assess for the adults’ functioning and trauma reactions as well. The National Child Traumatic Stress Network has a helpful tip sheet on family trauma assessment at
  • Psychoeducation about trauma is needed for all family members. Normalizing trauma reactions can relieve the worries shared by children and their caregivers. Adults worry that there is something really wrong with children when they act out in aggression, tantrums and defiance. Giving them a trauma informed lens that asks the question “What has happened to you?” moves the focus from pathology to compassion. I teach children and their adults about their amazing brains and the role of the amygdala in keeping them alive. An easy and engaging description of how trauma affects the brain and behavior comes from Dr. Daniel Siegel – The Brain in the Palm of Your Hand. This YouTube video offers a great explanation of this model.
  • Everybody needs self-regulation! Play activities that help families recognize their feelings, stop their bodies and get calmed down are essential in helping families move into well-being. These skills may not come naturally to families. I engage young children with a scripted story Tucker Turtle Takes Time to Tuck and Think that tells the tale of a turtle that feels angry and out of control sometimes. A calm down area in the home – a retreat with a soft pillow, a special blanket, Tucker Turtle poster, coloring materials – can promote self-regulation for all family members. The Center on the Social and Emotional Foundations for Early Learning has many free resources, including Tucker Turtle’s story and feeling face cards.
  • Reach the Amygdala to increase feelings of safety. Continued trauma places our systems on high alert, leading to difficult behaviors of hyper-vigilance. Caregivers need to understand that safety is more than providing housing, food, and clothing. The amygdala needs to recognize safety on a sensory level. Explore the sights, sound, smells and touches of safety with both the children and adults in the family. Recalling times of safety using a guided meditation is a great first start. Be creative in developing new experiences of safety for children. One foster mother I know helped each foster child chose their “Magic Spray” from the fragrances aisle of the drug store. She would spritz them as they shared happy moments of snuggling and attachment. Later, when the child was struggling with emotions, the child could use the “Magic Spray” to calm themselves. What a powerful use of a sensory intervention to promote peace!

The addiction and recovery issues facing our nation will not be solved easily. But there is great hope! Early intervention for youth experiencing such adverse childhood experiences as abuse, neglect, parental drug addiction, incarceration and death can move children from victim to survivor to thriver. We need to include their adult caregivers in treatment to ensure they get there!

Self-Care & Creativity in the Trauma-Informed Workplace

Self-care in relationship to trauma work is an essential practice for professionals in this helping field. Without attention and connection to our own self-care, the demanding toll of aiding and supporting others in pain and distress can often leave us vulnerable to compassion fatigue, vicarious trauma and burnout. In relationship to this necessity for provider self-care, this post will focus on considerations about one’s workplace environment and the role creativity can have as a trauma-informed practice.

Laura van Dernoot Lipsky, (2009), who is author of “Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others,” identified 16 Trauma Exposure Responses that can manifest within trauma workers “as a result of exposure to the suffering of other living beings or the planet,” (p. 41). These responses can range from, but are not limited to, feelings of hopelessness and helplessness, experiencing pervasive exhaustion, an increasing incapability for empathy, and struggling with states of guilt, numbing, anger, and fear (Lipsky, 2009).

Experiencing minimized creativity in our work is also identified as a trauma-exposure response and also worth paying attention to. Using our sense of creativity in the work we do as trauma specialists is a critical, as it helps us be open to and see new ideas or solutions that can empower problem solving, growth and different ways to view situations, tasks and challenging issues with clients, co-workers and ourselves. In addition, when trauma exposure limits our ability to embrace the fresh air that creative thinking can breathe into our work, our efforts to help others may eventually feel immobilized without meaning, hope or new possibility. We also may become apathetic to working within systems, strategies and approaches that do not nurture professional growth, invite opportunities for change, or best serve the client’s needs and trauma recovery.

To support the value of creativity within the workplace, as well as offer one way to foster a healthy safeguard to decreasing the effects of trauma exposure and stress, here are some suggestions to consider implementing into your work practice and setting:

    Be mindful of the physical environment around your workspace and/or agency and how you could invite more joy, fun and creativity through the use of color, scents, sound, lighting and other sensory-based incentives. Some examples are adding a favorite, comforting piece of art, nature inspired items, plugging in a lavender air freshener, or a cheerful lamp to brighten the space.
  • Create a box or basket that includes easy, go-to comfort care items that help you engage in playfulness, relaxation, and re-energizing.
  • Establish a mandala coloring area in your staff break room or kitchen with colored pencils, gel pens or markers that you and your co-workers can use for a creative break. Print Mandalas is an online site where a variety of mandala coloring pages can be printed for free.
  • Include creativity into your agency’s staff meetings by beginning with a meaningful poem, song, story or image that relates to the organization’s values and mission. Invite staff members to take turns being responsible for this activity.
  • Support your co-workers and staff through making artsy notes of gratitude, affirmation or inspiring quotes on sticky notes and index cards to leave in workspaces or mailboxes. Use stickers, a magazine photo collage, and simple art materials to leave an expression of your appreciation, support or just for a creative hello. You could even institute an agency-wide event dedicated to this practice! Connection and encouragement from those we work with helps foster emotional resiliency and better manage work stress. Recognizing the challenges, achievements and commitment to our work in this tangible, creative form reminds us that our efforts do make a difference and have purpose.

Lipsky, L. V. N. (2009). Trauma Stewardship: An Everyday
Guide to Caring for Self While Caring for Others. San Francisco, CA: Berrett-Koehler.

Treating Trauma: Self-care for Providers
International Society for Traumatic Stress Studies

Self Care for Providers
SAMHSA’s Homelessness Resource Center

Self Care and Trauma Work
Office on Violence Against Women, National Sexual Violence Resource Center and National Sexual Assault Coalition Resource Sharing Project

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