ARC Implementation in The First Two Years: Refining the of Care & Building ARC Fidelity Emily Neal, LCSW, Clinical Director Jeremy Karpen, MA, LCPC, Director of Learning & Development 1
Session Objectives 1. Develop familiarity with Mercy Home s range of services and philosophy of care. 2. Understand the basic tenets of the ARC framework. 3. Gain exposure to effective ARC implementation strategies and clinical practice examples relevant to trauma-impacted youth in residential settings. 2
Agenda Overview of Mercy Home Programming Evolution of Mercy Home s treatment philosophy ARC Framework overview Initial Implementation Overview Staff Training Application of ARC in a residential milieu Implementation Examples: Year 1 & 2 Q&A 3
Mercy Home - Programming ILP Programming: Women 4 Beds Men 4 Beds Boys Programming: Young Boys 18 Beds High School Boys 36 Beds Young Men 30 Beds Girls Programming: Young Girls 10 Beds High School Girls 12 Beds Young Women 20 Beds Supportive Housing: 22 apartments AfterCare & Community Partnerships Friends First Mentoring 4
Mercy Home Residential Programming 5
Evolution of Mercy Home s Treatment Approach Orphanage Therapeutic milieu Behavior modification Strengths-based perspective Trauma-informed Trauma-responsive 6
Evolution of Mercy Home s Treatment Approach Orphanage Three square meals a day and a bed to sleep in. 1887 7
Evolution of Mercy Home s Treatment Approach Bruno Bettelheim power of a positive environment Family Teaching Model house parents Shift to therapeutic focus Therapeutic Milieu 1970s-1980s 8
Evolution of Mercy Home s Treatment Approach Michael Durrant s Strengths-Based Approach Stricter behavioral approaches until leadership change in 2007 2007 2015 Conceptual Framework: Trauma-informed Attachment-focused Family systems Strengths-based Milieu Therapy Competency-Based Milieu 2000s 9
Development of : 2007-2017 Conceptual Framework ARC of Care Framework 10
Mercy Home for Boys & Girls The A trauma-responsive, competency-based, therapeutic milieu model for promoting the development of youth and caregiving systems.
ARC Caregiving Systems Neurodevelopment
Neurosequential Model of Therapeutics Adapted from Perry, B. (2009). Examining Child Maltreatment Through A Neurodevelopmental Lens: Clinical Applications Of The Neurosequential Model Of Therapeutics. Journal of Loss and Trauma, 240-255.
The ARC Framework Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005
ARC Framework Trauma Experience Integration Competency Executive Functions Self Development & Identity Developmental Tasks Regulation Affect Identification Affect Modulation Affect Expression Attachment Caregiver Affect Management Attunement Consistent Response Routines & Rituals Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 16
ARC Framework Trauma Experience Integration Competency Relational Engagement Executive Functions Self-Development & Identity Regulation Affect Identification Affect Modulation Attachment Caregiver Affect Management Attunement Effective Response Engagement Psychoeducation Routines & Rituals Karpen, 2016: Adapted from Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 17
Building Resilience: The ARC Framework Treating youth and caregiving systems that have been exposed to varying levels of complex trauma requires an intervention model that: Can address continuum of trauma exposures (layers of chronic and acute), including ongoing exposure Is sensitive to individual developmental competencies and vulnerabilities, and flexible in its approach Addresses individual, familial, and systemic needs and strengths 18
Developmental Resilience is the process of, the capacity for, or outcome of successful adaptation despite challenging or threatening circumstances. Masten, Best, & Garmezy, 1990, p. 426 19
3 Primary Domains Competency Regulation Attachment Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 20
Supported by 3 Integrative Strategies Competency Regulation Attachment Engagement Psychoeducation Routines & Rituals Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 21
With 1 Overarching Goal Trauma Experience Integration Competency Regulation Attachment Engagement Psychoeducation Routines & Rituals Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 22
ARC Framework Trauma Experience Integration Competency Relational Engagement Executive Functions Self-Development & Identity Regulation Affect Identification Affect Modulation Attachment Caregiver Affect Management Attunement Effective Response Engagement Psychoeducation Routines & Rituals Karpen, 2016: Adapted from Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 23
ARC Framework: Integrative Strategies Engagement Psychoeducation Routines & Rituals Karpen, 2016: Adapted from Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 24
ARC Framework: Attachment Creation of a safe environment (trauma-informed system) and safe relationships which are able to support youth in meeting developmental, emotional, and relational needs. Attachment Caregiver Affect Management Attunement Effective Response Karpen, 2016: Adapted from Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 25
ARC Framework: Regulation Work with youth to build ability to safely and effectively manage experience on many levels: emotional, physiological, cognitive, and behavioral; this includes the capacity to identify, access, modulate, and share various aspects of experience Regulation Affect Identification Affect Modulation Karpen, 2016: Adapted from Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 26
ARC Framework: Competency Build the foundational skills needed for healthy ongoing development and resiliency Competency Relational Engagement Executive Functions Self-Development & Identity Karpen, 2016: Adapted from Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 27
ARC Framework Trauma Experience Integration Work with youth to actively explore, process, and integrate historical experiences into a coherent and comprehensive understanding of self in order to enhance capacity to effectively engage in present life. Karpen, 2016: Adapted from Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 28
Each skills target is built in layers Attachment Overarching Domain Goal: Creation of a safe environment (trauma-informed system) and safe relationships which are able to support youth in meeting developmental, emotional, and relational needs. Attunement Core Target: Help caregivers to better understand and respond to children / adolescents Key Sub-skills: -Parallel attunement to caregivers -Support active curiosity -Build and support mirroring skills -Use attunement skills in support of youth regulation -Build pleasure / positive engagement Techniques: i.e., dyadic check-ins, feeling charades, etc. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005
ARC Framework Trauma Experience Integration Competency Relational Engagement Executive Functions Self-Development & Identity Regulation Affect Identification Affect Modulation Attachment Caregiver Affect Management Attunement Effective Response Engagement Psychoeducation Routines & Rituals Karpen, 2016: Adapted from Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 30
ARC Implementation Preparation: October 2014 January 2015 Reading Groups: Admin level staff assigned to facilitated reading groups to build expertise among leadership. Ambassador Training: Sent admin level staff to an open-enrollment training with Dr. Blaustein in Boston. 31
ARC Implementation Agency Training: January 2015 February 2015 Agency-Wide Training: Hosted Dr. Spinazzola for two 2-day trainings for every staff member across the agency. Hosted Stacey Forrest for a 1-day advanced residential application training for our program leaders. 32
ARC Implementation First Year of Implementation: March 2015 March 2016 ARC Leadership Team: Identified key agency leaders to guide the implementation process. This group of 12 people meets monthly. ARC Champions: Identified key direct care staff in every program to serve as ARC Champions. Champions meet once per month to brainstorm activities and create a brief presentation on blocks. They then present to their own teams and lead activities to increase confidence and competence in the framework. 33
ARC Implementation First Year of Implementation: March 2015 March 2016 Outcomes & Testing: Began aligning our agency outcomes and assessment measures with key ARC domains and skills. Clinical Calls: Once per month, we engage in an agency-wide clinical case conceptualization conference call that is facilitated by Dr. Spinazzola. One program selects a youth to write about and every program focuses on a block of the framework based on a rotating schedule. Systems Calls: As needed, the Leadership Team consults with Dr. Spinazzola about our implementation process. 34
ARC Implementation First Year of Implementation: March 2015 March 2016 Training Curricula: Our Learning & Development team worked throughout the year to faithfully integrate the ARC Framework into our of Care. We conceptualize ARC as the organizing framework for our model that is supported and expanded by various other models (e.g. NMT and SMART). Additionally, we have worked to integrate ARC language throughout our crisis prevention curriculum to support consistent and safe practices. 35
Staff Training
Course Agenda: Overview DAY 1: Who can we support? DAY 2: Structure & Culture of the Model DAY 3-4: Effective Caregiving: Living the Model & Transitioning Out of Care 37
Mastering My Experience: What is my story? C R A Skills & Strengths Emotions & Energy Caring Adult Relationships How can I effectively express my needs in the moment? How am I feeling? Where is my energy? Calm caregivers. Learning to organize, plan ahead, & manage my impulses. Observing & listening with curiosity & care. Who am I? Who do I want to be? How can I manage my energy & get things done? Responding to help you grow. Engaged caregiving systems. Empowered with knowledge. Intentional and meaningful structure. Karpen, 2016: Adapted from Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 38
Caregiver Affect Management Your Attachment Skills and Integrative Strategies Build The Safe Container Relational Engagement Affect Identification Caregiver Affect Management Attunement Trauma Experience Integration Executive Functions Attunement Self-Development & Identity Affect Modulation Effective Response Effective Response Engagement Engagement Psychoeducation Routines Routines & Rituals & Rituals Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005 39
Neurosequential Development Impulse Control Thinking Emotion & Reaction Frontal Cortex Cortex Limbic System Body Systems Brain Stem Adapted from Perry, B. (2009). Examining Child Maltreatment Through A Neurodevelopmental Lens: Clinical Applications Of The Neurosequential Model Of Therapeutics. Journal of Loss and Trauma, 240-255.