GEPS Flowchart for the use of EMDR as an Intervention
EMDR guidance for working with CHILDREN
https://www.nice.org.uk/guidance/ng116/chapter/Recommendations#management-of-ptsd-in-children-young-people-and-adults
Dissociation as a defence against stress
Adaptive Information Processing Model – Theory underpinning EMDR and our response to trauma
The Body Keeps The Score – Theory linked to the focus on trauma intervention
Supervision Case Presentation
Suggested Process for Wellbeing / therapeutic Interventions:
All documents mentioned below have direct links, and are also on the next page in the blog
Here is a Flow Chart that outlines your decision points with regards thinking about a Wellbeing Intervention : EMDR-Flowchart
If you (or in SIIM / LC JST / LIG discussions) identify a child / young person that may be struggling with significant loss and change; have experienced a critical event, or from the description of concerns, indicate some level of Post-Traumatic stress (Arousal / Avoidance / Intrusion), then a Trauma informed Wellbeing intervention may be an option.
The rationale for a Trauma informed Wellbeing intervention is based on the fact that these changes / loss / trauma experiences may be impacting on the child’s ability to access education and learn. Our main role, as EP’s, is to support access to education and support attainment.
It may help to provide initial education about how we all respond to stress using the Accompanying Information: Understanding Trauma and ideas for Wellbeing Intervention
You may also signpost teachers / parents and Carers to the start of this blog
Once there is some level of understanding about the purpose of a Wellbeing Intervention you can then start gathering Pre-Intervention data Screening and Assessment Tools
This process and suggested Assessment tolls are not prescriptive and may also include the Glasgow Motivation and Wellbeing Profile (GMWP). (Download as a EXCEL doc)
This education about stress / trauma, and the subsequent gathering of data, IS a Wellbeing Intervention in itself and may help alleviate the need for any further specific intervention.
Hopefully with the education provided, and use of the Screenings measures, the child/ young person / family can realise that:
“It’s not what is wrong with this child, but what has happened to them.”
Consequently, there may not be anything we can ‘do’ about what has happened but we ‘CAN do’ something about how we take control and choose how we are going to respond and manage what has happened. (Significant Change and Loss – ‘trauma’ – often keeps children stuck in the present and pre – occupied with the past. This allows for some thought about here and now and then shifts to the Future and how this may become different).
The Pre screening measures are In this folder Screening and Assessment Tools
The Lifetime Incident of Traumatic Events (LITE) 1-LITE-for-Child potentially reduces Isolation – It is an International Questionnaire and allows children to see that this ‘stuff’ does happen to children everywhere, and that they are NOT alone in this and that we Do want to hear about what has happened to them. Here is the document for Parents: LITE-for-Parent-Carers
The isolation they may be feeling is the biggest risk for potentially developing mental health difficulties and becoming a suicide risk. This is the ASSIST rationale for asking: “Are things so bad that you may be thinking of killing yourself?”
This process of asking ‘What has happened to you?’ increases a sense of Connectedness (the biggest protective factor in mental wellbeing) and then links these events to how the child / young person is currently feeling and behaving.
CROPS for Child (Child Report of Post Traumatic Symptoms) is completed (literally) alongside the LITE and the link made explicit. In other words, if you have bad stuff happen (LITE) – it may affect you in these ways (CROPS).
The Understanding Trauma and ideas for Wellbeing Intervention then also provided ideas of what the child / young person CAN then DO to help themselves – links to CHOICE / CONTROL in the face of events over which they have had little or no control. You can also direct them to the earlier pages in the blog.
If there is a particular event that the child can identify (possibly from the LITE) that in their view is the most distressing, then you can use the Impact of Event Scale .(IES) Once scored this will give an idea of the extent of ‘Arousal’ – ‘Intrusion’ and ‘Avoidance’. Use the results from the Intrusion and Avoidance scales only. If the sum of the scores on these two scales is 17 or more, then the probability is very high that that child has got Post Traumatic Stress at a clinically significant level and if left may develop into a Post Traumatic Stress Disorder.) In other words, if you have bad stuff happen (LITE) – it may affect you in these ways (CROPS) to the extent you have Post traumatic stress symptoms (IES). The information from the IES can also help you and the young person better understand the CROPS and indicate ways to respond.
In working with the family / child/ young person, it is recommended that you actually lay out the documents below on a table in this order. This helps with visually and practically make the connection between the documents and it shows the process – from left to right – that we are following.
| Education about Understanding Trauma and ideas for Wellbeing Intervention
LITE for Child– What has happened to you?
You can then can see differences / similarities – people ‘forget’
|
CROPS for Child This shows the Impact of LITE on feelings and Behaviour.
PROPS for Parent Carers Helps parents / carers understand the link to LITE
Possible use of IES Impact of Event Scale and Scoring Can also use GCC-GMWP-MASTER-DATA-ANALYSIS1
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What You / We Can Do about this:
Education Understanding Trauma and ideas for Wellbeing Intervention 2 Then Safe Place – acb animations.
Wellbeing Interventions
Then also potentially EMDR or CBA
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Post Intervention – to see if we have made a difference? Session Rating scale. Post Session and Outcome Rating scale Measure Impact – SUDs reduction.
Post CROPS – Linked to PROPS (Impact of Events Scale) Post GMWP
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The kind of Wellbeing / therapeutic intervention is determined in consultation with the child / young person / family and based on the Educational Psychologist’s training and experience.
An additional intervention may involve EMDR / CBA – specifically if there are indications of elevated levels of Arousal – Intrusion and Avoidance. Please discuss with trained colleagues. See EMDR-Flowchart
Post-Screening Measures are completed after the Wellbeing / therapeutic Intervention. (CROPs and PROPS then Impact of Events if used and the Session / Outcome rating scale). GMWP as a potential post measure.
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