Addressing Crises in Recovery from Trauma

Unhappy girl behind a fence. (Getty Images)
Unhappy girl behind a fence. (Getty Images)

When it comes to traumatized youth, therapists are well versed in how to deliver evidence-based treatment, and there are clear guidelines for safety and for ethical therapeutic behavior.

There are no hard and fast guidelines for how to respond at the moment when a child says she or he is going to commit suicide. — Julian Ford

But while they’re helping children recover from complex trauma, potentially dangerous clinical therapy dilemmas – such as the risk of suicide, self-harm, or other violent behavior – can emerge.

For those situations, the best-practices book is largely empty.

UConn Health clinical psychologist Julian Ford is leading a national effort to get that book written, by developing a repository of demonstrations of how these critical incidents can be handled.

“There are no hard and fast guidelines for how to respond at the moment when a child says she or he is going to commit suicide, or when a parent becomes so angry at a child that they start yelling at them and you can see the beginnings of what might actually be abuse outside the therapy session,” Ford says. “It’s those critical incidents – when a crisis is just about to happen or is just happening – that therapists have no systematic guidance on how to handle. And that’s what we’re going to address.”

Psychiatry professor Julian Ford is an expert on post-traumatic stress. (Janine Gelineau/UConn Health Center Photo)
Psychiatry professor Julian Ford is an expert on post-traumatic stress. (Janine Gelineau/UConn Health File Photo)

Ford, a professor of psychiatry and law, recently started the Center for the Treatment of Developmental Trauma Disorders at UConn Health. The CTDTD is part of the National Child Traumatic Stress Network, a group of programs funded by the Department of Health and Human Services that exist to provide or improve services for children who’ve experienced trauma.

Ford says the initiative will attempt something that he believes has not been done before: Experts in the field of developmental and complex trauma will address important challenges presenting in therapy when working with highly traumatized children and families.

“Hopefully we’ll advance knowledge in the field,” he says.

The CTDTD is one of two centers at UConn Health for which Ford won separate federal grants last year, each worth $3 million over five years. The other is the Center for Trauma Recovery and Juvenile Justice, which started in 2012 and focuses on advancing the treatment of traumatized children who’ve been involved in the juvenile justice system.

Performers from the Looking In theater group stay in character as they take questions from middle-school students following a dramatic presentation at the Academy of Science and Innovation in New Britain. (Photo by Greg Person)
Performers from the Looking In Theatre group stay in character as they take questions from middle-school students following a dramatic presentation at the Academy of Science and Innovation in New Britain. (Photo by Greg Person)

As director of both, Ford is the only principal investigator nationwide with two National Child Traumatic Stress Network centers.

Ford and associate director Rocio Chang, a clinical psychologist and assistant professor in the Department of Psychiatry who sees patients in UConn Health’s child and adolescent psychiatry practice in West Hartford, have detailed plans for the new center over the next five years. They will start by engaging experts from across the U.S. to help identify the moments in therapeutic services that are the most critical, dangerous, and difficult.

“We’re surveying people all over the country, not just professionals, but also the youth and families themselves,” Ford says. “We’ll probably end up with 50 or 60 moments that every therapist wants to know how to handle and nobody has a definite answer for.”

Once they’ve identified the critical incidents to tackle, Ford and Chang will bring in another important partner. They’ve enlisted the Looking In Theatre to perform dramatizations to illustrate the stresses and traumas that children and adolescents experience.

Performers from the Looking In theater group take questions from middle-school students at the Academy of Science and Innovation in New Britain. (Photo by Greg Person)
Performers from Looking In Theatre take questions from middle-school students at the Academy of Science and Innovation in New Britain. Looking In will provide dramatizations of challenging incidents to be used in training webinars that the Center for Treatment of Developmental Trauma Disorders will offer to therapists across the country, as it works toward developing guidelines for how to handle critical moments during patient interactions. (Photo by Greg Person)

Looking In is a program of the Greater Hartford Academy of the Arts, an interdistrict magnet high school of the Capitol Region Education Council. The student performers travel to schools and youth organizations throughout the state and present dramatic scenes about issues that challenge adolescents, such as drug or alcohol use, teen pregnancy, bullying, and suicide. After the performances, they stay in character and take questions from their audiences, who are largely middle and high school students.

For this project, the audience will not be their peers, but rather, national experts in child and adolescent behavioral health who serve those peers.

“They’re going to actually act out the role of a child or teenager, and we’ll have some adults who are going to play the role of the adult, and we’re going to have moments of therapy sessions or assessment sessions that we’ll film to show exactly what happens,” Ford says. “One of our expert clinicians will be in the therapy session and will demonstrate an approach to handle that critical moment.”

In addition to their theatrical contributions, the Looking In students also are serving as advisers, bringing the perspective of today’s teens.

Video from these reenactments will be incorporated into a series of webinars for therapists across the country, not only as a training tool for them, but also as a mechanism to collect intelligence from those experts to further shape the new center’s work.

Ford is aiming to produce 54 webinars over five years in the effort to facilitate a national multimodal learning community on developmental trauma disorders. He intends to reach more than 40,000 counselors.

“We’ll be working with other centers and groups in this network that have fabulous, outstanding treatment models and approaches to treatment and to dealing with the general issues in treatment,” Ford says. “The expertise is out there. We’re not duplicating that. We’re building alongside of it.”