Social Work Practice with Children in Schools and Therapeutic Settings - Essay Example

Social Work Practice with Children in Schools and Therapeutic Settings Introduction: Childhood traumatic experiences pose a great threat to the life of the individual unless they are taken care of and effective intervention strategies are implemented. Childhood trauma can have a life long effect on the individual and such trauma affects the behavioral, psychological, biological, cognitive, social and interpersonal traits of the person. As Morrison observes, childhood traumatic experience not only cause social and emotional difficulties but also affect “the way the child views self, others and the world” (2009, p. 57). Therefore, it is imperative that proper and timely interventions are offered to such children who are forced to undergo traumatic experiences of one sort or other. An effective therapist or social work practitioner makes use of different theoretical orientations in dealing with a child who suffers from trauma or maladjustment. In the case of Ramon Rivera, the therapist can gain insights from psychodynamic, attachment, cognitive-behavioral, neurobiological, and social-learning approaches in designing effective and appropriate intervention programs and specific developmental strategies for him. Thus, an integration of these various theoretical approaches serve him better in dealing with the stress, social isolation and aggressive behavior shown by the child. This paper seeks to explore the possible intervention strategies and approaches that can be employed in the therapeutic relationship with Ramon Rivera and the paper offers fresh insights into social work practice with children in schools and Therapeutic settings. Ramon Rivera: Implications of his Traumatic Experience: Analyzing the case study of Ramon Rivera, it is evident that the first childhood trauma of the boy occurred three months before the family shifted Boston to a suburb due to their fears of gang violence in his native city. The sound of the frightening gunshots which caused the death of a teenage boy who lived on their street at night must have been a drastic traumatic experience for the 9 year old boy. This must have made feelings of insecurity, anxiety, fear and frustration in the young boy’s mind. Ramon Rivera did display a number of immediate post-traumatic symptoms as he insisted on sleeping with his parents thereafter and the parents often found the boy getting up at night, trembling, crying and shaking. However, the parents did not take his post-traumatic symptoms seriously. After his first traumatic experience the young boy suffers a number of psychological setbacks. He fails to get sufficient amount of support and feelings of security from the attachment figures-the parents and teachers; is forced to repeat kindergarten and second grade against his wishes; and is subjected to traumatic reminders which cause developmental disorders in his personality. He becomes alienated and lonely; demonstrates problems in academic studies; becomes distraught and refuses to go to school; and finally, shows aggressive behaviour towards the peers at school. Analysing the case study, it is clear that he suffers from lack of sound attachment figures, lack of timely therapeutic intervention and a series of psychological blows after his first traumatic experience. Therefore, it is imperative that a comprehensive intervention program that integrates various psychotherapy approaches is developed to address all the above mentioned issues. Functional Behavioral Assessment to First Step to Success program: In the case of Ramon Rivera, it is imperative that a Functional Behavioral Assessment to First Step to Success is employed to derive the major psychological and behavioral problems faced by the boy. As Carter & Horner purport the First Step to Success aim at developing social behavior patterns among kindergarteners through second-graders through standardized and collaborative home-school interventions and therefore a therapist needs to understand more about the boy’s problem through interconnected modules: screening, school intervention, and parent training (Carter & Horner, 2007, p. 229). The aim of this functional behavioral intervention is to instill in the mind of the child a distinction between appropriate and inappropriate behavior and to help him develop more of appropriate and socially accepted behavior. For this, the therapist or social work practitioner needs to adopt a Systematic Screening for Behavior Disorders (SSBD) through dialogues with the parents, the teachers and through direct observation. The next step is to employ effective intervention programs whereby the therapist can help the child to reduce problem behavior and increase ‘adaptive, prosocial behaviors’; the therapist can make use of red and green cards to teach him to distinguish between appropriate and inappropriate behavior (Carter & Horner, 2007, p. 229). It is also essential that the therapist offers sufficient training and instructions in limited setting to Ramon Rivera’s parents and teachers to support appropriate behaviours in the child. At school, the teacher should be specially trained to consider Ramon Rivera’s problem behavior and academic engagement and for this a Teacher phase with function-based support should be provided. The teacher with the assistance of the boy’s peers need to offer incentives and peer attention to Rivera’s appropriate behaviors whereby the child can make a clear cut distinction between appropriate and inappropriate behavior. The child is most likely to display more of academic improvement and develop social skills. Therefore, it is the duty of the social work practitioner to design effective first Step plus function-based support to Ramon Rivera and as a prospective therapist I strongly feel that this intervention can be adopted as a primary attempt to deal with the case of the boy. The Effective Use of various play therapies: It is also significant that Ramon Rivera develops mastery over his own traumatic experiences and the therapist can employ effective play therapies with him. The therapist can benefit from the good insights gained from Adlerian play therapy and as Morrison observes the posttraumatic play therapy can offer the child a unique opportunity for Rivera “to express fully and gain mastery over his experience” and “to gain insight and understanding to establish social interest and a sense of belonging” (Morrison, 2009, p. 57). There is no doubt that the childhood trauma has adversely affected the child’s emotional, physical, cognitive and social faculties and has contributed to his social and emotional difficulties in such a way that he fails to cope up with his studies, peers and the social world around him. One has to bear in mind the fact that Rivera will not be able to express himself or share his feelings completely to the therapist through normal conversations or dialogues just as an adult is able to do. Therefore, it is imperative that the therapist elicits responses regarding the boy’s experiences, inner feelings, emotions and frustrations through play therapy. The therapist needs to derive significant play themes through the four phases of counseling that include ‘building an egalitarian relationship’ with the client, ‘exploring the clients lifestyle’, ‘helping the client gain insight into his or her lifestyle’ and ‘reorientation’ whereby the therapist offers other positive alternatives to the client to solve the problem behavior or situation (Morrison, 2009, p. 60). In the case of Ramond Rivera, it is essential that the therapist helps him out of his fear, insecure feelings, anxiety, social alienation and loneliness. For this, it is important to restore his attachment and feelings of security with his parents and to develop his social and interpersonal skills. Parent-Child Relationship in the Play Therapy: Robinson, Landreth, & Packman, in this respect argue that play therapy assists children to develop their ‘self-understanding, self-acceptance, personal power, self-control, and self-discipline’ which will help them to accomplish their academic, social, and personal goals (p. 21). Similarly, the therapy sessions also provide an opportunity for the therapist to break any sort of barriers that exist in the parent-child relationship; the child may have developed certain misperceptions regarding the parents’ behavior, feelings and attitudes during his frustrations and insecurities and it is the duty of the therapists to bring out such frustrations, needs and thoughts that the child has internalized. In Ramond Rivera’s case, it is evident that he fails to receive feelings of security from his attachment figures; even though he seeks for security from his mother she fails to assure him the same. The child must have seen the horrified look on his mother’s face on the night a young boy was murdered in the street and the sad and frustrated demeanor of the mother during their shifting and thereafter must have added to his feelings of insecurity. Similarly, Rivera is able to read the same fear on his teacher’s face when she closes the classroom door in the trauma reminding incident. Therefore, it is necessary that the therapist addresses these issues during the play therapy sessions. Role of Empathy in play therapy: It is also significant that the therapist develops empathetic feelings towards Ramond Rivera. Researchers have pointed out that an empathic therapist is better equipped to track the client’s emotional responses, inner feelings, values and aspirations (Crenshaw & Hardy, 2007, p. 162). Children need to unburden all their emotions, feelings, needs, terrifying experiences, fear and anxieties in front of the therapist during play therapy sessions and it is the responsibility of the therapist to ensure that the child’s needs are properly addressed in the therapeutic process. One should always keep in mind that play is the natural and native language of children, a unique way through which the child expresses himself and his difficulties (Garza & Bratton, 2005, p. 3), and therefore the play therapy sessions can offer great insights into the psychological, behavioral and social problems faced by Ramond Rivera. Assessment and Treatment Process for Ramond Rivera: While the Functional Behavioral Assessment to First Step to Success program and the use of play therapies are sure to bring about the major behavioral, cognitive, psychological and social maladjustments faced by Ramond Rivera, it is essential to develop a competent assessment process whereby the common themes derived out of the play therapy sessions can be evaluated. It is important to collect information regarding the pre and post-traumatic life of Rivera through interaction with the parents and other primary caregivers and by direct observation, so as to design structured cognitive and sensorimotor assessments. In designing the assessment programs for the boy, one should bear in mind four overreaching principles of assessment that takes into account the child’s developmental stage, preliminary interventions, the role of parents and caregivers, and being receptive to new information and insights (Chapter 4: The Assessment Process. Psychotherapy with Infants and Young Children, p. 100-101). It is also worthwhile to take into account the assessment procedures put forward by Liberman & Van Horn. The researchers suggested a “best practices” approach for children who were subjected to traumatic experiences. The ‘best practices approach’ include an assessment of the “history of the child’s development before and after the traumatic events, observation of the child-parent interaction, and the child’s narrative of the traumatic experiences through the use of toys, drawing, story telling, or other evocative materials, Additional sources of information may include observing the child in the child-care setting, interviews with child-care providers, and standardized assessment procedures” (Liberman & Van Horn, p. 113). One should also take into consideration such insights of psychotherapy brought out by modern attachment theories and advancements in interpersonal neurobiology and should deal with such factors as components of complex trauma interventions, the role of schools, teachers and peers, Developmental Trauma Disorders, neurobiological factors, the role of affect regulation, trauma reminders, the relation between trauma and attachment and Disrupted Attachment Disorder (DAD). Parents as Attachment figures: The Child-Parent Attachment Model: It is also worthwhile to take into account the assessment procedures put forward by Liberman & Van Horn. For the researchers, the child’s relationship with his parents is of utmost importance. Very often, childhood trauma stems from the child’s feeling that the parents are unable to protect him and this lack of trust adds to his traumatic responses and adversely affects the child’s ourse of development (Liberman & Van Horn, p. 112). The attachment figure very often regulates the child’s behavior and physiology and he tends to internalize the caregiver icon (Hinshaw-Fuseuer, Heller, Parton, Robinson & Boris, p. 52). The therapist should always keep in mind that lack of consistent sense of safety from the attachment figure can enhance the traumatic experience of the child just as it happened in the case of Ramond Rivera. All throughout the case study one can find Rivera yearning for the attachment support from his mother which he fails to receive in accordance with his needs. Similarly, it is also essential to consider the socio-economic and cultural domains of the child. The therapist should gather essential information regarding the specific features of the trauma before and after the traumatic event from the parents, caregivers, teachers and the peers of the child. In Ramon Rivera’s case, the Child-parent Model seems to be the most appropriate one. As Liberman & Van Horn point out, the Child-Parent Model makes use of the parents’ knowledge regarding the child’s traumatic experience and his reaction to it and the therapist can very effectively involve the parent also in the therapeutic process (129). In Rivera’s case, it is quite desirable to involve the parents especially his mother in the therapeutic process as her presence will be an added advantage for the success of the intervention. Components of Complex Trauma Interventions: An effective therapist or social work practitioner should have a thorough understanding of the various components of complex trauma interventions. Studies have shown that children who suffer from complex trauma are exposed to seven primary domains of impairment: “attachment, biology, affect regulation, dissociation, (ie, alterations in consciousness), behavioral regulation, cognition, and self-concept” (Cook et al, 2005, p. 392). No doubt, Ramond Rivera also suffers from most of the above mentioned problems; he faces social isolation, interpersonal difficulties, emotional turbulences, difficulty with emotional self-regulation, low self-esteem and displays self-destructive behavior, social detachment and aggression toward others. The six core components of complex trauma intervention include enhancement of internal and environmental safety, enhancement of the client’s self-regulation, developing the ability to engage in self-reflective information processing, integration of the various traumatic experiences, enhancing relational engagement that develop effective attachment and interpersonal relationships, and developing positive affect enhancement (Cook et al, 2005, p. 394). Therefore, it is imperative that the therapist engage in special sessions with Rivera’s parents and teachers to provide him with internal and environmental safety, to enable him towards self-regulation and self-reflective information processing, and to help him building up strong interpersonal and attachment relations with his parents, teachers and the peers. Developmental Trauma Disorders and Reminders of Trauma: The child is likely to undergo developmental trauma disorders unless he is offered timely therapeutic support after the traumatic experience. In the case of Ramond Rivera, the first traumatic experience goes unnoticed and it later leads to poor academic performance, social isolation and aggressive behaviors. As Van der Kolk observes, traumatic incidents not only result in such behavioral and biological responses to trauma reminders but it also affect the ‘neural development and social interaction’ of the child (Van der Kolk, 2005, p. 402). Thus, it is essential for the therapist to understand and realize the internal factors that has affected Rivera’s cognition, appropriate plans of action and responses to traumatic reminders. For Ramond Rivera, Developmental Trauma Disorders reach its height when he is confronted with reminders of the trauma in the second classroom. As the author puts it exposure to reminders of a trauma such as sensations, images, sounds and situations will prove to be catastrophic for the traumatized child (Van der Kolk, 2005, p. 403). Thus, it is necessary that the therapist addresses the possible traumatic reminders in the life of Ramond Rivera and equip him to face them realistically. As Gaffney observes impressions regarding the traumatic memories is always so clear and vivid in the mind of the child compared to his ordinary memories and these can negatively affect the child’s emotional life (Gaffney, 2006, p. 1006). Interpersonal Neurobiology and Childhood Trauma: Interpersonal neurobiology, for Siegel, “presents an integrated view of how human development occurs within a social world in transaction with the functions of the brain that give rise to the mind” (2001, p. 67). The interpersonal Neurobiological Treatment Model has been an offshoot of studies in attachment theory, neuroscience, interpersonal neurobiology, and childhood traumatic grief (Crenshaw, 2006-2007, p. 319). In Ramond Rivera’s case the final straw can be considered as the life transition-his shift from Boston to the suburb, his repeat of the course at Kindergarten and second grade. One can notice considerable differences in the behavior of the child in both the instances where he was forced to repeat the course against his own wishes. In the second instance, Rivera becomes disrupted and develops aggressive behavior towards his peers. The twelve fold tasks pointed out by the author that highlight safety needs, identifying with the reality and recovering from the trauma is highly useful for any therapist. Similarly, Diseth (2005) also highlights neurobiological factors when the author associates childhood trauma with abnormalities in brain (Diseth, 2005, p, 85). Modern Attachment Theories: Self-Regulation and Right Brain Neurobiological Systems: Schore & Schore (2008) have made some remarkable studies on Bowlby’s attachment theory. The researchers want to highlight “how affective attachment communications facilitate the maturation of brain systems involved in affect and self regulation” (Schore & Schore, 2008, p. 9). It has also been identified by researchers that it is the right brain neurobiological systems that process emotions, modulate stress, self-regulate and control origins of the bodily-based implicit self (Schore & Schore, 2008, p. 10). One also needs to keep in mind the fact that it is the attachment experiences of the child that forms his early organization of the right brain. Therefore, it is essential that transference–Counter transference process in the therapeutic relationship is based on this awareness and that the therapist takes into account the working of the right brain of the client. The Role of Schools, Teachers and Peers in the Intervention Process: The therapist needs to take into account the school environment of Ramond Rivera as it has a great influence on his behavior and social skill development. In this respect, Herman, Reinke, Parkin, Traylor & Agarwal state that schools have a pivotal role in offering mental health service and support to children and parents (2009, p. 433). Similarly, positive student-teacher relationship is a necessary prerequisite as far as children with traumatic experiences are concerned. In this respect, Cole et al. (2005, P. 6) observe that teachers have the responsibility to connect traumatized children with the community and to assist them in setting competent goals and achieving them. Similarly, teachers should not only pay attention to the learners’ physical and safety needs but also to other higher level needs (Sitler, 2009, p. 122). Conclusions: To conclude, it can be stated that the therapist can bring Ramon Rivera back to normalcy through an integration of the above mentioned interventions. For this, the therapist needs to take into such factors as the safety needs of the child, his need for security, attachment and recognition. Similarly, the various domains that influence the child’s functioning such as the circumstances and sequences that led to his trauma, the role played by his attachment figures, the post-trauma experiences of the child, his emotional, social and cognitive faculties, traumatic reminders, the developmental disorders faced by the child, and any mental health disorders that the child is likely to suffer from. Effective intervention strategies and approaches are to be employed by the therapist to provide alternative solutions for the problems faced by the child and in doing do the therapist should give primary importance to the child’s needs, frustrations, feelings, emotions, and anxieties. References Alexandra Cook et al. (May 2005). Complex Trauma in Children and Adolescents. Psychiatric Annals, 35(5), 390-398. Carter, D.R & Horner, R.H. (Fall, 2007). Adding Functional Behavioral Assessment to First Step to Success: A Case Study. Journal of Positive Behavior Interventions, 9(4), 229–238. 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Infant Mental Health Journal, 22(1–2), 67–94. Sitler, H.C. (Jan/Feb 2009). Teaching with Awareness: The Hidden Effects of Trauma on Learning. The Clearing House, 82(3), 119-123. Susan F. Cole et al. (2005). Helping Traumatized Children Learn: Supportive school environments for children traumatized by family violence. Massachusetts Advocates for Children Trauma and Learning Policy Initiative. Van der Kolk, B.A. (May 2005). Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35(5), 401-408. Gaffney, D.A. (Aug 2006). The Aftermath of Disaster: Children in Crisis. Journal of Clinical Psychology: In Session, 62(8), 1001–1016. Read More