Trauma, Therapy, & TestimonY Dr. April Garofano Brown, Ph.D., LPC-S, RPT-S, CCPT-S, MS, LSSP

CPS CASE TEAM PLAYERS: Parents Children Caseworker CASA Attorneys Therapists Other Service Providers Foster/Kinship Providers

TYPES OF TRAUMA: Physical Abuse Psychological/Emotional Abuse Sexual Abuse Neglect Abandonment Attachment Disruption Death/Grief Injury/Accidents In Utero /Traumatic Birth Incidents

“JUST NEGLECT” AND OTHER MISCONCEPTIONS REGARDING TRAUMA AND CHILDREN: Myth: The earlier/younger the child experiences trauma, the better the prognosis Myth: Babies and young children will not remember the trauma and thus will recover easier Myth: : “This child didn’t really experience trauma, just neglect” Myth: “Family is ALWAYS a better placement than foster care”

EFFECTS OF REPEATED EXPOSURE TO TRAUMA: In utero-infancy Toddlers Young children-under 7 Children over 8

CHILD INTERVENTIONS STABLE PLACEMENT EVALUATIONS FOR SERVICES: ADDRESS MEDICAL/PSYCHOLOGICAL NEEDS ADDRESS LEARNING/ADAPTIVE NEEDS

ROLE OF THERAPISTS Provide: Individual Therapy Family Therapy Group Therapy Couples Therapy LIMITATIONS: Texas Family Code 104.008: A person may not offer an expert opinion or recommendation to the conservatorship of or possession of or access to a child at issue in a suit unless the person has conducted a child custody evaluation relating to the child under Subchapter D, Chapter 107 ADDRESS LEARNING/ADAPTIVE NEEDS

THERAPISTS AND TESTIMONY: -Therapy notes are written for the therapist's use and only require demographic and treatment information required for insurance billing and for therapists to review for future sessions. -Notes are not written for court, or to be interpreted by others without clinician’s review. -Request for records even under subpoena must include Hipaa release or therapist must get release from client. Otherwise therapist must be ordered by judge in court to release records to avoid ethical and Hipaa violation.

PARENT INTERVENTIONS ASSESS STENGTHS AND DEFICITS IDENTIFIY AREAS OF SUPPORT EVALUATE MEDICAL/PSYCHOLOGICAL NEEDS PROVIDE SERVICES ASSESS PATTERNS AND RISKS ASSESS CAPACITY TO PARENT

THERAPY NOTES: What to look for: Goals: What client/therapist is working toward Progress: How client is responding to therapy; hindrances Recommendations: Therapist documents any recommendations deemed helpful What to Ask for: Case Conceptualization /Therapeutic Summary

Progress Note Example: Goals: Client will demonstrate age appropriate social boundaries Client will follow directions within two prompts Session Focus: Client presented with bright affect and happy mood. Participated in therapeutic activity. Showed improvement in coping with frustration. Will continue to monitor. Recommendations: Speech therapy evaluation to address articulation difficulties.

Case Summary Example: Client has participated in therapy for 20 sessions and initially presented after removal from parents for domestic violence and neglectful supervision. Client appears well adjusted in new placement. Client initially presented with anxiety and fearful responding to loud noises, sudden movement, and attempted to please adults with her behavior. She experienced frequent and excessive tantrums when told no and demonstrated sleep disturbance. During play therapy sessions she frequently played out violence with male and female dolls and verbalized curse words and threatening statements between the dolls. Over time, client demonstrated more nurturing and relational themes in the playroom and appeared to tolerate changes in routine without anxiety. Parent child visits continue weekly, and client experiences behavioral outbursts the day before and after visits. Therapist consulted with parent’s therapist and based on report of parent’s instability in mood and anger, family therapy is not recommended at this time. Therapy will continue weekly for child.

ASSESSING PARENTS PROGRESS: -Court ordered services are only a starting point -Therapist and caseworker consultation is imperative -Ask about risk factors and continued patterns of concerns -Clients should make progress when inundated with supportive services. If not, ask for a psychological evaluation to determine presence of larger impairment -Determine if client is “UNSKILLED” OR “UNAVAILABE” -Child therapist and Adult therapist consultation should be facilitated by caseworker

USING CRITICAL THINKING IN DECISION MAKING: -TEAM CONSULTATION APPROACH -AVOID “ALL OR NOTHING” THINKING -CONSULT WITH SERVICE PROVIDERS BEFORE ORDERING SERVICES TO ASSESS BENEFIT -USE DATA TO SUPPORT DECISIONS

IMPORTANCE OF SELF CARE: -EMOTIONAL VAMPIRES -SECONDARY TRAUMA/COMPASSION FATIGUE -BURNOUT