Trauma, Addictions, Mental Health, and Recovery for Youth Facilitators’ Manual
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Trauma, Addictions, Mental Health, and Recovery for Youth Facilitators’ Manual Prepared for the Maryland Department of Juvenile Services Contents Welcome ........................................................................................................................................ 2 Rationale ........................................................................................................................................ 2 TAMAR-Y Background .................................................................................................................... 2 The TAMAR-Y Approach ................................................................................................................. 3 Creating a Trauma-informed Learning Environment ..................................................................... 4 Gender Considerations .................................................................................................................. 5 Module Elements ........................................................................................................................... 5 Time Management ......................................................................................................................... 5 Module 1: Introduction to TAMAR-Y ............................................................................................. 6 Module 2: Understanding Trauma’s Impact ................................................................................ 11 Module 3: Dealing with Triggers .................................................................................................. 15 Module 4: Trauma and Addiction—How We Cope ..................................................................... 18 Module 5: Keeping It Together—Containment ........................................................................... 22 Module 6: Who I Am .................................................................................................................... 26 Module 7: Connections ................................................................................................................ 29 Module 8: Betrayal and Abuse..................................................................................................... 34 Module 9: Boundaries .................................................................................................................. 38 Module 10: Conclusion ................................................................................................................ 45 Worksheets and Lyrics ................................................................................................................. 49 Facilitator Resources ................................................................................................................... 72 Suggested Videos/Music .............................................................................................................. 73 6/5/2017 - 1 Welcome Congratulations! By becoming a facilitator of Trauma, Addictions, Mental Health, and Recovery for Youth (TAMAR-Y), you will play an essential role in helping justice-involved youth understand the impact of trauma on their lives, their families, and their communities, as well as helping them develop vital skills that will build resilience for a lifetime. This manual will provide you with everything you need to facilitate successful TAMAR-Y groups. Rationale For many youth, trauma has shaped their experience of the world in devastating and persistent ways long before they reach the juvenile-justice system, through both their personal trauma experiences and encounters with other public service and educational systems.1 Research indicates that the vast majority of youth who enter the juvenile-justice system have experienced many forms of adverse childhood experiences, including emotional, physical, and/or sexual abuse; neglect; witnessing domestic violence; or living in a home with an absent, incarcerated parent. Additional research indicates the traumatic effects of growing up in distressed neighborhoods and/or witnessing violence in the community. Loss of friends and loved ones to community violence is a common experience for justice-involved youth. We also know from scientific literature that early exposure to trauma and violence results in changes to the brain that can severely impact learning and behavior. Early intervention is integral to breaking that cycle and helping youth learn to manage their trauma symptoms and begin a sustained healing process. Finally, it is important to recognize that the experience of being removed from one’s family, friends, and community by entering a Department of Juvenile Services (DJS) facility can be, in and of itself, a highly stressful and even potentially traumatic experience. Add to this the potential for conflict with other youth, which compounds the stress. By acknowledging that incarceration is traumatic, you can help promote the trauma-informed principles of trustworthiness and transparency and validate the experience of young people residing in DJS facilities. TAMAR-Y Background TAMAR was developed in the late 1990s as part of a federally funded, gender-specific program for incarcerated women in Maryland. It has since been implemented in multiple justice and behavioral health systems across the country. The original TAMAR intervention was customized for Maryland DJS, in concert with youth, families, and DJS staff, to create TAMAR-Y. This clinical intervention combines psychoeducation about trauma and its impact with concrete techniques 1 Dierkhising, C. B., Ko, S. J., Woods-Jaeger, B., Briggs, E. C., Lee, R., & Pynoos, R. S. (2013). Trauma histories among justice-involved youth: findings from the National Child Traumatic Stress Network. European Journal of Psychotraumatology, 4(1). Retrieved from http://dx.doi.org/10.3402/ejpt.v4i0.20274 6/5/2017 - 2 designed to help participants identify their triggers and learn and practice skills to self-regulate trauma symptoms. The training incorporates the use of expressive arts therapies, an approach that successfully engages youth in age-appropriate, meaningful ways. The TAMAR-Y Approach Expressive arts. Researchers conducted by Kisiel et al.2 and Zucker et al.3 on at-risk youth found significant positive results from interventions that involve drama, storytelling, and other expressive aspects. Such expressive therapies are most likely to engage youth in a culturally competent manner and to keep them interested in learning throughout the intervention. In each TAMAR-Y module, youth learn about the impact of trauma on their lives and engage in structured exercises designed to help them creatively explore the concepts through visual art, poetry/spoken word, hip-hop/rap, and expressive movement. Including creative and expressive therapies in the TAMAR intervention is well-suited to engaging a youth population in learning about self-management of trauma symptoms. In addition to trauma-healing benefits, the inclusion of expressive therapies is a strengths- based approach that will help youth develop self-esteem; find healthy, powerful, and personal ways to express their emotions; and achieve a sense of competence and mastery. The arts have been successfully used to enhance emotional, behavioral, cognitive, and cultural competencies as resiliency factors and add a creative, engaging, and profoundly healing component to the model that cannot be achieved through talk-based group therapy alone. Hip-hop therapy. Elements of “hip-hop therapy” are incorporated throughout this training as a powerful means of engagement. Music is vital to youth culture, and these elements serve to engage the youth and provide a powerful jumping-off point for exploration of the concepts and skills presented. While hip-hop was once condemned as a destructive influence by many educators and clinicians working with youth, it is now increasingly validated as an important therapeutic tool in clinicians’ and educators’ toolboxes. This manual provides information on hip-hop therapy to help you understand the full range of theoretical and practical uses of this modality. For background on teaching about trauma, addiction, and mental health using hip-hop lyrics, go to http://www.apa.org/pi/about/newsletter/2014/05/hip-hop.aspx 2 Kisiel, C., Blaustein, M., Spinazzola, J., Schmidt, C. S., Zucker, M., & van der Kolk, B. (2006). Evaluation of a theater-based youth violence prevention program for elementary school children. Journal of School Violence, 5(2), 19-36. Retrieved from http://dx.doi.org/10.1300/J202v05n02_03 3 Zucker, M., Spinazzola, J., Pollack, A. A., Pepe, L., Barry, S., Zhang, L., & van der Kolk, B. (2010). Getting Teachers in on the Act: Evaluation of a Theater-and Classroom-Based Youth Violence Prevention Program. Journal of School Violence, 9(2), 117-135. doi: 10.1080/15388220903479628 6/5/2017 - 3 NOTE: Kendrick Lamar’s music is used throughout this intervention because his lyrics are particularly relevant to the themes in this course. To be as culturally competent and youth-friendly as possible, ask participants which artists and tracks they currently listen to or favorites from their past. Search the internet for lyrics of these tracks to see if they can be used to illustrate concepts in TAMAR-Y. Please use clean or “radio edit” versions only. Lyrics obtained online will need to be similarly cleaned up. Youth-generated suggestions can keep the playlist current and relevant. Asking participants for music suggestions