Episode 7 – Trauma Informed Practice: Understanding the Roots of Behavior in Children and Adults with Sarah Ascienzo

Episode 7 – Trauma Informed Practice: Understanding the Roots of Behavior in Children and Adults with Sarah Ascienzo

Dr. Jones talks with Sarah Ascienzo about trauma-informed care, best approaches to trauma in children & families and how to practice self-care while still being an effective social worker.

 

BIO:

Sarah Ascienzo, MSW, LCSW has over 15 years of experience working with children and families in a variety of roles, including work as a case manager, forensic interviewer, and clinician. For the majority of her career Ms. Ascienzo has worked as a clinician in both community and school-based settings with children and adults adversely affected by trauma. She currently teaches in the Master of Social Work program at UK and works as a clinician and research assistant at the UK Center on Trauma and Children. Her current research interests include investigating mediators and moderators of trauma-focused treatment outcomes, gender-based differences in symptom progression during trauma treatment, treatment attrition, effective interventions for secondary traumatic stress, and the implementation of evidence-based practices and trauma-informed care. Ms. Ascienzo completed her Master of Social Work degree from Colorado State University in 2005 and is currently a doctoral student in the College of Social Work here at the University of Kentucky.

LINKS & RESOURCES:

ACE Study – Adverse Childhood Experiences

https://www.cdc.gov/violenceprevention/acestudy/index.html

Kentucky’s Division of Behavioral Health – Trauma-Informed Care:

http://dbhdid.ky.gov/dbh/tic.aspx


TRANSCRIPT

Transcripts are created using a combination of speech recognition software and human transcription and may contain errors. Please check the full audio podcast in context before quoting in print.

 

Dr. Jones: [00:00:01] Today I’m joined by Sarah Ascienzo. Thank you so much for joining me.

Sarah : [00:00:05] My pleasure. It’s nice to be here.

Dr. Jones: [00:00:06] It’s really nice to meet you. I was saying before the we started here that I don’t really know you very well you’ve helped me. I really appreciate your help on some classes that we’ve taught together but I’m really interested to get to know you as a person and kind of your research interests so I want to make sure that I get this right. You are a doctoral candidate here in our college.

Sarah : [00:00:28] Correct.

Dr. Jones: [00:00:28] Where you are at in the program?

Sarah : [00:00:30] So I’m finished with my coursework and my preliminary exam is completed and my systematic literature reviews I’m I just began my dissertation phase.

Dr. Jones: [00:00:40] All right. Getting ready to write the book.

Sarah : [00:00:42] Yes.

Dr. Jones: [00:00:43] Good. So tell us a little bit about what brought you to social work. I think we all kind of have a bit of a story about what brings us into this profession what what drew you to social work?

Sarah : [00:00:58] Sure so I was a psychology major in undergrad and a women’s studies minor. And then when I graduated college I moved out to Wyoming and worked on a Native American reservation as part of Americorp. And I think through that experience primarily I really got in touch with issues around social justice. My women’s studies minor certainly helped. And so then when I was looking at furthering my education I thought I might always want to work as a clinician and a therapist. I enjoy kind of helping people in a smaller one on one type settings or group in family settings. But I really liked social work because of its emphasis on social justice so I would say that was the primary motivator for why I chose to go on to get my MSW and I would take kind of continues to be a big motivator and passion.

Dr. Jones: [00:01:54] So you practiced before as a as a clinician or you do practice now.

Sarah : [00:01:59] Both yes.

Dr. Jones: [00:02:00] As a therapist ok – working primarily with children?

Sarah : [00:02:03] Yes so I have worked primarily with children since I finished my MSW. But I would say in a family context so you know anytime you’re working with kids you’re working with parents or caregivers or foster providers so a lot of my work is done with families. There was a period where I really enjoyed working with young women like 18 to 24 year olds so I was seeing more of them. But now it’s primarily children and families.

Dr. Jones: [00:02:28] So that takes a special style I think. And I’ve figured out a long time ago as a therapist that I I really wasn’t very effective with small children. I see you know teens and older clients but I wonder for you in working with children. What is important to remember as a as a therapist? what do you need to really keep in mind as you’re working with that population of clients?

Sarah : [00:02:57] Oh that’s a good question. A lot of things I think but primarily that they’re a kid. So just developmentally what they’re capable of. I try. You know particularly when you’re working with young kids but even adolescents you know I think we take for granted a lot of the knowledge and the way we see the world. And so it’s easy to lose sight of what they’re literally capable of and not capable of understanding, perceiving and just, you know, trying to harness in some ways you know how does a 3 year old or a 5 year old or a 10 year old see the world and what’s their kind of lens that they see the world and then how can I meet them where they are to be able to communicate and try to work on whatever it is that brought them to me to kind of help or promote that healing process.

 

Dr. Jones: [00:03:45] Yes I would think your knowledge of development brain development social stages – that that’s really important.

Sarah : [00:03:55] Absolutely yes. All of that development socialization is hugely important and family and family roles and culture I think is huge. You know the way we grow up in our family systems and the cultures in which we exist and whether we’re talking about something like geographical area as a culture or we’re talking about ethnicity or race or gender or socioeconomic class etc.

Dr. Jones: [00:04:23] So this kind of brings us to our topic for today which is what you’re working on in your doctoral studies around “trauma informed care.” Can you tell us a little bit about what that means? That’s a very popular word these days and lots out there about it but what does it mean to be trauma informed when treating a client?

Sarah : [00:04:45] Yeah it’s definitely become a bit of a catch phrase but I think when I think about trauma informed care for me it’s a philosophy and a framework to approach work. And one of the reasons I really enjoy the framework is because it doesn’t talk about just me as a clinician in the way I approach the work but it approaches it from the larger organizational structure. So everyone from the receptionist to the person who greets clients and helps us with our keeping our setting clean everyone’s kind of trained in approaching the work in a way that appreciates everyone’s life experiences and how that may impact their behavior when we are interacting with them so that we can approach individuals in a way that maximizes their ability to have choice and control, trust with the system. And in a way that’s culturally competent.

Dr. Jones: [00:05:46] So what would be an example of that so if a kid comes in and is in his very angry very afraid begins to act out traditionally and I’m thinking about school settings you know they send that kid to detention – they ban them from school. So it sounds like what you’re talking about is more really trying to understand what what is deeper what’s behind the behavior? In that situation. Is that right?

Sarah : [00:06:17] Yeah absolutely. Yeah. So what’s causing them to act in the way what’s asking them what’s happened to them instead of you know what they did or what they did wrong oftentimes. So trying to kind of dig a little bit deeper to understand why they may be having the behaviors that they’re having. So with the example you just gave you know a child acting out in school. How might a teacher or support staff member approached that student in a way that kind of gives them some control over the situation and some choice but also helps to de-escalate the situation and help them to feel safe as opposed to, unintentionally of course, but you know escalating that situation or causing a power struggle.

Dr. Jones: [00:07:00] Which is really the worst thing to do right. I mean they’ve had enough power struggles in their lives and they’ve learned how to defend themselves and protect themselves right.

Sarah : [00:07:10] Yes absolutely.

Dr. Jones: [00:07:14] So tell us a little bit about your particular research. Where do you where do you see yourself taking the research that you’re doing?

Sarah : [00:07:22] Well I think one of the main motivators for me coming back to school I was in practice for close to 10 years before I decided to come back for my doctorate. And so a huge motivator was to be able to develop the skills to do research. I had a lot of questions from my clinical work that were many of them were answered in the literature some I were not. And I just wanted to delve a little bit deeper and be able to answer some of those questions so I would say, currently, my main interests revolve around looking at trauma informed interventions for kids and families and developing them I think right now that the field of trauma is at a point where we have a lot of empirically supported interventions that have some good research behind them that have shown to be effective with with children. But I think we’re getting to the point where we’re trying to better understand the mediators and moderators of treatment and what’s impacting treatment successes. And also, you know, helping treatment success isn’t just a decrease in a pathology from from baseline determination right it’s also an increase in functioning and the ability to kind of move through the world and adapt. So looking at you know there’s potential mediators and moderators and how we might need to modify treatments to better treat kids.

Dr. Jones: [00:08:46] So you know David Royse very well – Is he your chair of your committee or you’re involved with him?

Sarah : [00:08:52] Yes.

Dr. Jones: [00:08:52] He was my chair as well and I just I think he’s great. I just love that guy and you know a question he always asks me when I was doing my research was why did why does this matter. So you can do all the fancy regressions and do all that stuff but why are you doing it and who does it help? So I guess I would kind of ask you that question why should we even be concerned about trauma informed care as as a society as a profession?

Sarah : [00:09:22] Sure. Well I think for lots of reasons (laughs) but I think I have not met a human being yet who has not had some adverse experiences even the most privileged of us. So I think we’ve all been affected by trauma in some way shape or form at different levels. And so I think it speaks to human experiences that we might not always be able to prevent trauma from occurring. But we can certainly find ways to help kids in particular but also adults adapt and heal and move on from it. So why does it matter. Think it just you know it it helps the kind of human condition in a way and it helps kind of promote healing and finding really worthwhile ways to do that in really meaningful ways to help people understand, you know, that they’re worthy of moving through the world. And you know when we talk about trauma we talk about it primarily affecting systems of meaning. And you know how we see ourselves how we see the world and how we interact with others. And so helping individuals kind of develop really solid systems of meaning where they know that they are worthy and they’re worthy of having healthy relationships with other people and they’re you know they have a place in this world. I think I probably couldn’t think of something that matters more maybe.

Dr. Jones: [00:10:50] Yeah. I mean that’s kind of the heart of social work isn’t it is to help people heal and to function at the highest level that we can help them with and overcome some of the things that have happened to them or the systems that they’re in.

Sarah : [00:11:03] Yeah. And in a way I’d say that’s not overly paternalistic and that’s something I like about trauma informed care it’s not that top down approach where it’s I know what’s better for you or I know what’s best for you but really trying to collaborate with children and families to figure out like you know you know what’s best. So let me kind of help guide and facilitate that process a little bit so that it works for you not for what would work for me.

Dr. Jones: [00:11:29] Right. And it seems like it would have all kinds of implications for things like you know the criminal justice system mental health treatment all kinds of things if we can help people kind of heal and avoid those kinds of things in their life.

Sarah : [00:11:49] Oh absolutely. I mean I think there’s a plethora of research at this point that talks about when we have adverse childhood experiences like the ACE study for example in particular how that can set us on this trajectory where we are at higher risk for so many things like interactions with the criminal justice system physical health problems mental health problems. You know there is a laundry list of things. So any way we can interrupt that and get us back on a on a on a path that helps us to feel you know healthy and fulfilled.

Dr. Jones: [00:12:21] That’s great. So I want you. I’m going to give you a thought experiment.

Sarah : [00:12:26] Okay <laughs>

Dr. Jones: [00:12:26] You know we like to do that with our students right. A little thought experiment. Let’s say you’re at a conference and you’re presenting on something that you’ve done and Bill and Melinda Gates are there and they’re multi gazillionares you know and they come up to you and say this is really interesting work we’re going to give you a boatload of money to address this problem. What do you think you might do if you were just to kind of dream about a system or something that would address this problem that you’re talking about. What might that be?

Sarah : [00:13:05] So many things I think it’s hard to choose one. But I’ll tell you what kind of pops into my head initially I work. I’m not sure if I’ve mentioned this yet but I work with trauma as the umbrella. But I would say by and large the kids I’m working with have been affected by Child Maltreatment and that is a system of care that’s sorely underfunded and under-resourced. And I would say even in a bit of crisis perhaps. So I think my first go to would be helping to develop a stronger supports for child welfare so that they have the tools and the training and the resources they need to be able to do their their work training and that would include you know training for foster caregivers. And you know the whole kind of larger system and then I think I’d also want to of course funnel money into creating interventions for after trauma has occurred to help children heal and to help families heal, I should say. But another big piece of this is we know we can do so much with early childhood. And so I would say a big piece of that too would be creating programs that maybe we used to have but have been cut due to funding or just kind of strengthening those programs that we have. There’s a lot of good ones out there for early childhood. Or what they’re talking about you know support for pregnant mothers or we’re talking about early childhood – birth to age five we know that getting kids on that healthy trajectory early just means so much and has such an impact on their later development.

Dr. Jones: [00:14:48] Yes so linked isn’t it.

Sarah : [00:14:50] Yes.

Dr. Jones: [00:14:50] You know and that’s one of the things I love about social work is that we don’t see an issue like this in a vacuum. You know it’s so it’s so linked and so complex sometimes and generational.

Sarah : [00:15:03] Yes.

Dr. Jones: [00:15:04] Right. And if we can intervene if we can help break that cycle that’s so, that’s so powerful.

Sarah : [00:15:12] Absolutely. And when you said that I you know what occurred to me as I a big gaping hole that I left out of that is we know there’s such disparity around who gets affected by trauma. When we talk about culture when we talk about social economic class and even race and ethnicity and sexual orientation and all these issues of social justice, religion, that I would also say you know if we’re going to work on trauma we have to address some of the larger social inequalities that exist in our in our society.

Dr. Jones: [00:15:43] Absolutely. So here’s my final question for you. I ask this to all of my guests. Social work is a difficult profession and working with trauma and hearing trauma, reading about trauma listening to people’s stories about trauma is hard, I would think. It is for me as a therapist and so I wonder for you what do you do to take care of yourself?

Sarah : [00:16:12] Yeah I have learned the hard way. I will say how to be able to do this work and still live happy be happy and joyful. I mean you know we all have bad days but for the most part. And I will share briefly that you know when I first finished graduate school I was a forensic interviewer. So you’re hearing a litany of horrific things that have happened to kids day in and day out. And I think I thought I was prepared to do it and I was taking fairly good care of myself. You know I was doing whatever exercising trying to eat healthy the things that we tell ourselves we should do. But I was still it was affecting me and I think through going through that experience I really learned some things about myself and how I kind of hold this work and things I needed to do moving forward to be able to if I wanted to sustain it to be able to do it I it’s one of the things that actually prompted me to move more into therapy and less out of forensic work because I think we kind of find our niche where where we can sustain and or at least I did. And so I think there’s a couple of things that really help taking care of myself is important. Right. But it’s unfair to put all the impetus on clinicians or social workers to take care of themselves when you know and not put any impetus on the systems of care to also take care of their employees. So I think it’s also finding a healthy supportive agency or setting where you can work where you get the support and supervision and training that you need so that I feel comfortable and competent and if I have questions I know who I can go to to ask. And it’s also been a learning experience of knowing that, you know, this is what I can do and I’m going to do what I can do really good. I’m going to do what I can do the best. And then I’m going to have to relinquish some control over you know I’m not going to save the world. <laughs>

Dr. Jones: [00:18:09] Right

Sarah : [00:18:11] I’m going to do what I can do with this interaction right here and let that you know let the chips fall as they may. Kind of thing.

Dr. Jones: [00:18:19] Yeah. I think that’s great. I was doing some reading the other day about self-care for therapists. And one of the things that one of them was talking about was was in-between their clients kind of taking a circle I think she had like a brass circle or something in her office and just kind of holding that in her hand and thinking about all the other people in her client’s life who also were trying to help or you were the helpers.

Sarah : [00:18:47] Yeah.

Dr. Jones: [00:18:48] And she didn’t feel so alone and so isolated by the you know the magnitude of that person’s problems or just feeling so you know like what what can this 50 minute therapy session do with all of this so I thought that was really a neat way to think about how we were part of a system that is impacting people’s lives.

Sarah : [00:19:09] Yeah absolutely. That’s a really beautiful exercise. And I would say like you know my colleagues are – I’m hugely grateful to them for being you know for us supporting one another and having to be able to have conversations and process through things.

Dr. Jones: [00:19:22] Yeah that’s great. Well Sarah I want to thank you so much for talking with me today and I really appreciate you appreciate your work. And just the good that you’re doing in the world. Thanks for coming on.

Sarah : [00:19:34] Well thank you very much and ditto. So thank you guys for doing this.

Dr. Jones: [00:19:37] Sure thing.