Treating Traumatized Children Israel Trip 1 2009 Final

Partners in Healing:Treating Traumatized Children and Families

Crisis as an Opportunity: Organizational and Professional Responses to Disaster

Presented by:

Dr. Shelly WimpfheimerExecutive Director

Partnership for After School [email protected], January 8, 2009

mailto:[email protected]

Mission Statement

PASE is a child-focused organization that promotes and supports quality after school programs, particularly those serving young people from underserved communities.

9/11 Created a new awareness about trauma - agencies who were not in the business of treating trauma, but were in the business of working with children and families around building their resiliency and competence, became very concerned about how children would react to this tragedy

PASE is the lead agency of a network of 1,600 NYC–based agencies providing afterschool services. Members rely on PASE to….

Lead this network of individuals and organizations committed to afterschool excellence

Be a recognized leader and expert in the field of afterschool education

Provide training and technical assistance to the network and beyond

Consult with organizations to build their capacity and sustainability

Program PhilosophyPASE’s program philosophy rests on the theories and practices of youth development. Through our work with afterschool programs and staff we promote and teach the concepts of resiliency, using an assets-based approach to working with young people, and building competencies in young people to prepare them to manage the many challenges that will come before them in life.

According to the Carnegie Council on Adolescent Development a resilient individual is one who has:

Social Competence Problem-solving skills Autonomy (sense of self-identity, and

the ability to act independently, and to exert control over his/her environment and

Sense of purpose and of a future

The events of 9/11 led PASE and other agencies to develop a plan that would enhance the foundational skills of youth workers and provide them with “new core skills” to successfully create emotionally healing, culturally sensitive, community-building programs.

Results of PASE Study Conducted Post-9/11

Increased violence and aggressionYoung people reported feeling they needed to be “on guard; ” they felt more paranoid. Much of their violence and aggression was directed against individuals of Arab and South Asian descent

Increased risk-takingIn addition to increases in common behaviors such as drinking, smoking, drug use and sexual activity, many youth workers reported an increase in risk-taking behaviors that seemed related to a sense of hopelessness about the future and a sense that efforts to stay safe were futile

Results of PASE Study Conducted Post-9/11, cont.

Anxiety about Future OpportunitiesThe economic repercussions of 9/11 were a major concern to young people who needed to be employed to assist their families in providing for basic needs; they were fully aware that there were major changes in the local job market.

Increased Apathy and DisengagementYoung people were very concerned about their “place” in the aftermath of this tragedy. They felt that their needs were being ignored in comparison to other and newer issues, and if they could not participate in creating solutions, they were justified in being apathetic and disengaged.

Pervasive Fear and InsecurityYoung people were haunted by the fear of another attack

What do we know about children and trauma?(Dr. Claude Chemtob)

Trauma in NYC is not a rare event, Seventy percent of children from low

income communities in NYC have seen someone shot or killed

Trauma leads to more risky behavior, more substance abuse, more diseases, etc.

Trauma interferes with a child’s ability to form effective and positive relationships

Chemtob (cont.d)

Kids need to be able to tell the difference between what is safe and unsafe

Trauma can impact a child’s identity; it can interfere with his/her ability to feel good and safe

Trauma can rob children of their “voice;” they do not think that they have the right to talk about their experiences

Post 9/11 Concerns about Children and Trauma

A relatively small number of children were accessing regular mental health services after 9/11.

What would happen to those children who were not given the opportunity to “voice” their feelings?

How can we make the best use of existing community resources to address the needs of young people affected by to the 9/11 attacks?

Agencies Began Talking

New partnerships grew(sometimes strange bedfellows)

PASE convened a new group

of agencies to develop a new program model

…one that would combine the best of mental health and social

services and the youth development approach of

afterschool programming to address childhood trauma…

Differential Impact of 9/11 on Youth Population

Based on the review of several trauma experts, PASE conceptualized NYC’s youth population as falling into 3 groups, each affected by the aftermath to different degrees:

Hi-Risk: Severely compromised psychological and social functioning or evidence of mental illness. This group requires intensive therapeutic intervention.

Differential Impact (cont.d)

At-Risk: People who may have experienced loss and disruption in their lives and feel a sense of despair or hopelessness but are able to negotiate daily life nevertheless. This group is particularly at risk of deterioration without intervention.

Differential Impact (cont.d)

Lower Risk Group: People who may not have been directly affected but may have other generalized symptoms such as physical and mental exhaustion. They are not likely to be experiencing the depth of the problems of the other two groups.

NYC Department of Education Post-9/11 Survey Results

Approx 10% of students severely affected and suffering from PTSD

Approx 90% fall into the two lower risk categories

For the vast majority, providing indigenous networks with the resources they need to help one another is (or should be) the primary objective of disaster mental health policy.The ultimate task is to foster a mobilization of community support that will be powerful, inclusive and lasting enough to conquer the spiral of losses.

Dr. Fran Norris - The National Center for PTSD and the Center for Mental Health Services

What should this new program model look like? Safe space Supervised by caring adults A place to learn/improve social skills

Social competence Problem-solving skills Autonomy Sense of purpose and the future

Partners in Healing Was Born

What is Partners in Healing?

The overall goal of Partners in Healing is to increase the capacity of youth practitioners and agencies to work with young people in an emotionally responsive way, in order to strengthen young people’s emotional well-being through resiliency-building activities and providing access to counseling and support services within a youth development context…

Program Components Train afterschool staff to recognize

mental health issues in young people and respond appropriately

Train staff to implement resiliency-building activities with young people

Place graduate social work interns in afterschool programs to provide counseling to youth and families

Program Components (cont’d)

Provide agencies with site-based technical assistance

Strengthen the relationships between youth agencies and existing mental health community resources

Document and evaluate all aspects of the model for future replication.

Partners and Their Roles

PASE Project Management Training of Interns, afterschool personnel, supervisors Curriculum Development Supervision of MSW Students in some sites

NYU School of Social Work Internships (52 NYU interns over 4 years)

Mount Sinai Adolescent Health Center Curriculum Development Expert Consultation in Trauma

Partners and Their Roles

Mental Health Association of New York City Consultation on the Mental Health Directory

Youth Communication Consultation on the Mental Health Directory

Safe Horizon Expert Consultation and Training

Partners and their Roles

Members of the PASE Network

Voices from the Field “Young people were more anxious and

demonstrated a greater sense of vulnerability.”

“One of the things that stood out was the kids being more concerned about each other.”

“We noticed they were at the program way more. They came to hang out more often. They were scared and confused.”

Relationships between Schools of Social Work and Afterschool Programs

Limited prior to 9/11 Afterschool traditionally aligned with the

field of education although programmatically more aligned with youth development/social work

Partners in Healing became a prototype for the natural relationship between afterschool and social work

Why Build the Capacity of Community-Based Youth Serving Organizations to Work with Youth in an Emotionally Responsive Way?

Wide Reach – more than 500,000 young people are reached annually, in communities throughout the City

Daily programming - promotes intellectual, social and emotional development of youth

Programs - accessible to community members and their families and are a trusted and respected resource

Programs enjoy long-term, positive and enduring relationships with youth and families

How Community-Based Organizations Support and Foster Healing

They provide a safe space for people to gather

They offer culturally relevant and age appropriate programs and services and provide healthy outlets for youth that allow for multiple forms of self-expression

Staff is trained to work with young people and help them to deal with traumatic and/or stressful experiences

How Community-Based Organizations Support and Foster Healing

They promote positive relationships with youth building on young people’s strengths;

Through structured activities, they build and support resiliency in youth

Strong ties with local communities are developed to provide a web of supports for youth and families (enrichment activities, counseling, tutoring, etc…)

Description of the Participating Programs

54 afterschool programs over 4 years Selected through an application process

Initially targeted areas thought to be most affected by the terrorist attacks

Broadened reach to other areas of the City Applicants submitted a proposal Proposals reviewed by a committee of experts and

practitioners Programs given a stipend to participate Required to make a written

commitment to participating fully in the program

PASE Partners in Healing

St. Nicholas Neighborhood Preservation Corporation

Williamsburg, Brooklyn-based agency serving 200 school-aged children and teens who witnessed 9/11 attacks

Proposal: Workshops culminating in family retreat; home visits and counseling; arts-based programming to deal with increased levels of stress, anxiety, and risky behaviors


Queens Child Guidance Center Central Queens-based agency serving 150

young people in middle school, primarily of South Asian descent

Proposal: Expand a peer-to-peer tolerance project to deal with increased prejudice and anti-Muslim and Arab sentiments after 9/11; use the arts as a medium to address issues of bias and diversity


South Asian Youth Action (SAYA) Serves 50 South Asian teens, ages 11-19, in

Elmhurst, Queens Proposal: Use PIH training to build staff

counseling skills; integrate resiliency-based activities into existing programming. Issues addressed include being victims of discrimination, cultural identity, dealing with new immigration rules and procedures


Generation X-Cel Serves 35 youth from 8-13 years old on

Manhattan’s Lower East Side, particularly those in close proximity to the World Trade Center

Proposal: Create weekly support groups for both youth and families dealing with the issues faced from witnessing the attacks and experiencing disruption in neighborhood living immediately afterward


Lower East Side Girls Club Girls-only programming, mostly African-

Americans and Latinas, from 8-21 Proposal: Provide individual and group

counseling, integrate a resiliency-building curriculum into an existing arts, wellness and entrepreneurship program


Hamilton Madison House Located in Chinatown, serving Asian youth of

middle school age Proposal: To deal with issues raised by the

threat of SARS in Chinatown and cultural resistance to mental health support, staff will use skills from the outreach program in order to raise awareness of problems of discrimination, stress and anger


EARS Serves pre-teens from 4 middle schools on Staten

Island, an area where a large population of police and firemen were lost in the attacks

Proposal: Train teens as peer-to-peer “counselors” who can intervene and refer young people dealing with issues of grief, PTSD and anger to appropriate mental health supports. Fifty students at each school will be trained for a total of 200 counselors.

Benefits for Participants

More children served with individual and group counseling on site than ever before

New workshops, curricula and programming developed (e.g. Rap groups)

Enhanced awareness and sensitivity to mental health issues, increased willingness by youth to talk about mental health issues

Youth leadership activities created/or enhanced, increasing youth participation in agencies

New forms of parent/child interventions offered and dialogues opened with parents without stigma (e.g. mother’s support group, parent social action group)

Benefits for Agency Staff

Better understanding and increased involvement with mental health and youth development issues

Increased training and skill development about making themselves available and using themselves to help others

More skills development in gathering information about participants to improve service delivery, including using case conferencing and making referrals

Benefits for Agency Staff

More access to trained social workers on site to assist with managing affected young people

Staff’s perceptions about youth were altered so that they were better able to discuss problems and exchange ideas about how best to deal with issues that were seen as intractable in the past

Benefits for Programs/Agencies

Graduate student involvement and the professional development of program staff enhance staff competence in the area of mental health. This new awareness leads to the development of new policies and procedures related to mental health. (e.g. referral processes for counseling)

New and more positive responses to children with behavior problems (e.g. formerly problem behaviors led to ejection from program, now there is a greater inclination to view problems differently)

Benefits for Programs/Agencies

These new services contribute to a changed view of agency needs and services, including a range of mental health/social services (e.g. parent support groups, outreach services to emotionally needy families)

Benefits for the Community

Enhanced outreach to, and linkages with, school-based and community agencies (e.g. new partnerships to access professional development, such as training for students as mediators)

New services to families including support services (e.g. parent meetings and workshops, other community recreational activities)

Increased parental involvement in programs (e.g. creation of Parent Advisory Councils)

Professional Development Activities

Workshops• For Interns• For Supervisors• For Afterschool Staff• For Site Staff/Management

Technical Assistance - Site Based Public Forums Publications Conference Presentations

Workshops

General (for all) Program Orientation Creating a Safe Environment for Children and

Adults Understanding Mental Health from a Cultural

Perspective Reflections on Practice Sessions Sessions on Program Evaluation Creating Culminations: Addressing Termination

and Celebrating Client Relationships

Workshops (continued)

For Social Work Interns and Afterschool Program Staff (examples)

Integrating social work practice into afterschool programs

Recognizing signs and symptoms of trauma

Helping Kids Heal (Activities to help kids recover from trauma and loss)

Groupwork Practice


For Social Work Interns and Afterschool Program Staff (examples)

Developing and Implementing Resiliency-Based Activities for Youth

Grief, Loss and Endings

Conflict resolution

The Arts as Resources for Healing


For Supervisors and Program Managers(examples)

Training of Trainers Strategies for Using Supervision and Staff

Meetings to Address Mental Health Issues in Youth

Making Effective Use of Community Resources Helping Staff to Cope in Crisis Situations

Other Activities

Site-Based Technical Assistance Public Forums Publications Celebratory Events for Interns and

Staff

EvaluationsConducted by:

NYU School of Social Work

Purpose: To gather data on the clients served by the

program; their presenting problems, the environmental factors that were present in their lives before the attacks and the impact of the services they received from the program on their beliefs and behaviors

EvaluationsConducted by:University of Pennsylvania Out of School Time

Resource CenterPurpose:

To refine and improve the overall professional development process

To provide essential evaluation information to multiple parties, e.g. funding entities and staff of PASE

To improve future professional development provided to social work interns and afterschool staff

Benefits for Social Work Students (NYU)

(Gathered by Dr. Gerald Landsberg)

Placement experiences were often challenging and forced students to be creative and innovative

Students learned how to navigate non-traditional agencies

Benefits for Social Work Students (NYU)

(Gathered by Dr. Gerald Landsberg)

Learned new skills - communicating effectively with non-professionals, negotiating for space, creating group activities, developing innovative approaches to counseling youth and families

Learned how to use supervision provided in a variety of ways

Served as a catalyst for promoting agency understanding of social work and mental health, for creating new services and for enriching the agency

Often served as a source of support for workers on mental health and counseling issues

Learned how to refer participants and families to formal mental health services

Frequently served in a lead role in assisting agencies to modify their practices e.g. improved record keeping and creating discussions of mental health issues

Key Learnings for NYU

Field Learning Students must be selected with care and with

emphasis placed on those who can integrate into nontraditional settings and who demonstrate the ability to act independently

A well constructed orientation for students and faculty advisors can and should be offered in conjunction with PASE, to highlight the role of the afterschool program and the role of the students in these settings

Key Learnings for NYU

Field Learning Agencies should be screened to ensure that

they are going to be supportive of students and the goals of the initiative

Some agencies found that integrating the social workers into the program as a program staff in the beginning, to simply learn about the agency, community and youth was effective. Following this the students are more effective in carrying out the social work role.

Other Curriculum Areas

Practice Moving group work, with content relevant

to providing services to children youth and families, was added to the first year course offerings

Content on working with youth needed to be strengthened, with the inclusion of substantial case examples and intervention strategies and approaches and the addition of useful reading materials

Other Curriculum Areas

Practice The content on working in community-

based or non-traditional organizations needed to be added to the practice classes

Traditional requirements (e.g.case write-ups) needed to be reviewed for their relevance to these placement settings

Other Curriculum Areas, cont.

Human Behavior Needed to be significantly strengthened, especially

content on youth development

Social Policy Content on policy issues related to children and families

needed to be strengthened and descriptive information on community-based organizations needed to be added

Research Discussions about research and research opportunities

in community-based organizations needed to be added to the content

Afterschool as a Sector for Social Workers Afterschool as a vehicle for recruiting

students into BSW and MSW programs Continuing Education programs offered

through Social Work Schools can be excellent sources of training for employees of afterschool programs

Afterschool is a rich area of research for social work schools and agencies

Afterschool and youth development agencies and organizations like PASE are rich sources of employment for graduating social workers

Partners in Healing Summary of Program Accomplishments (2003-2007)

Provided counseling and emotionally supportive services to 17,250 youth and families in 54 community-based sites (over 4 years) serving a wide array of ethnic groups in the five boroughs of NYC

Placed and supervised 52 graduate-level social work interns to provide on-site mental health services to assist young people and families in need

Partners in Healing Summary of Program Accomplishments (2003-2007)

Developed mental health-related skills and competencies of approximately 200 afterschool program directors and staff

Created and disseminated the Directory of Mental Health Programs for Youth and Families in New York City in partnership with The Mental Health Association of New York City and Youth Communication

Created opportunities to share best practices with the field through city wide networking events and forums

Program Finances

FundersPrivate Foundations (3) - $805K over 4 years

Major ExpensesPASE Staff - Range @200K in Year 1 to $50K in Year 4Stipends for Partners - Range $10K-$68KStipends for Sites - $8K-$10K eachEvaluations - Foundation Funded

The Future

Received a Promising Practices Designation from the New York State Department of Education for Partners in Healing

Will be offering an Advanced Course in Mental Health and Social Services – Spring 2009

Working with social work programs in other areas of the country to establish Partners in Healing programs(e.g. New Orleans, Chicago, NJ)

Preparing articles/publications/conference presentations for the field of Social Work about Afterschool as a venue for Social Work practice

Health & Medicine

Treating Traumatized Children Israel Trip 1 2009 Final