Aliah Wright:
This is Aliah Wright with Social Work Talks. Nearly 35 million Americans have experienced at least one event that could lead to childhood trauma. Schools have an important role in decreasing the impact of a traumatic event on a child. How can we support our schools as mental health initiatives that help raise awareness of trauma and build resilience to make schools safer? Trauma Focused Cognitive Behavioral Therapy or TF-CBT can play a key role in identifying, supporting, and reducing school violence, especially if parents play a key role. Today, we're talking with Martha Rodriguez, LCSW, the Service Manager of Recovery at Broward County public schools in Florida. Ms. Rodriguez also works at Marjory Stoneman Douglas High School in Parkland, Florida, the site of a major school shooting in 2018. Thank you so much for joining us, Martha.
Martha Rodriguez:
You're very welcome. Thank you so much for having me today.
Aliah Wright:
Tell us about your work at Marjory Stoneman Douglas. Pre-pandemic days, what was a typical day like for you?
Martha Rodriguez:
My day at Marjory Stoneman Douglas High School varied. There was no typical day for me as my role is one in which I coordinate recovery services, which are delivered to Marjory Stoneman Douglas High School and its feeder schools. And that includes development coordination of the delivery of mental health services, support to the students, to families, staffs and any other individuals that were affected by the MSD tragedy.
Aliah Wright:
Children at your school experienced a profoundly traumatic event two years ago. How has this affected them on a practical level? And what kinds of emotional aftereffects were you seeing in the children there?
Martha Rodriguez:
Every child has been affected differently. Their emotional aftereffect vary. We have put in place a plan that includes various interventions to allow us to constantly evaluate and assess our progress and the supports that we're providing as a district. We understand that together, we must share the responsibility for a response. And the reality is, is that as a district, we look at the social, emotional and behavioral recovery of our students and not only our students, but the teachers, the staff, and that may continue long after. So some of our students that may have experienced a lack of engagement or poor attendance, physical and emotional withdraw, through recovery, through the work that we're doing in recovery, we're able to help coordinate the various resources that are created and implemented by our departments in Broward County public schools.
And some of these departments may be student services, employee assistance program, school counseling embrace. I mean, there are many others and these departments, they work tirelessly to ensure that we're providing direct and indirect services. So without them, recovery wouldn't be possible. We also work with consultants through the National Center for School Crisis and Bereavement, and these are experts and they have assisted with hundreds of schools and communities in the US coping with the aftermath of tragedy. And they play a vital role in helping to foster resiliency and crisis after events.
Aliah Wright:
Now, what about the school staff? You mentioned them, how are they doing?
Martha Rodriguez:
So again, recovery is a long-term process as you can imagine. There are many stages and healing is an individual process. So the effects of trauma, as we know, can often unfold over time. Therefore, our EAP program, it provides a tiered approach of intervention. It consists of tier one interventions, which may be generalized supports, and these are supports for all of our district employees. Then we have tier two interventions, which are more targeted service interventions that we provide to MSD zone. And I say MSD zone, to refer to not only the MSD high school, Marjory Stoneman Douglas High School, but we also support the schools around the high school, which were directly impacted or indirectly impacted. And those tier two targeted services include supports directly from EAP staff, as well as wellness checks. And then we have more intensive tier three approach interventions for those that were highly impacted, like direct or secondary employees. And these can be onsite wellness checks, we do onsite EAP support. And then we also have the traditional EAP assessments that we do through which we form referrals and we provide ongoing service monitoring.
Aliah Wright:
Now let's talk a little bit about trauma focused, cognitive behavioral therapy. What is it, and how can social workers use it to help children who have experienced trauma?
Martha Rodriguez:
Sure. So TF-CBT, it's an evidence based treatment. It's for children, for adolescents, and it's for those that have been impacted by trauma and their parents or caregivers. And it can successfully resolve a broad range of emotional and behavioral difficulties that may be associated with a single or multiple and complex trauma experiences. TF-CBT is time limited however, it is a time limited intervention and people need to understand this because this means that it usually lasts five to six months. It involves outpatient sessions with both the child and the caregiver and their intervention is manualized. Meaning it's a phase intervention and it helps the child develop and enhance their ability to cope with and regulate their responses to memories that may be troubling, to sensations that may be troubling and experiences. Over time, the idea is that through the course of treatment, the child who is engaging in this therapy can develop a trauma narrative and that trauma narrative will help them tell their story in a way that is safe and is supportive and in a supportive setting
Aliah Wright:
With this type of therapy, is there a different kind of time limit on it? Meaning is it something that has to happen immediately after they've experienced the trauma, or can it come years later?
Martha Rodriguez:
Whatever kind of trauma, a child experiences we ideally want that child to receive support right away after the trauma occurs. However, as you may know, a lot of our students enter our school district and they have experienced again, many forms of trauma at many different stages in their lives. So the intention for this is that anyone who has gone through a traumatic experience can receive these services and benefit from them. There is no timeline,
Aliah Wright:
How can TF-CBT help reduce violence in a school?
Martha Rodriguez:
So when we look at our district such as ours and all the interventions that we're putting into place, we are a trauma informed district. And TF-CBT is one of those interventions that can be used as a tool in the layered approach of trauma informed schools. TF-CBT not only addresses symptoms of post-traumatic stress disorder. But it also addresses other trauma impacts, including anxiety, cognitive issues, behavioral problems, it addresses effective parenting skills and it also addresses the distress that parents may experience about their child's experiences related to trauma. Through the treatment process, parents can learn to effectively address their own feelings, which is extremely important. Therefore, anyone who has experienced a single or repeated experience of physical, mental, sexual abuse, or has developed any PTSD symptoms can benefit from TF-CBT, which can help in turn to reduce violence in schools.
TF-CBT also allows for early identification of trauma, and the earlier that we are able to identify and intervene the better. As we know, it's no surprise that this is an essential tool for school violence intervention and prevention. When we think about the numbers, nearly 35 million children have experienced at least one event that could lead to childhood trauma. So schools, we have an important role in decreasing the impact of trauma on a child. And if we recognize this early, our school system could support this aid and this tool, and again, we can early identify supports and reduce violence in our schools.
Aliah Wright:
Listeners, we'll be back.
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Aliah Wright:
And we're back. In times like these with the coronavirus ravaging our country, what can social workers do for children who are still experiencing trauma?
Martha Rodriguez:
This is a difficult time and children are continuously experiencing trauma. We have to think about children who once relied on schools as a safe haven and we also have to look at the incidents and the numbers that are going up in terms of domestic violence. So for social workers who are working students and families who are still experiencing trauma, we must be supportive. We have to be supportive of our schools' mental health initiatives, those that raise awareness education and help build resiliency to ensure that our schools are safe.
We should also become knowledgeable, certified and competent in modalities that can support students who are still experiencing trauma. But we have to understand also the trauma is complex and we have to be patient and be aware of everyone's healing process. We can learn how to teach our students to cope, but we have to understand that this is a lifelong process. And quite often, as social workers, I know for myself, we feel that we want to just be there to support our students. And we want to be there to provide immediate support and relief. But we have to recognize that this is a lifelong process, meaning that we need to create and maintain trauma informed interventions and they require an ongoing commitment from all the key players.
Aliah Wright:
What are some tools and modalities that social workers can use to help children who have gone through traumatic experiences?
Martha Rodriguez:
We count on various modalities and various different treatment interventions. Some of these may be CBT, which is cognitive behavioral therapy. We also count on dialectical behavioral therapy, DBT. That's more of a cognitive behavioral treatment approach, and it has two key components. We also use skills training, but I think the most important modality, the most important key as social workers is to create relationships that will withstand any kind of pandemic, any kind of trauma to foster these relationships. And to understand that these relationships are going to be the key, they're the core to actually impacting and having our students experience success overall in their lives.
Aliah Wright:
Let me go back for a second. You mentioned that one of these modalities, I guess, has two components. It was the second one you mentioned.
Martha Rodriguez:
Correct.
Aliah Wright:
Can you [inaudible] in a little bit more detail?
Martha Rodriguez:
Absolutely. So DBT has two key components. The first is a behavioral component and it has to do with the problem focus, blended and you use accepting based strategies and you emphasize on dialectic processes. So the two components actually are intertwined. Dialectic refers to the issues involved in treating patients with multiple disorders and to the type of thought processes and behavioral styles that you use in treatment. So it has five components within, and those are skills training, individual behavioral treatment plans, access to a therapist outside of a clinical setting, structuring of the home environment. An example of this as like emphasis on reinforcement of adaptive behaviors and then therapist team consultation. So DBT, it emphasizes balancing behavioral changes, problem solving, emotional regulation, which is extremely important along with validation, using mindfulness and acceptance of patients. So therapists have to follow a detailed procedural manual when using DBT.
Aliah Wright:
And where can they find these resources?
Martha Rodriguez:
That's a great question. There are many places you can find resources, but you have to be very careful as to the validity of these resources. I always say first and foremost, to check your association of social work boards. So you can try and at National Association of Social Work Boards, they have wonderful resources. The American Psychological Association is another wonderful source. You also have the TF-CBT website, trauma focused behavioral therapy website. And we also have Child Mind Institute, which is another fantastic resource.
Aliah Wright:
Listeners, we'll put these resources in our show notes. Martha, is there anything else that you'd like to add?
Martha Rodriguez:
I just would like to add that recovery is something that, again, it could be a lifelong process. People are going to be experiencing different feelings and they're going to be going through different stages. But recovery efforts are not ones that can be carried out by one single individual. As I said, I'm proud to be a part of Broward County Public Schools because our superintendent recognizes the work and our departments, again, they work so tirelessly to ensure that we're creating different interventions and we're looking at different ways to support our students. So recovery is profound, but it will have lasting effects.
Aliah Wright:
Martha, thank you so much for joining us. We do appreciate you spending time discussing this topic with us today.
Martha Rodriguez:
You are very welcome. Again, thank you so much for having me and I hope that you're doing well and everyone continues to do well during this time.
Aliah Wright:
Thank you.
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