You may not have heard yet about the change in federal law that allows states to use federal matching dollars to pay for child abuse prevention services for biological families rather than solely for foster care services after the child has been removed from the home. This law was included in a large omnibus funding bill and so did not get a lot of notice, but nationally it is a huge change in perspective for how we have been dealing with families and children. There is much evidence that the removal of a child from her parent is a trauma similar to the trauma of abuse or neglect. If we can prevent families from descending into this level of dysfunction by providing mental health, drug abuse services and parenting support, we should be able to prevent this type of childhood trauma on a large scale. If you'd like to hear more about the new law, how it works, and my personal take on why it is needed you can listen HERE.
Laura Shamblin, MD
One of the best uses of TraumaInformedMD.com is to find out information about types of mental health treatments and to find mental health providers. The list of mental health resources was getting a bit long for the Healthcare page, so I decided to create a new page for only mental health resources in Oklahoma. It is listed as OK-Mental Health at the top of the website. If you live in another state there are still ways to search for resources in your state on the Treatments page. If you live in Oklahoma, this is a more comprehensive list and some search options which are great! These resources are helpful for patients, family members, and physicians as we try to find places to refer to that are close to our patients.
I am SO excited to share with you that TraumaInformedMD.com is opening an online store that will carry customized, printed-to-order, items that are specific to childhood adversity, resilience, foster care, and adoption. There will also be some more general items that anyone would love. Please take a look at what we have and share with your friends. These will make great gifts! The proceeds from the store will help me to continue to do the work of sharing this important information for free!
The Summer has been a busy one for me. I stay at home with 4 children most of the time, so summer means I am in full-time mom mode. I do work some evenings and weekends so I am still active as a Pediatrician. This summer I had the privilege of doing a few foster parent continuing education workshops with the Oklahoma Baptist Homes for Children. I was also surprised and honored to be appointed by our governor to the Board of Directors or the Oklahoma Healthcare Authority. Everyone asks me what the Healthcare Authority does, and I answer that they are basically in charge of all Medicaid money that the state spends through itself and 4 other agencies. The money that our state spends is matched by federal money, which requires us to be sure we are following all of the federal regulations on top of state laws. So far, I've done a lot of reviewing agency rules before we pass them to be sure they are clear and necessary. I enjoy the work and it is a volunteer position.
This summer, my husband and I also went through The HALO Project with our 6 year old daughter. This amazing program is based on TBRI principles. It provides 10 weeks of training and support to both parents while the children get to learn new skills in self regulation, and other skills needed by children from hard places, with a buddy working one-on-one. It is a great program because it provides so much help in a short period of time. It is also great because both parents are involved. I know from experience that one parent can have all the knowledge, but it will not work until both parents use it with consistency and support of each other. For more information on this see http://www.haloprojectokc.org/.
So I've been a little slow at getting updates out over the summer. Things are starting to pick up, though, with showings of the Resilience Film, which I sometimes get to serve on a discussion panel afterwards, conferences, and another foster parent training coming up. I hope to do a training with my church's children's workers soon and am developing that. I also plan to go back through all new research that has come out in the last few months for updated information I can share. Stay tuned!
The first is from The Karyn Purvis Institute of Child Development at TCU which is known for developing TBRI, Trust Based Relational Intervention, as a tool for working with children from hard places. TBRI principles focus on helping the child feel safe and connected to their caregiver so that they can focus on learning. This link is for a list of TBRI resources including videos and printables that you will find helpful in preparing for the school year. LINK
The second resource is Sesame Street in Communities. You definitely want to explore their website under the topics tab for videos, activities, and printables on many subjects like resilience, emotions, families, moving your body, math, literacy, foster care, and more. LINK
The third resource is a new online training compiled by a therapist who is trained by Bruce Perry's Child Trauma Academy and has spent the last few years training teachers in how to work with the most difficult students. It's called Trauma Camp. If you are interested in going further than your school district is currently providing in training this is a great resource for you to do on your own or with a small group of teachers. LINK
Lastly, don't forget to check out the Schools page of TraumaInformedMD.com for many more resources that you may be looking for. Don't forget to share this resource with your principles and colleagues. LINK
Have a Blessed Summer!
Laura Shamblin, MD
As they neared each child leaving the nest, they began having an itch to refill the nest again, rather than getting closer to an empty one. At first, they became aware of the plight of the children in Eastern European orphanages, where children were languishing with minimal food and almost no adult attention. This led the to their first adoption of four-year-old Jesse. She describes so well the wave of being pushed along by the tide of paperwork and family expectation, once you start the process of adoption, until you find yourself in another country and suddenly the only adult responsible for another human being who is a stranger to you. The feelings of “What have I done!” and the uncertainty that continues as you wait to see, over years, what the potential of this child will be in a loving environment. She describes a little of the struggle of post-adoption depression, bringing light to this little-known phenomenon that is so hard to talk about when the new parents are supposed to be happy and content with their new family.
As Jesse grows and the next child goes off to college, they become aware of the phenomenon of orphans in Africa flooding humanitarian organizations and becoming available for adoption due to the loss of their parents to HIV/AIDs. They are matched with a precious 5-year-old girl who had been the only child of parents who had died of AIDs. Melissa travels to Ethiopia, and this opens up a new panorama of people and places to the reader. Melissa develops a relationship with a woman who, after losing her own children, became a default mother for hundreds of AIDs orphans. Through these relationships the Green family ends up adopting another three older boys over the years. The stories of bringing home boys who had been shepherds in Africa, watching their families’ animals alone by the age of 5 are amazing. These children have talents and strengths rarely seen in Georgia, and yet the adjustment of adding an older child to a family that already has its own groove has its challenges, including an 18-day stretch of the “silent treatment.”
As the children become settled in their new life and identities as American teenagers, the family eventually makes a connection with the biological family members of each child. I love that they are able to keep a connection with their roots and ancestry. They provide support to family members in the third world conditions of Ethiopia. At one point, when Sol from Ethiopia is notified that his birth mother has been found and is coming to see him again, Jesse from Bulgaria cries harder than Sol out of joy for his brother!
This is a fun memoir-style book that will have you laughing many times. (I listened to it on audio and my kids kept asking what I was laughing at.) But it also gives some insight into the real hardness of adoption, including post-adoption depression, the difficulty of dealing with the unknowns and unanswered questions, the exhaustion, and the struggle to attach, make children feel safe, set boundaries, and mesh into a family unit. It is a celebration of accepting different cultures and people of different religious backgrounds, as well as a reminder that all children who have become available for adoption will have some amount of trauma. The more we can be prepared, lower our expectations for ourselves and them, have lots of grace, and get connected with the best support in our area, the more likely we are to have a joyful journey to becoming a family.
More resources for adoptive and foster families can be found at www.traumainformedmd.com.
Laura Shamblin, MD
In the last month I have had an article published by two major blog sites for physicians. I was inspired to pass on what I've been learning about secondary post-traumatic stress, which is the physical reaction that our bodies have when we hear stories of the trauma of other people, like our patients. This happens to physicians, nurses, first-responders, pastors, counselors and others. As physicians, we are reluctant to show any weakness or admit any mental health struggles due to our own expectations and the pressures of the healthcare system. Please read my take on this struggle and the steps anyone can take to reduce the burden of their own stress.
See OpMed article HERE
See KevinMD article HERE
The book is structured from the point of view of the author leading a support group of parents who are there to talk about the issues they are having with their children. Each class sets out to talk about a different subject, such as comparison of siblings, fighting between siblings, jealousy, etc. As the class progresses the author allows the parents to sometimes lead the subject into areas she hadn’t intended, but that are sometimes even more meaningful.
The subject of siblings does relate to childhood trauma in that sometimes a parent can create such animosity between children, or toward one child, that it really becomes a form of emotional abuse. In years past this probably wouldn’t have been recognized. There are many adults today who have suffered from a parent’s preference of one child over another. These wounds can be deep and can affect adult relationships.
Some of the takeaways I gleaned from this book include the fact that parents can use comparisons in two ways. She can either praise one child to make the other child feel bad – usually trying to motivate the child to do better. Or a parent can put down one child while trying to make the other child feel better about himself. In either case, both children will suffer. The praised child suffers just as much as the put down child because comparison will destroy the potential joy of the sibling relationship. It will cause resentment among siblings that may last into adulthood. It is possible to motivate our children and to praise our children while treating them as an individual, not in comparison to someone else.
There are many other subjects discussed, such as whether it’s necessary to always give every child the same things – it’s not, and how to handle frequent fighting – teach them to work it out themselves in a safe way. It also mentioned the affect that a sibling with special needs can have on the family and explored the best ways to include that child without having a negative effect on the siblings. In all, it was a very helpful book for parents. However, it could also be a helpful book for any adult who has had a difficult relationship with a sibling or parent. Many of these issues were explored in an easy-to-read way. If you are like me and don’t have time to read, you can also check out the audio book! Happy reading!
Laura Shamblin, MD
On Friday April 26th, I had the privilege of attending the Resilient Payne County Next Steps Conference. Community advocates from all over the state of Oklahoma attended and spent time learning from each other what is being done in their communities to foster resilience and combat adverse childhood events. The conference was planned and executed by the fearless Dr. Carolynn MacAllister, retired professor of OSU Veterinary Clinical Sciences. She is a community advocate for Stillwater and the state of Oklahoma, and has been instrumental in passing bills such as the one that formed the Trauma Informed Task Force for the the State of Oklahoma. She had help with the conference from the Potts Family Foundation, which remains dedicated to fostering programs that promote early childhood safety and education. I was able to talk with attendees and pass out flyers for Trauma Informed MD, and since then there has been an increase in website traffic which should mean that more Oklahoma communities are becoming aware of the resources available at TraumaInformedMD.com.
On Thursday May 2nd, I had the privilege of spending an hour talking to the therapists at SoonerStart of Oklahoma County about Trauma and Resilience. SoonerStart is a publicly funded program that provides therapy services such as Speech Therapy, Occupational and Physical Therapy to children ages 0-3 who have been identified as having a developmental delay in one of these areas. By providing early intervention we can make it more likely that these children will catch up and succeed in school. Since many of the studied interventions for preventing ACEs have been supporting parents of young children with home visits by trained professionals, it is intuitive that these therapists are poised to provide support to parents, since they are already doing home visits. If we can provide training and resources to these therapists, they will be able to pass on that information to parents who may be struggling. I look forward to more training opportunities such as this with our excellent professionals providing services to children in our state.
Now I am putting together a 2-3 hour training for Foster Parents who will be attending one of several free trainings put on by the Oklahoma Baptist Homes for Children One Such Child initiative this summer. OBHC provides free training while the children have fun attending a Vacation Bible School event. I'll be speaking June 5th at Eastwood Baptist Church in Midwest City, and June 14th at Capitol Hill Baptist Church as part of these trainings. If you are a Foster Parent and are interested in finding a training near you please go to https://www.obhc.org/FosterParentTraining.
Laura Shamblin, MD
For an introduction to the science of childhood adversity there really is not a better book out there than The Deepest Well by Nadine Burke Harris, MD. The title comes from the public health story of John Snow tracing the source of a massive cholera outbreak to a community well in London of 1854. This was a breakthrough, as previously cholera was assumed to be spread by foul air. This physician, through applying a systematic approach was able to narrow the source of a public health crisis down to a water source. In the same way childhood adversity has been the secret source of most of our public health problems. From obesity to illicit drug use, from heart attacks and strokes to suicide, childhood adversity plays a larger role than we have ever realized. And when we try to shout it from the mountain-tops we can expect some push-back and skepticism, as when any new concept is brought forward.
Dr. Burke Harris uses a skillful and engaging combination of explaining the science through the stories of discovery, case stories of actual patients she has treated, and anecdotes about family and friends to illustrate the different concepts that need to be understood. Concepts like nature vs. nurture, epigenetics, universal screening, the buffering that caregivers provide, and the physical reactions of the body to toxic stress and childhood adversity.
This book is an easy and accessible read for anyone, while also being a foundational text for primary care physicians to understand the importance of considering childhood adversity and the positive results we can expect if we apply universal screening for ACEs (Adverse Childhood Experiences) in our practices. The Healthcare page of TraumaInformedMD.com has a section of links to available screening tools that have been standardized for use in primary care, including Dr. Burke Harris’s. There is also a link to the National Pediatric Practice Community on ACEs which was organized by the non-profit she founded.
My favorite part of the book is a small section towards the end where she talks about how children who have grown up as survivors of childhood adversity often develop mini-superpowers. She describes her own ability to stay calm and follow protocols in a life-threatening situation. Some survivors develop an increased ability to be attuned to others, to read nonverbal cues and faces. Some become able to charm others in order to get their needs met, and some develop empathy and compassion for the vulnerable. People in serving professions often come from a background of adversity; they have overcome to use their special abilities to help others. This is my favorite concept.
I appreciate the author’s ability to take difficult concepts and make them interesting and easy to understand. I also appreciate her transparency as this is a memoir of sorts. She shares some very painful times in her life with the hope of helping others understand that adversity is something we all face at one time or another. It is not an issue of social class. Only universal screening and awareness would allow us to protect and treat all children. And aren’t they all worthy of protection and healing?
Laura Shamblin, MD