Building Self-Regulation Skills: a multidisciplinary approach Annika Moody Psychologist
Wooloowin, Brisbane
Intensive Therapy Program (ITP) Early Education Program (EEP)
Who are our clients? 0-18 years Have suffered some form of child abuse and/or neglect Referrals come from the Department of Communities, Child Safety Services May still live at home with parents or live with foster/kinship carers Majority of children have poor self-regulation skills
Impact of abuse and neglect
Hyperarousal (anxiety, hypervigilence, low thresholds, emotional storms) Window of Tolerance Just Right Zone We can think and feel at the same time Hypoarousal (Flat affect, numb, passive aggressive, appears sluggish)
What is self-regulation? Awareness and understanding of your emotions Ability to control/adjust your behaviour even when experiencing negative emotions Ability to use appropriate strategies to manage intense emotions Ability to recognise and respond appropriately to emotions in others
Psychology and Occupational Therapy How can we help these children stay in a physiological and emotional state which allows them to play, learn, socialise and ultimately heal?
Case Study: Sean Overview: 5 years old when referred History of neglect, physical abuse, witnessed domestic violence Multiple foster care placements Presenting challenges: Difficulties concentrating Explosive outbursts; hitting, kicking, pinching, crying Poor frustration tolerance Connection seeking behaviours Social difficulties
Sean s Goals 1. Improve Sean s ability to identify and label emotions he is experiencing. 2. Increase Sean s ability to manage his emotions without resorting to previous maladaptive strategies i.e. hitting or kicking. 3. For Sean to be better able to concentrate in class and therefore participate in table top activities.
Top down approach to self-regulation. Conscious control over behaviour Motivation Attention Bottom up approach to selfregulation. Direct input to the nervous system Less need for conscious control
What did it look like? Goal Psychological Intervention Occupational Therapy Intervention 1. Improve Sean s ability to identify and label the emotions he experiences. Play therapy; Body outline activity; identification of emotions and linking of behaviour to emotions Role playing of different emotions; Psychoeducation with Sean s foster carer The Alert Program: Body is an engine metaphor; Visual and tactile supports to assist learning.
Goal Psychological Intervention Occupational Therapy Intervention 2. Increase Sean s ability to manage his emotions without resorting to previous maladaptive strategies i.e. hitting or kicking. Feelings Toolkit; Relaxation strategies; Advocating for Sean to participate in sport outside of school The Alert Program: Exploration of sensorimotor input ( bottom-up approach to regulation); Parent and teacher education on how to support skill development outside of therapy sessions.
Goal Psychological Intervention Occupational Therapy Intervention 3. For Sean to be better able to concentrate in class and therefore participate in table top activities. Psychoeducation was provided to Sean s teacher, foster carer and parents, how can they support Sean to use the strategies he has learnt. Sensory suggestions were made to Sean s teacher i.e. frequent movement breaks, fidget toys; A Calming Space was set-up in the classroom.
Outcomes Increased ability to attend in class; Increased ability to participate in groups; Was better able to put words to his feelings instead of using his behaviour to get his message across; Improved academic performance; Increased confidence
Additional information 1. http://www.alertprogram.com/ 2. http://www.thespiralfoundation.org SAFE PLACE Sensory Attunement Focused Environments (Jane Koomar, psychologist, occupational therapist) Playfulness, Love, Acceptance, Curiosity and Empathy (Dan Hughes, psychologist) 3. http://www.traumacenter.org SMART Sensory Motor Arousal Regulation Treatment. (Elizabeth Warner) based on Ayres Sensory Integration theory and Pat Ogden s sensorimotor psychotherapy