TBRI^® is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children. TBRI^® uses Empowering Principles to address physical needs, Connecting Principles for attachment needs, and Correcting Principles to disarm fear-based behaviors. While the intervention is based on years of attachment, sensory processing, and neuroscience research, the heartbeat of TBRI^® is connection. (copied from KARYN PURVIS INSTITUTE OF CHILD DEVELOPMENT https://child.tcu.edu/about-us/tbri/#sthash.0FHKWiIv.dpbs )

TBRI is a particularly great resource for training parents and teachers in developing relationship building skills. The knowledge of its principles forms a foundation on wich to build

The whole style of the school is play, so it is natural that we would include play. Play therapy is a common form of therapy for younger children and as such, it may be easier to recruit therapists with this skill. I imagine these professionals as team teachers in classrooms for lower grades.

Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to the developmental and later also their mental health needs. It is also used for forensic or psychological assessment purposes where the individual is too young or too traumatised to give a verbal account of adverse, abusive or potentially criminal circumstances in their life.

Play therapy is extensively acknowledged by specialists as an effective intervention in complementing children's personal and inter-personal development. Play and play therapy are generally employed with children aged six months through late adolescence and young adulthood. They provide a contained way for them to express their experiences and feelings through an imaginative self-expressive process in the context of a trusted relationship with the care giver or therapist.^[1] As children's and young people's experiences and knowledge are typically communicated through play, it is an essential vehicle for personality and social development.

In recent years, play therapists in the western hemisphere, as a body of health professionals, are usually members or affiliates of professional training institutions and tend to be subject to codes of ethical practice.

(copied from https://en.wikipedia.org/wiki/Play_therapy)

The use of rhythm, tone, pitch and volume all touch us at a biological, emotional and cognitive level. Music, especially music and dance integrates the "bottom up", the "top down", and even the left to right regions of the brain. Music reorders, restores and regulates our nervous systems. We get to come into community with those we create music with. We connect on a level that cannot be achieved in many other ways. I see music being used in a variety of ways in a therapeutic environment. It can be used to mark the time of day, to celebrate together, to connect and to create identity.

An important element of the therapeutic school that I envision would be the use of Occupational Therapy (OT). I would hope for two or three OT rooms, one being a larger space, visible from other spaces so as to be inviting, for families and class groups to be able to enjoy collaborative play, and for the development of attachment and social skills. The other rooms would be reserved for private individual and family sessions. Here I share two links that demonstrate how OT has been adapted for this population. This is a bottom-up therapy.

1. Here in a Robyn Gobbel podcast, we hear about principles that govern the integration of OT and trauma therapy. https://robyngobbel.com/occupationaltherapy/

2. SAFE PLACE provides a therapeutic framework for service providers and parents/guardians which emphasizes development of body-based regulatory and adaptive functions with co-regulation and intersubjective experiences, deepening of attachment bonds and security, and processing and healing of traumatic experiences in the context of a sensory integration intervention process. Based on the work of Jane Koomar, PhD, OTR/L, FAOTA and Daniel Hughes, PhD, the term “SAFE” in this model of care reflects the sensory component of the model and means Sensory Attunement-Focused Environment, representing the use of safe, supportive, developmentally appropriate, sensorimotor activities and environments that promote play and fun in children’s physical and emotional development. (https://www.otawatertown.com/safe-place-2/)

Much could be said about the power of art to heal. I envision using the arts in a fully integrated and holistic way. From a literature based reading curriculum that incorporates powerful stories to multiple opportunities to produce art. These activities help children to form trauma narratives that draw on a collection of resources, re-framing the stories into traumatic wisdom. Participating in these activities normalizes the experiences they are having and brings families into communities. These activities are attractive to students and offer a doorway into other therapies.

Mindfulness is not so much a therapy but an approach to life. Mindfulness concepts can be integrated easily into the educational aspects of the school day and taught explicitly to students in individual and group settings. It is usually included in the other therapies but deserves mentioning here for its ability to permeate all the therapeutic and educational endeavors of the school.

Mindfulness involves meta-cognition or thinking about thinking. It involves an awareness of self and others.

I like this model for its involvment of the whole family and the emphasis on relationship repair and attachment. From the introduction to Daniel Hughes book we find:

Over fifty years ago, John Bowlby and Mary Ainsworth's research on the developmental psychology of children formed the basic tenets of attachment theory. And for years, following these tenets, the theory's focus has been on how children develop vis-á-vis the attachments--whether secure or insecure--they form with their caregivers. In the therapy room, this has meant working with individuals one-on-one, with the therapist assuming the role of the attachment figure in order to provide a secure base for treating clients' problems that arose from troubled interpersonal relationships in childhood. Here, Daniel A. Hughes, an eminent clinician and attachment specialist, is the first to expand this traditional model, applying attachment theory to a family therapy setting. Drawing on more than 20 years of clinical experience, Hughes presents his comprehensive, effective, and accessible treatment model for working with all members of a family--not simply the individual in question--to recognize, resolve, and heal personal and family problems using principles from theories of attachment and intersubjectivity. Beginning with an overview of attachment and intersubjectivity--the twin theories from which he forms his treatment plan--Hughes carefully outlines, chapter by chapter, the core principles and strategies of his family-based approach. He elaborates on the need to develop and maintain PACE (playfulness, acceptance, curiosity, and empathy)--the central therapeutic stance of attachment-focused family therapy--and supplies tips and sample dialogues for implementing this position. The importance of fostering affective/reflective (a/r) dialogue is covered in detail, as well as helping families to manage shame, understand and embrace the break-and-repair cycle of their interactions, and explore and resolve childhood trauma. Also discussed are the more procedural issues of how to incorporate parents into therapeutic conversations, when and how to question them on their own attachment histories, and how to "be" with children. Grounded in the fundamental principle of parents facilitating the healthy emotional development of their children, Attachment-focused Family Therapy is the first book of its kind to offer therapists a complete manual for using attachment therapy with families. Extensive case studies, vignettes, and sample dialogues throughout clearly demonstrate how Hughes's model plays out in the therapy room. By showing therapists how to create a bond of psychological safety and intersubjective discovery with parents and caregivers, Hughes reveals how they, in turn, can bring about similar experiences of safety and discovery for their children. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Hughes, D. A. (2007). Attachment-focused family therapy. W W Norton & Co.

https://psycnet.apa.org/record/2007-08306-000

This bottom-up modality offers a promising solution for children and their parents. In our setting, we could utilize the smaller Occupational Therapy rooms for this purpose. From the website for Somatic Experiencing International we learn that;

Somatic Experiencing (SE) is a body-oriented therapeutic model applied in multiple professions and professional settings—psychotherapy, medicine, coaching, teaching, and physical therapy—for healing trauma and other stress disorders. It is based on a multidisciplinary intersection of physiology, psychology, ethology, biology, neuroscience, indigenous healing practices, and medical biophysics and has been clinically applied for more than four decades. It is the life’s work of Dr. Peter A. Levine. The SE approach releases traumatic shock, which is key to transforming PTSD and the wounds of emotional and early developmental attachment trauma. It offers a framework to assess where a person is “stuck” in the fight, flight or freeze responses and provides clinical tools to resolve these fixated physiological states. SE provides effective skills appropriate to a variety of healing professions including mental health, medicine, physical and occupational therapies, bodywork, addiction treatment, first response, education, and others. (https://somatictrauma.wpenginepowered.com/wp-content/uploads/2022/03/SEI-MEDIA-KIT-rev-March-2022.pdf)

CBT is a gold standard for therapy in general. For this day treatment center, I believe it will be the most useful for parents, teachers, older children and teens. CBT is a "top-down" cognitive talk therapy and as such, may not be as useful for highly dysregulated children. Trauma- Focused CBT is more specific to this population but is still a "top-down" therapy requiring the use of cortical processes. Having a balance of "top-down" and "bottom-up" (referring to neurological brain processes) approaches is an important component of this day treatment plan. I envision moving from one type of treatment to another as the child matures, showing interest and motivation. From Trauma-Focused Cognitive Behavioral Therapy National Therapist Certification Program website we find;

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment for children and adolescents impacted by trauma and their parents or caregivers. Research shows that TF-CBT successfully resolves a broad array of emotional and behavioral difficulties associated with single, multiple and complex trauma experiences. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) was developed by Drs. Anthony Mannarino, Judith Cohen and Esther Deblinger. TF-CBT is an evidence-based treatment that has been evaluated and refined during the past 25 years to help children and adolescents recover after trauma. Currently, 21 randomized controlled trials have been conducted in the U.S., Europe and Africa, comparing TF-CBT to other active treatment conditions. All of these studies have documented that TF-CBT was superior for improving children’s trauma symptoms and responses. TF-CBT is a structured, short-term treatment model that effectively improves a range of trauma-related outcomes in 8-25 sessions with the child/adolescent and caregiver. Although TF-CBT is highly effective at improving youth posttraumatic stress disorder (PTSD) symptoms and diagnosis, a PTSD diagnosis is not required in order to receive this treatment. TF-CBT also effectively addresses many other trauma impacts, including affective (e.g., depressive, anxiety), cognitive and behavioral problems, as well as improving the participating parent’s or caregiver’s personal distress about the child’s traumatic experience, effective parenting skills, and supportive interactions with the child.(https://tfcbt.org/)

DBT is also a "top down" therapy. As you can see from the video, it has valuable application for youth who have had adverse childhood experiences. From VeryWell mind we learn:

Dialectical behavior therapy (DBT) is a modified type of cognitive behavioral therapy (CBT). Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.¹

DBT was originally intended to treat borderline personality disorder (BPD), but it has been adapted to treat other mental health conditions. It can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors (such as eating disorders and substance use disorders).² This type of therapy is also sometimes used to treat post-traumatic stress disorder (PTSD).

(https://www.verywellmind.com/dialectical-behavior-therapy-1067402 )

This is also a top-down therapy useful for those ready to engage in this powerful therapy. This is a therapy that I have been privileged to witness and found interesting. It requires the student to have a creative and open way of thinking and is one that students and parents can become ready to engage in over time.

From the website VeryWellMind I learned that, Internal Family Systems, or IFS, is a type of therapy that believes we are all made up of several parts or sub-personalities. The founder, Dr. Richard Schwartz, thought of the mind as an inner family and began applying techniques to individuals that he usually used with families.

The underlying concept of this theory is that we all have several parts living within us that fulfill both healthy and unhealthy roles. Life events or trauma, however, can force us out of those healthy roles into extreme roles. The good news is that these internal roles are not static and can change with time and work. The goal of IFS therapy is to find your Self and bring all of these parts together. https://www.verywellmind.com/what-is-ifs-therapy-internal-family-systems-therapy-5195336

The Neurosequential Model is a developmentally-informed, biologically-respectful approach to working with at-risk children.

The Neurosequential Model is not a specific therapeutic technique or intervention; it is a way to organize a child’s history and current functioning. The goal of this approach is to structure assessment of a child, the articulation of the primary problems, identification of key strengths and the application of interventions (educational, enrichment and therapeutic) in a way that will help family, educators, therapists and related professionals best meet the needs of the child. (neurosequential.com)

https://www.neurosequential.com/

I am curious about this model to use for tracking the developmental progress of the students. It comes from the work of Dr. Bruce Perry. Other concepts we learn from Dr. Perry are also useful for understanding trauma.