Most of the children who are in Children’s Home in Guyana have typically experienced or been exposed to traumatic events such as physical abuse, sexual abuse, neglect, sudden or violent loss of or separation from a loved one or witnessed domestic violence. Often times, these children have emotional, behavioural, social and mental health challenges that require special care and treatment. This has significant implications for the delivery of services at the Blossom Incorporated especially since some of the children have acute, chronic or complex trauma exposure. To this, Blossom Incorporated ensures its staff are both trauma-aware and trauma-informed to address the multiple challenges that traumatized children and their families bring with them when they enter the system. Hence, the organisation works to change the paradigm from one that asks, “what’s wrong with you?” to one that asks, “what has happened to you?”
To address these complex challenges the organization provides individual and group specialized Trauma Focused therapy to children who might have experienced traumatic episodes.
Blossom Inc. utilises a combination of behavioral and family therapy with children who are housed at the government run Children’s Homes and who have symptoms of post-traumatic stress disorder (PTSD), depression, behavioral problems and other difficulties related to traumatic life experiences.
The therapy that is used is the Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), which is a components-based model of psychotherapy that addresses the unique needs of children. The TF-CBT is a short-term treatment approach that can work for between 12 and 20 sessions. It can also be provided for longer periods of time depending on the needs of the child and family. Individual sessions for the child and for the parents or caregivers, as well as joint parent-child sessions, are part of the treatment. As with any therapy, forming a therapeutic relationship with the child and parent is critical to TF-CBT.
The specific components of TF-CBT are summarized by the acronym PRACTICE:
- Psycho-education – is provided to children and their caregivers about the impact of trauma and common childhood reactions.
- Relaxation – and stress management skills are individualized for each child and parent.
- Affective expression and modulation – are taught to help children and parents identify and cope with a range of emotions.
- Cognitive coping and processing – are enhanced by illustrating the relationships between thoughts, feelings and behaviors. This helps children and parents modify inaccurate or unhelpful thoughts about the trauma.
- Trauma narrative – in which children describe their personal traumatic experiences, is an important component of the treatment.
- Parenting skills are provided to optimize children’s emotional and behavioral adjustment.
- In vivo mastery of trauma reminders – is used to help children overcome their avoidance of situations that are no longer dangerous, but which remind them of the original trauma.
- Conjoint child-parent sessions – to help the child and parent talk to each other about the child’s trauma.
- Enhancing future safety and development – which addresses safety, help the child to regain developmental momentum, and cover any other skills the child will need to end treatment.
Blossom Incorporated uses as a guide, in our work, the key assumptions that the Substance Abuse and Mental Health Services Administration (SAMHSA) identified as needing to be inherent in any trauma-informed program. These are based on four “R”s:
- Realisation – at all levels of an organisation or system about trauma and its impacts on individuals, families and communities;
- Recognition – of the signs of trauma;
- Response – where the organisation and its systems respond by applying the principles of a trauma informed approach to all areas of functioning;
- Resist re-traumatisation—of clients as well as staff.
At the end of the 12 sessions children are expected to display improved Post Traumatic Stress Disorder (PTSD) symptoms which include depression, anxiety, behavior, sexualized behaviors, any trauma-related shame, interpersonal trust and social competence.
Individual and group discussions will be conducted at the end of the 12th session to support changes or lack thereof in the post counseling screening.