Lunch and Learn: Therapeutic Parenting for Children with Trauma --- [Grace Cameron] University of Oklahoma Anne and Henry Zarrow School of Social Work, and the Oklahoma Adoption Competency Network. We appreciate everyone joining during your lunch or noon hour. We want to get started so we can make sure to respect everyone's time and the great information being discussed today. First, let us go over a few housekeeping things for our time together this afternoon. The first is that we are recording this meeting and by participating, you are giving your consent to be recorded. The second is that we want you to help us reduce distractions so we can all focus and participate. We have muted everyone to make it possible for everyone to hear the speakers. We want you to express your thoughts and questions, so please utilize the chat for this purpose. We will monitor the chat and questions will be touched upon during our Q&A time during the last 15 minutes of the webinar. We want to see you, so if you're willing and you can, please turn on your video. If you are unable, that is fine also. To receive information about other post-adoption events, please list your name and email in the chat and we'll make sure to add you to our contact list. The third is that we want to remember confidentiality. It is vital that we protect confidential information, so we will not share specifics, name, details, et cetera, about adoption cases, about people, or children. The fourth is that CEUs are now available to professionals for this training. Foster parents attending this training will also receive one hour of training credit towards the 12 hours of in-service training that you need each year. Please indicate in the chat if you would like to claim the CEU by posting your name and email. We will send you a certificate of attendance and participation. Now, I wanna hand everything off to Kelley Ivey, who is today's host. [Kelley Ivey] Thank you, Grace. Um, gimme a second so I can share my screen with you guys. [Title Slide: Therapeutic Parenting Kelley Ivey, LSW-ADM] [Kelley] Okay. Gimme a thumbs up if you guys can see the screen that says "Therapeutic Parenting." Awesome. Um, so My name's Kelley Ivey. I'm currently an LSW admin, um, and I am one of the clinical social workers with post adoptions of Oklahoma Department of Human Services. I'm currently under supervision for my LCSW and we're gonna be talking about therapeutic parenting. Um, there's a lot of misconceptions about what therapeutic parenting in -- is. [Slide: Agenda] [Kelley] So for today, we're gonna go over, um, this is really just touching, like super, super superficial level of therapeutic parenting. Um, if you want more research on it, there's tons of different resources online. Um, we're gonna kind of go over the bullet points of kind of the main principles and then ways that you can start using it in your parenting style with your children. So we're gonna talk about what therapeutic parenting is, and then some of the key elements of therapeutic parenting are structured. We're then gonna talk about nurture and emotional regulation because you can't do the nurture and the structure if you yourself are not emotionally regulated. And we're also gonna talk about co-regulating with your child, um, consequences versus punishment. And then, uh, I'm gonna give you some kind of what it could look like using therapeutic parenting to control aggression and kind of manage aggression in your household if that's something that you experience. I personally have seen that a lot with my, with the families that I work with, is their children present with aggressive behaviors. Um, so we're gonna talk about how that could be implemented in that scenario. And then doing relationship repair, which is also crucial to therapeutic parenting. [Slide: What is Therapeutic Parenting - Purposeful and Intentional - Balance of Structure and Nature - Builds Resilience - Impacts Healing] [Kelley] Therapeutic parenting is hard. Um, there's really no way to kinda sugarcoat that. It, it just is, and it is a lifestyle. Um, we'll definitely talk about techniques that parents can use today that they can implement, um, on an as-needed basis, kind of to address behaviors and things like that. But to really have the effect that therapeutic parenting is shooting for, this really has to become your 24/7 lived experience with how you parent your children, which means that it's gonna be applicable to every child in your house, um, not just necessarily your child that has, that comes from, you know, trauma that's experienced, diverse childhood events. It's going to be, it's gonna become the new parenting style in the household. If this is the, the strategy that you want to use with your children, um, or, you know, to teach your clients how to use with their children. Um, it's very, you have to plan out every part of this parenting strategy and you have to come at parenting being prepared. I have heard, um, it compared to leagues of playing a sport. So, um, for, for a lot of us we're just out here parenting, kind of just winging it. We're, you know, we're in the recreational baseball team that, you know, plays on Thursday nights or whatever, and we do pretty good. Sometimes we win, sometimes we lose, but we can have fun. We're just out there and we're, you know, we're hitting the ball and just flying by the seat of our pants. Um, with therapeutic parenting, you are now in the big leagues. So you have a game book, you have rules that you yourself follow as a parent. You do not deviate from the plan and you go in as this is like your Super Bowl every single day and have plans and know how you're gonna respond when, when things arise in your, you know, your day-to-day life. At the Center of Therapeutic Parenting, um, especially therapeutic parenting for a child that's experienced trauma, um, we look at the attachment and attachment stra-- strategies. Um, the, to build on that attachment, especially children that have, you know, weak attachment style from the get-go. We are going to be incorporating structure and nurture. That is the key to all of it, is finding the balance. We're looking for high structure, um, and then pairing that with high nurture. So in my experience, a lot of parents are either good, really good at one, they're really good at having that structure and, you know, they have their routine down and they, the, the rules and kind of consequences if a rules are broken are pretty clearly laid out. They have that na-- nailed down, but that doesn't leave a lot of room for the nurturing part of the relationship. Or the parents are really good at nurture. Um, you know, the child is comfortable talking about their feelings. The parents are comfortable coming back and apologizing if, you know, they did a misstep in the relationship. There's a lot of focus on the connection, but then the parent spends a lot of time and energy focusing on that and they kind of lose sight of maintaining the structure that really provides the scaffolding to build the nurturing relationship around. Um, if we're able to do this right, and it is hard, um, and we will mess up. We're gonna talk about some mess-ups later on in, um, in this talk. But if we, if we reach the goals of therapeutic parenting, it's not gonna be permissive. It's not a passive-type parenting approach. Um, kind of one of the misconceptions is that when you have a relationship that's high nurture, that the kid just rules the house, they rule the roost and you know, they get away with whatever and you don't have rules and they don't have consequences. Um, and that's not true of therapeutic parenting. It is focused on building resilience and providing a place for healing for your child through the way that you're parenting them. Um, and what this does for your kiddo is it gives the opportunity for the brain to build new, you know, new brain pathways that help the child develop trust -- real, like, felt trust where they feel safe in the relationship with you. Um, and then it provides that, the physical safety as well, as well as the felt emotional safety. [Slide: Structure Establishing boundaries and routines are a must! The parent's calm, loving structure also conveys the message of strength The more you can provide consistency and predictability, the more the child will start to feel the sense of safety] [Kelley] So structure, um, and I, structure is probably my, I'm all about the nurture. I could do, nurture all day. Structure is harder for me as a parent and as a clinician. Um, just 'cause sometimes it feels mean to say no. Um, and we don't wanna be mean, but that is not structure. Structure is not saying "No," and it being mean. Structure is saying "No, because this is what keeps you safe." Um, and it's, it's really important for a child that has a history of trauma to feel safe. And what safety is for them might not look like what safety is for us. So, um, if we have a tornado shelter in our house, we know that the tornado shelter is safe. I mean, you know, there might be a spider, there's probably a handful of spiders of mine, but we're gonna go in the tornado shelter and we're gonna clean it out and we're gonna get rid of the cobwebs and, you know, get rid of the spiders and, and be the adult and pretend we're not scared when we go down there to, to check for the spiders, but we know it's safe. But for a child, just, you know, that combined envi-- environment, if it's a little bit damp or musty in there, if it's dark in there, all of those things can make the tornado shelter feel extremely unsafe and they might not be able to articulate why. Um, and so in the therapeutic parenting model, we're not going to say, "We know it's safe, so, you know, march on down to the tornado shelter." we're gonna work through that preemptively. We're gonna provide, um, we're gonna, we're gonna control the environment to where we help them see the safety that is, um, you know, that we know is there in their tornado shelter. So in this analogy, just day-to-day life is our tornado shelter. Um, and we all feel safe knowing where the boundaries are. We know that this is our, you know, this is our safe place. And then outside of that is, there's consequences or, you know, repercussions. Knowing what's expected of us and what's gonna happen next provides most people a sense of security and just kind of overall wellbeing. Um, and ultimately it lets the child know that you, as their parent, as their, you know, their person over time they learn that they can depend on you and that you're gonna be there. So that in and of itself helps to build kind of that confidence of, of, "I am safe here." So some of the ways that we do that in therapeutic parenting, um, it can seem counterproductive in the beginning, but it, it's limiting the child's choices. Um, you might not give them, you know, seven pairs of shoes in their room and they have to pick one that they're gonna wear that day. You, "Are you, do you want the blue ones or do you want the red ones?" Um, they're still getting a choice. They're still getting to participate in the activity, but you're kind of, you're controlling the environment to not set them up to fail, essentially, um, by having, you know, seven shoes that they have to decide from or, um, not agreeing to do the three extracurricular activities, you know, they might do one that is not excessively stimulating. Um, where you can be there, you can help control the environment while you're out in public. Um, and you're not overwhelmed as a parent. So you have the energy to stay there and be focused and really be present in that moment for whatever activity they're doing, because chances are they're gonna need you. Um, and if you give into what they're wanting and wanting to, you know, give them all of the extracurricular, extracurricular activities, it's just unrealistic that the parent is gonna be there and be able to be present in that moment for all of them. Um, it's limiting their access to overstimulating things, that is definitely necessary. Um, kind of with the example before, an overstimulated child is, the next step is a meltdown. Um, and we're gonna talk about managing that a little bit later too. Establishing boundaries and the routine. Routine is a must. Like, there's, there's not a way around that. Um, the child knowing what the next steps are gonna be in their day builds up predictability. They know what you're gonna do, and they know what, that they're gonna be safe doing it because they have now done this 25 million times. Um, and as a parent it can become exhausting. You know, that you have, you know, eaten dinner, brushed your teeth, read a book, went to bed, you've done that a million times, you know that that's what's gonna happen. But for the child, even though they may have done it a million times, you are still gonna have to remind them, you know, "We're, we're eating dinner right now, and then after this we're gonna go and brush our teeth, and then we're gonna put on our pajamas, and then we're gonna lay in bed and we're gonna read a book." Reminding them and just making that part of the conversation, um, conversation. And, you know, at some point, especially with older kids, they're gonna be like, "I know, you know, I know what I'm supposed to do," but just calmly and, um, I don't, I can't think of the word, I wanted to say authoritative, but that's not the word. Like, just being the adult in this situation, calm and firm, calm and firm, just kind of re-state, you know, well, "After dinner, you're gonna have some screen time," or whatever it is, but it's going to be same every single night so that they know what they can depend on. And they, they know it's gonna be there a hundred -- when I hit my light switch, I know the light's gonna be on. That's what this level of routine has to be like for, for our kids that have experienced trauma. When you finish dinner, they have to know what's happening. Just like you can know the light's gonna turn on. Um, this level of such high structure can definitely feel controlling, and at times it can feel punitive. Um, if it is not then paired with a, a matching level of nurture. Um, and a lot of kids can find this level of control very uncomfortable. So for the parent, maintaining this attitude of love, curiosity about the child, respect for the child, a mutual respect-based relationship is, you know, another key aspect of this therapeutic parenting. Maintaining the structure of, "I love you." "I care about what happens to you." All of our implementing structure is done from this mindset of calm, self-regulated love for the child. And it's important for the parent to show up with self-confidence. Um, because, you know, as we know, a, our kids generally have a weakened trust system. Um, they don't always believe that whatever's happening around them can, is, is real. Um, they're constantly questioning and, you know, testing the boundaries and all of that stuff. So you showing up, um, confident and regulated and saying, you know, "This is fact," over and over in repetition, um, helps for them to believe like, "This adult's got me, they have this under control, um, and they can navigate this and I can kind of sit back and let them, you know, let them drive the plane through our life." Um, through that, word choice is also, when I said that you have to be thinking about what you're doing in therapeutic parenting. Word choice is big. Um, there's, we're going to, where I'm gonna get you some examples of word choice here in a little bit, but we definitely wanna steer away from, um, things that, even unintentionally, are blaming the child for their behavior or anything that's gonna cast shame. Um, or, you know, anything that's going to make, make them feel like they, their behavior is anything, uh, other than just a response to what's happening inside of their body. And then just the final note on structure is the more that you're able to do this and provide consistency and that predictability, the more the child's gonna be able to start to feel that sense of safety. Um, they have to know what the expectations are, and they have to know what the next steps are. Um, and you'll have to re -- supply reminders all the time. [Slide: Nurture Children with a history of trauma do not always feel safe in a nurturing environment. Nurture, even in very small micro-doses is exactly what your child needs and critical to helping our children's hearts to heal. The balance is to have nurture without being too permissive and to have structure without being punitive.] [Kelley] So nurture, this is where, this is where I shine. Um, I think a lot of parents shine in nurture, um, but we can spend so much energy on the structure that we almost forget about the nurture. So it really is finding that balance. Um, children that have a history of trauma don't always feel safe in that nurturing environment. And it could be very hard for the parent when we are providing this nurture for the child to not have it reciprocated. Um, that could be a very sad feeling for the parent to feel like if our, our expectation is, you know, we ask for a hug or some sort of affection and the child says no, and we're like, "Man, I've just been trying, I've been trying to love on this kid, and they just keep, like, pushing away from you and pushing away from me." It gets, it's easy to say, you know, "I feel, I don't want to feel that rejection from them anymore, so I'm gonna, I'm gonna not provide this loving, nurture aspect of our relationship." Obviously, we're not probably thinking that actively, but it's just kind of like human behavior. It's just what makes sense to do. Um, but that is the opposite of what we need to do. And you can expect for them to reject your nurture. Um, and you have to just keep offering it. One of the concepts that, um, is talked about in a lot of therapeutic trainings, um, is the serve and return. So, um, parent and child both serve and return to each other, but so in the nurturing environment, you're going to serve, uh, a nurture activity and acknowledge and be kind of mentally, emotionally prepared, prepared within yourself to not get the return. Um, it is definitely about kind of putting your own wants and desires on the back burner throughout these interactions with the child. And really focusing on, is your job as the parent and as the adult to focus on the connection and not the behavior that you're seeing. Um, and sometimes when a parent is, is showing kind of these nurturing behaviors, a, a kid can think that that means that the parent is maybe soft, they're permissive. This, this child can, you know, they know that they could push you and that you're gonna bend and they're gonna get what they want. Um, which is why having this high level of nurture has to be paired with a high level of structure. They literally, you know, structure is the framework and then nurture builds the building around it. In therapeutic parenting, you cannot have one without the other. Um, and sometimes the child can push back from nurture just because of their own, you know, negative self-image. They might feel like they're not good enough to deserve, um, this love and this warmth and this unconditional acceptance. Um, they might want to show you that they don't deserve, um, the love and nurture that you're trying to provide them. And part of, one of the hardest part of therapeutic parenting is not taking that personal and just keeping in your brain that this isn't about me, this is about the experiences they have had, you know, prior to me. And, um, and I'm just gonna keep serving it to them. So I'm gonna talk just a second about finding that balance. Um, the, recognize we're gonna have days that it's not balanced, right? We're gonna have days that it's just harder behaviors. Um, there's a lot to get done or whatever your day consists of, where you're going to have to have high structure. Um, and then there's gonna be other days where maybe you don't have a lot going on, or the day before was a really hard, heavy emotion day. So today you're really gonna focus on kind of nurture and the relationship repair. It's not gonna be a 50-50 day-to-day. The goal is just to keep in mind that you're reaching for both. So if you recognize, you know, "Lately I've been really high structure, um, I've had to kind of keep a really tight ship around here," the next day keep the tight ship, but just make a mental note to add in a higher level of nurture. So being able to recognize, um, and bring yourself back to trying to get to a 50-50 goal, um, is really the goal. The goal -- it's almost impossible to do an actual 50-50, but as long as that's, is that your goal, you're probably gonna get as close as you can to it. Um, and overall, um, like a good way that I keep it in mind is you want balance, um, to you to keep the balance you want nurture without being permissive or passive, and you want structure without being punitive. [Slide: Emotional Regulation - Managing big emotions is not about ignoring them, nor is it you/your child pushing them down. - Prioritizing the relationship and connection over the behavior is central to therapeutic parenting. - Part of helping your child with co-regulating is acknowledging the feeling that they are having. - Being able to regulate emotions helps build the skills for impulse control, delayed gratification, and executive functioning.] So in order to do that very, very hard work, um, we have to, as the adult, be able to have emotional regulation, um, and then use, be able to be in a regulated space in order to help our child co-regulate. Um, emotional regulation is not about like, smushing your feelings down. It's not about, you know, telling yourself, "Don't cry, don't feel that." It's, uh, it's about allowing yourself to feel it, but controlling how it is expressed, um, and how it impacts your behavior. And then we have to be able to allow our child that same space too. Um, emotional co-regulation is not telling your child like, "Stop crying." That's, that's not gonna do it. Um, but we are gonna talk about some tips on what to actually do. So you have to be regulated in order to help them regulate. And, um... sorry, I lost my train of thought. Um, we can learn to, to, so if you have a younger child and you know, they didn't get their way, they didn't get whatever they want. Um, for some parents it's natural just to tell, like, you know, "Stop pouting, get up off the floor and come, you know, sit at the dinner table, stop pouting about whatever you didn't get." Um, a therapeutic parenting approach would be replacing "Stop crying," "Stop pouting," whatever it is with, you know, "I understand that it's, it's hard for you to not have that sweet treat right now. Um, they are good, like, I understand, I like them too, but we are gonna have, we're about to eat dinner here in just maybe 20 minutes and then you can have that sweet treat after dinner." Um, so it's acknowledging what is going on with the behavior. What it, why is the child pouting in the first place? We acknowledge, we accept, we don't tell them they're wrong for, you know, feeling sad that they can't have a treat. Um, and then we set structure around, "We're gonna have dinner in 20 minutes after that, then you'll be allowed to have, you know, your sweet treat." With a teenager because, ooh buddy, those teenagers can be real hard to stay emotionally regulated with. Um, an example is, so like an unregulated response to a teenager could just be, "Don't talk back to me." "Don't argue with me." Doing that exact, how you can respond to that in a therapeutic way is you can say, you know, "I know putting your phone away during dinner can be really tough 'cause your friends are very important to you. I have friends that are really important to me too. Um, but at dinner we don't use our phones. 'cause for this time we're really gonna focus on our family time. And then after dinner, you can get back to your friends." That's not gonna mean that they're gonna instantly not argue with you. They're not gonna be like, "Oh yeah, that totally makes sense. Lemme put my phone away." But you are going to acknowledge that they could be frustrated. It's okay to be frustrated, but here's our structure and then here's what we're going to do. Um, and you have to do that every time. 'Cause the first time you say, you know, no phone at dinner, and then that's a rule, that's an established rule. The child knows it. And then the first time you say, you know, "You've had a really hard day, let's go ahead and use your phone at di -- at dinnertime?" Out the window. You, you're back to starting at day one on that phone. And now, so it is consistency over time. Um, that's gonna show the results. Um, and it's important, like what emotional regulation is so important for teaching this to our children, um, is because over time that helps an individual to build impulse control, it's, uh, delayed gratification. And then all of these are building blocks that, you know, ultimately help the child with their executive functioning. So like helping them to be able to plan for the future and stuff like that. All of this, um, is kind of built on having that emotional regulation and emotional control that a lot of our kids just don't have the skills to do yet. And there's, uh, I wish I knew where I saw it or where I read it, but I picked up on this, uh, this phrase a while back and it's just stuck with me. Um, and what it says is, "An unmet need stays unmet until it's met," which is also to say, an unlearned skill stays unlearned until it's learned. Um, so if a child, even if a child is 16 years old, if they haven't learned that emotional regulation and emotional control, they are not going to know how to do that until they learn how to do that. Um, so we might have to go back to, um, you know, things that we would expect them to already know, they might not know, and we're gonna have to model that and we're gonna have to do it with them. Um, and you have to, we have to keep in mind that children that have had trauma and neglect don't trust their environments. So we are going to have to do it over and over and model for them and accept them and empathize with them over and over again. And, you know, over time, this isn't a one-day, quick-fix thing, but over time they do start to recognize and trust the process. [Slide: Three steps to teaching your child emotional regulation: 1 - Regulate yourself 2 - Helping your child get to a calmer state: Food, water, sleep? Sensory. Breath work. 3 - Maintain the connection/relationship] [Kelley] Um, so we're gonna talk about how you can help, um, your child co-regulate. Three steps. So step one, you have to be regulated, um, which is very hard to do if your child is dysregulated and might be screaming profanities at you or telling you, you know, that you're ugly names or something like that, could be very, very hard to, to be emotionally regulated by yourself, for yourself. But you cannot help someone else regulate if you yourself are not regulated. So that is step one. Do what you need to do to regulate. Take a pause, take, you know, do some deep breathing, take a minute before you respond. Um, whatever it is that looks, whatever it looks like for you, do that. Step two, now you can, you're in a place where you can help your child enter into a calmer space. For young kids, Um, I will always suggest looking at, are they hungry? Are they thirsty? Are they sleepy? First because I mean, I'm not a young child and I get hangry. Um, and there's not really going to be a whole lot of, you know, soft talk or cuddles that's gonna really help me until I get a sandwich. Um, so for younger kids or for older, you know, even for older kids, you, it's fair to say, you know, "Let's, do you, do you want a glass of water or whatever." Um, they're a little bit better at, well, maybe they might not be, but they might be better at identifying, you know, you know, "I'm really sleepy, I need a nap, and then we can talk about this." Um, but check food, water, sleep -- if they are not hungry and they're not thirsty and they are not sleepy. Um, two kind of very common ways to help a child regulate is with a sensory experience. Um, so some examples of this are like, um, having anything that, that disperses that kind of anxious energy. So spinning, swinging, rocking, a lot of us rock to self-soothe. Um, I actually rock this way because I don't know, I'm weird, but you guys have probably seen me do this several times now even through talking. Um, it just helps me regulate, um, weighted blankets, help kind of have this, uh, this, you know, the pressure on the body helps regulate the nervous system. And the same can be said if your child is willing, um, to, to have some physical contact, you know, a firm hug, putting that pressure on the body, if the child is open to it in the moment, just doing a hug and then adding a little bit of extra pressure to it, um, can help bring in their nervous system and kind of help get rid of some of that anxious energy. There are, um, there's two really good videos in our, um, in our file that you can find on Oklahoma Fosters that, uh, Katie Stewart did about, um, how trauma impacts the brain. And she talks, all of, you know, she explains how the nervous system responds to this trauma, what that, what the messages are that the nervous system is sending the brain. Um, so if you haven't watched those, I would definitely, definitely recommend going and watching her two videos on, um, the trauma and the brain and then behaviors, because that is kind of like a gr -- a framework, a groundwork to understanding how, um, what's happening that you are now trying to unhappen. You're trying to help them come down from it. Um, and breathing exercises for a young child, it could be hard for them if you just, you know, ask them to sit and take a deep breath. Um, so some of the tools that can be successful for a young child is having them lay down and asking them to have their belly move, um, so they can put their hand on their belly. And the goal is for them to be, to watch their hand move up and down. And it kind of just makes it feel not, uh, I don't know, not so scary for a little kid to have to, you know, to take these big breaths. Um, for an older child, a lot of the times you can just do the breathing with them. Um, and after you've done this many, many times, they will start to be able to recognize, "I need to take a breath." "I need to, you know, do this moment." Um, or, you know, there, a key part of this is that not everything works for everybody. You really have to find whatever the thing is that works for your child, which might be different than the thing that works for you. Um, but helping them in the beginning, demonstrating it for them with the expectation that over time, months, sometimes years, um, the child will then be able to recognize when they're needing to do those behaviors, whatever it is that helps them become regulated. And your job through all of this is to maintain the connection, um, modeling the appropriate behaviors and then walking alongside of them during the process. It is not about the behavior. Um, you can, that could become a mantra in therapeutic parenting. Your interaction with your child is not about the behavior that they're displaying. It is about the relationship and the connection that you have. And that is the supreme important thing is the connection and the relationship. The behavior is just a response to what is happening inside their body and a response to what has happened to them in the past. [Slide: Consequences vs. Punishments - Punishments impact the relationship in a negative way - Natural consequences happen as a direct result of the behavior - Logical consequences happen because of the parent intervening] [Kelley] Um, so you know, when a kid is just really being a butthead or just really, you know, really acting out, uh, that can feel like it is intentional disobedience. It could feel like your child is being manipulative. Um, but in reality, from the therapeutic perspective, we are looking at, "If they could do better, they would do better." I think, I know, I feel pretty confident to say that everyone who's here with us today has had a moment of time in their life that they, you know, overreacted, lost control, screamed at somebody, did something that you could look back on and be like, "Well, dang, didn't do that well. Did not handle that moment well. I really messed up." Um, if we have some emotional maturity and some emotional regulation, um, we can recognize that. And then, you know, if it had to do with a personal relationship, we could repair that relationship with our, with whoever we harmed. Um, but we recognize that in that moment we lost control. Um, so for the child that is responding to the messages that their body is sending them. In that moment, they're not able to control what is happening. Um, and recognizing that if they could control it, they would control it. No one likes feeling out of control. Um, so this brings us to the consequences versus punishment. Um, again, I, I said this and I'll say it probably, you know, 20 more times, but prioritizing the relationship is, um, we just have to do it, which means we can't punish. Um, a punishment, a punishment is meant to give someone, "You messed up so now you have to suffer a little bit." Um, which, that is not conducive to having this trusting relationship. We don't want our children to suffer. Um, they've probably suffered enough through a lot of other stuff that has happened to them before we came into their lives. And suffering does not create trust and that felt safety. Um, but that's not to say that these kids get to just, you know, run around and do whatever they want to do with no consequences. Um, so we, for therapeutic parenting, we focus on the consequences for their behavior. And there's two different types of consequences. There's natural consequences that happen as a direct result from what the child did. Um, so if they were throwin' a fit and thrashing around and they broke their electronic device that they had, they no longer have that, that electronic device, that is the consequence of breaking the device. A logical consequence is when, um, the, the natural consequence isn't going to function. Maybe there isn't an immediate natural consequence. So the parent implements a logical consequence. Um, so an example for this is you have established with your child that they are allowed to ride their bike on the sidewalk and they have to stay on your block where you can immediately see them. Well, the child decides that they're gonna, you know, take their bike and ride off into the road. A natural consequence of that is you take the bike away for a set amount of time. So that natural consequence, you couldn't wait for the, for the natural consequence because we don't want them to get injured. So we have to immediately apply a logical consequence that, um, the keys to a logical consequence is it has to be directly tied to the behavior. So in this instance, in this example, they rode the bike to the road, the bike gets taken away. Um, the bike is directly related to what they did, and it has to be as soon as you can after the, the unwanted behavior happened. Um, 'cause it helps build that relationship in the brain of, "This is what I did and this is what was the consequence of it." [Slide: Strategies for Aggression - Important for the parent not to take it personally, even when it feels personal - The first course of action for the parent is prevention - The next course of action if de-escalation] [Kelley] Um, so we're gonna quickly talk on how to use therapeutic parenting with aggression, with children that appear, um, in an, in an aggressive fashion. Whether that is, you know, through their language, through their body posture, or even through, you know, breaking things or items or wanting to become physically aggressive with you. It's important to understand, and this again, we have to go back to our own emotional regulation. Um, I have heard kids and I have had my kids say horrible, very mean things and they are hurtful and they are triggering. Um, but to be successful at the, at the therapeutic parenting, you have to be able to understand that this is not personal. Um, it is not, it feels very personal 'cause they're saying it to you, but it's not about you. Um, and you have to maintain being that firm, but loving, emotionally regulated adult in that moment with them. Um, so the first step in your home to implement is you can control the environment and try to prevent the conflict from happening. If you know you have a child that escalates quickly, that moves into aggressive behaviors or aggressive language, first line of defense is to prevent the escalation. Um, so for example, when it comes to controlling the environment, um, if you've had, if you've regularly had an argument with your child because they keep going into their sibling's room and taking things that don't belong to them, um, the first thing you might try is putting a visual sign on the door that says, um, "Please knock" or "Knock before entering." So, you know, when the child walks up to the door, they get a moment, they get a visual reminder that, you know, "I need permission to enter into this room." For some kids that might be enough. Um, if it isn't, then you might consider putting a lock on the, on the sibling door that the sibling can lock when they're not in the room. Um, because we're gonna control the environment, but to prevent the child from going in the room and taking things that are not theirs, that will ultimately prevent that argument from happening in the first place. Um, then your second course of action is de-escalation. Um, this often looks like stepping away from the conflict or stepping away from the argument. So an, uh, a very common motivator, um, for our children that are responding in an aggressive fashion or acting in an aggressive fashion towards us is their own need for control. And in that moment, they are, um, there's a lot of talk about, uh, you know, the brain, their, their lid flips. They're no longer in their thinking brain. They're in their survival brain, and they need to control, they have stress hormones going off in their body, and they are not in the, in a place to be able to identify that this stress hormone is not, um, you know, a life-threatening event. But their body is still feeling like this is a life-threatening event. Um, so they have flipped and they need to control the environment so that they can control whatever harm they perceive is going to happen. Um, and in that moment is not the time to try to have a rational conversation with them about their behaviors. So it could very much look like stepping away from the moment. Um, and as the parent knowing that the child is coming, you know, coming at you in an aggressive fashion, walking away could feel like you're giving into them or like you're permitting that behavior, you know, they screamed profanities at me, and I'm not going to respond, I'm not gonna correct this behavior? You are gonna correct the behavior just not in that moment when the child's already escalated and flipped into their survival brain. Um, and that could look a lot of different ways for the parent if that, in that moment it's gonna be whatever the parent needs to do to regulate themselves and then step away. Um, so if the, if this situation's not an immediate safety threat, um, you could step away from it and it's not going to look like blaming the child. You're not gonna say, um, "I can't, I can't handle you when you're like this. I'm going to my room." What it can look like is, you know, "I can tell that this issue is very important to you. Because it's very important to you. It's also very important to me. Um, I really wanna be able to talk about this, but right now I need a break so I can think about, you know, what we, what the next steps are gonna be or what the plan of action is going to be." You're acknowledging that they're having big emotions. You acknowledge that they are at a heightened state, but you don't engage in the argument and you let them know that you will be coming back to this at a later time. Um, and then, you know, you have to kind of navigate the situation for however it presents. And that could look like anything. Um, if the child is okay with that, then you know, they can go to their room or go to the living room or whatever, and then that's the end of the conflict. Then you can bring it back later to them and kind of identify what they were feeling in the moment. And I say that with some caveats because they might not know what they were feeling in the moment. Um, if the child is walking away from you, this happens a lot. It's happened in my home, you know, the child might be going upstairs or going to their bedroom and they're like, you know, "I hate you and you're the worst parent ever, and I don't wanna be here." Or whatever it is that they're saying. They're saying all these really hurtful things, but they're walking away. Let them say it. Let them walk away because you're, that is not going to escalate the issue. If you want -- if you try to address that with them in that moment, and you say, "No, no, Mister, you can't talk to me like that. You are gonna come back and apologize." You are now just, you've, you've stepped it up and the argument's gonna continue to escalate. Um, so let them say what they're gonna say, let them walk away. That in and of itself is a de-escalation. You can come back and address the behavior later on when everyone is in their emotionally regulated state. Um, a good tip is, that works often, I see this work all the time, um, is sometimes when there's conf-- you feel the tension. You feel your child escalating, changing the environment. Um, so stepping outside with them. Sometimes fresh air is just like a magic light switch for our kids. Um, inviting them to take a walk with you, something that helps expel some of that nervous and anxious energy. Um, and you don't have to talk about whatever it is that the conflict is about in that moment. Um, just take a walk and when you come back and everyone's regulated in an a calmer state, you can come back and, and talk about what had happened. Um, and again, do not go in to that talk afterwards expecting them, you can't say, "Why did you act like that?" "Why did you do that?" Because they probably don't know. Um, a good way to do that is, is going in with empathy and with curiosity. Um, so that could look like saying, you know, "I wonder if, I wonder if you were feeling so strongly about not wanting to turn off the video game because you knew that your friends were still gonna be playing and you didn't wanna be left out of the fun." And, you know, they might say, "Well, no, not really. I was just, you know, I was mad." Like, but that's, walking through that help, being curious and helping them figure out the emotion that was happening underneath the behavior, um, helps them to learn how to regulate that. [Slide: Repair There will be times we mess up. Modeling repair behaviors shows the child that it is okay to make mistakes and it is okay to use the mistake as a learning opportunity.] [Kelley] Um, so then repair. We're running outta time, so I'm gonna go through this fast, but this is, this is the good part. Um, in my opinion, I love repair. So we're gonna mess up, and we're gonna mess up a lot. And, uh, we are going to lose our cool and we are going to yell, or we are not gonna make sure that we are a hundred percent emotionally regulated before we engage our dysregulated child. Um, and it's gonna happen. Just know it's gonna happen and be ready to acknowledge it and own it with your child. Um, so the, repair in the relationship is a big part of therapeutic parenting because we as the parent want to be able to go back to our child and say, "Hey, I messed up." Um, and that's sending a message to them that people mess up and it's okay, that it's not a, a reflection on who they are as an individual. Um, we're gonna mess up, but it's important to go back and repair. And then that teaches them that they also need to be able to go back and do repair because they are also going to mess up. Um, an apology is, uh, not always required in the repair process, but what is required is, is owning whatever your mess up was and not blaming it on the child. So, um, you can't say, you know, "I'm sorry I yelled at you, but you know you're not allowed to do that thing." You are now blaming the child because, for you yelling, um, what it actually needs to look like is, you know, "I'm sorry I yelled at you this morning. I recognize that I should have taken a moment to take some breathing before, you know, before I came and spoke with you. And I'm gonna, I'm gonna try to do better on that one next time." Being able to own it, recognize it, say what you're gonna do differently next time, those are all techniques and modeling that behavior that we eventually want them to be able to do on their own without us walking them through those steps. [Slide: Questions Kelley Ivey, LSW-ADM Kelley.ivey@okdhs.org Oklahoma Fosters - (okfosters.org)] [Kelley] And that's it on what I have, but does anyone have any questions on therapeutic parenting? Um, I'm going to stop my screen share so that I can see the chat just in case anything is in there. One second. I'm behind in the chat. So, um, does anyone have, if I'm, I don't see any questions, but if anyone doesn't have questions, does anyone have a, um, suggestion or technique for therapeutic parenting that maybe they have used that they could share with, um, with the other attendees? [Participant 1, off-screen] Hello? [Kelley] Yes. [Participant 1, off-screen] Um, one thing that works is having a common corner. [Kelley] Mm-Hmm. [Participant 1, off-screen] Set up and letting the child go. And even using that common corner to model, like, "Hey, I need to a break. I'm going to go to the common corner," so the child know how is it used and everything. But it definitely give them time to go and take a breather like you said, and do something and then come back to address the issue at hand if that's something they still want to do. [Participant 2, off-screen] We, and we use the red light system at home. If it starts to be coming, becoming too, uh, too escalated or someone's, it's, our conversation might have sparked an anger or an emotion. We can just use the red light system. "I need to go into red right now." And then we give permission and we check in before we continue our conversation. Um, so that tends to work pretty well. Um, so green is just a natural state. Yellow would be, "I'm starting to get upset, maybe we can continue this later," and red is a complete halt. [Kelley] Yeah, I like that. Um, I don't necessarily like, so I like the way that you're implementing the, the yellow, green, yellow and red in the way to, um, to show where you're feeling. I don't wanna say that I like the color systems in that I don't like color related baby behavior charts where they start in the green and if they're a little bit bad, they go to yellow and then if they're bad, they go to red. So that could be very anxiety-inducing for children and sometimes they're like, "I'm too nervous about going to red, I'm just gonna get there and get it over with." So, um, when, when at first when you were like, we use the color system, I was like, [gasps] but you, the way you use your color system, um, that is fantastic because it def-- it uses a language that a child can use readily. They don't have to think about, you know, I'm feeling overwhelmed or I'm feeling scared or anxious or whatever. They can very easily and quickly use the language of, "I'm in the yellow," or "I'm in the red," Um, and be able to articulate it for themselves. And that's a very good, um, use of, use of a color system. Um, there's a question in the chat that asks the recommendations on how to make it work in joint custody when one household isn't interested in the approach. Um, well, staying emotionally regulated, um, and ultimately understanding that you can't control how the other person parents, um, but you can very much control how you parent and the child, um, you know, it can be frustrating and maybe a little bit confusing for the child, but over time they do learn that, you know, in this household these are the rules and these are the expectations and how, these are how things go. Um, and then what happens in the other household's parent -- in the other household with the other parent, um, you just, you can't manage that for them. So them knowing what's gonna happen and what to expect in your house is, is all you can do on that. And then there's another, um, question about ideas for toddlers specifically. So with toddlers, a lot of, um, the therapeutic parenting focuses on, um, managing the environment. Um, so for, you know, if, if what they're doing, if they're, if they're being rough with a toy, you know, they're banging a toy or doing something like that, um, you manage the environment for them. You can say, you know, "I, I'm seeing that you, you're having a lot of, you know, big emotion" or whatever it is, whatever, they're banging the toy, "I see you're behaving in X fashion and that this might be really hard for you, so now you're gonna have a, a logical consequence. I'm gonna take this toy and put it up. Um, you can have it back this evening." So it's less about, you know, and then teaching them to co-regulate because you, that's where you can start. They will probably not be able to regulate on their own, but starting to model that behavior, using some of the deep breathing, using a weighted blanket. Um, but a lot of it's gonna be structured on controlling the environment so that they don't become dysregulated. And then when they do become dysregulated, walking through it with them and modeling it with them and talking about, um, how they're feeling inside, how, where the anxious energy is in their body. Um, yeah, managing the environment. Redirection. Um, in the chat it says, "Visual schedules where they can move a task from to do to completed are really helpful for toddlers for setting the structure." That is true, [reading] "And they can look at it and see what is still left to be done, um, and slowly introducing more steps to the routine." That is a good thing. [Participant 3, off-screen] Hello? [Kelley] Uh, Go ahead. I was reading a question in chat. [Participant 3, off-screen] Something that I was gonna share is, uh, we like doing check-ins, zero through 10. How are you feeling today? [Kelley] Mm-Hmm. [Participant 3, off-screen] Sometimes it's hard to pick feeling words. Um, but then after we've identified, hey, I'm a four, then what's the difference between a four and a five? What's one thing that we can do together to get us up to a five? Just kind of breaking it down easier works well for us with my littles and the olders. [Kelley] Uh, so there's a question in a chat about, um, two children that are moving homes often because of one of the children's behaviors. And it's asking, um, what type of therapeutic or counseling services would you recommend? So for, because of their age, um, if you are able to get them in a home that is committed to the process and committed to, to sticking with these child-- children? Um, I would definitely recommend looking into a provider that provides theraplay. Um, not, I mean, play therapy is good. I'm not abs-- I'm not discrediting play therapy at all, but specifically a child that does theraplay, that builds on attachment and, um, connection between the, the helpful loving adult and the child. Um, I can't speak highly enough of theraplay, but it does take having a parent that's committed to going through the process with them or an adult that's committed to going through the process with them. I'm looking to see, um, if Dr. Goodwin is with us today, I don't think she is, but um, I think that she would have some really good answers on that. Like what, um, what therapeutic interventions, but I would recommend theraplay. Um, Yasmine asked how long is theraplay treatment modality and where can we, where can a provider get that training? Um, so we, I, the Theraplay Institute is where I received my training. Um, and the, the theraplay treatment modality obviously can be adjusted to meet the needs of the family. Um, the modality that I use right now is, um, with the goal of eight to 12 weeks of theraplay intervention with the family. Um, but of course that, that treatment plan can be, can be changed according to the needs of the family. Um, the question was, are there any locations in Oklahoma City? Is there, are there any locations for... the counseling or for theraplay training? [Participant 4, off-screen] We actually have a Chubb program in Oklahoma City through North Care that offer managing child behavior. And so you can actually talk to your foster worker and ask for her to put in referral for that, and we'll go in there and work with you on managing his behavior, give you tips and tools on that. [Kelley] Hmm. I lost the, I lost the chat. Um, so... sorry Melissa, the question, so are, for Theraplay services to receive Theraplay services in Oklahoma City? Is that the question? Okay, gotcha. Um, so we're looking for therapeutic, for Theraplay services in, um, in Oklahoma City. I actually don't know the answer to that, but I can find out. Um, I'm going to take a note of that and then I can, um, follow up with you via email about who offers theraplay services in the Metro. Okay. And, you know, I do wanna respect everyone's time. Um, we're coming up at one o'clock, so I, we will call it. And I appreciate everyone, you guys have some great questions and great thoughts. Um, but I, I appreciate you guys so much and you guys just really motivate me and feel inspired for what we're doing for these kids and I hope everyone has a great afternoon. [Participant 5, off-screen] Thank You. [Slide: Anne & Henry Zarrow School of Social Work Continuing Edcuation, The University of Oklahoma Virtual CE: Therapeutic Parenting for Children with Trauma Tuesday, February 20th, 2024 WE WANT TO KNOW YOUR THOUGHTS! Please use the link or scan the QR code to complete a short, online evaluation https://bit.ly/3SQYrpY] [Kelley] I dunno if you guys are still on, but I have a question about the follow up email that goes out to the participants after it's over. [Megan] Hi Kelley, this is Megan from, um, the School of Social Work. I'm the one that sent that email out. Um, it should have already gone out actually, but I can try and send another one if there's something that you would like included. [Kelley] Well, I, um, I was just reviewing some of the chats that happened during the, um, during the presentation. [Megan] Mm-Hmm. And a couple people had asked about the links to Katie Stewart's, uh, the Trauma Behind the Behavior videos that I, that are up on the, um, they asked about where to find those. So is that information included in their follow up email? [Megan] Um, so I've got two links to the foster care training website and then I've got two YouTube video links. Um, I saved those and I'm putting them in a document, um, that's gonna go in the resource database along with the recording of this video. Um, and that will be posted for them later today. A link to that resource database went out in the email that they received. [Kelley] Awesome. Okay. Thank you. Awesome. [Megan] Thank you so much. And, um, I always like to ask, is it okay if we put a copy of the presentation in that resource database?