I Feel Better Now! Intervention Program

I Feel Better Now! TRAUMA INTERVENTION PROGRAM

William Steele, PsyD, MSW Pamela Lemerand, PhD Deanne Ginns-Gruenberg, MA Caelan Soma, PsyD, LMSW

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I Feel Better Now! Manual

William Steele, PsyD, MSW Caelan Soma, PsyD, LMSW Pamela Lemerand, PhD Deanne Ginns-Gruenberg, MA, BSN, LLP, RPT-S

13725 Starr Commonwealth Road, Albion, MI 49224 www.starr.org | info@starr.org

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Starr Commonwealth’s professional training and consultation arm emerges from the vision that: knowledge + empowerment = impact.

Starr provides guidance and expertise to “helpers” from around the world in the form of research, publications, e-learning courses, in-person trainings, conferences and events, professional certifications, as well as school/agency-wide accreditation. These products and services are offered through Starr’s three key training programs: The National Institute for Trauma and Loss in Children (TLC), Reclaiming Youth International (RYI), and Glasswing (GW).

Starr’s proven SITCAP® (Structured Sensory Interventions for Traumatized Children, Adolescents and Parents) model was pioneered by internationally recognized experts and is centered on the concept that changing behavior isn’t possible until you change the sensory memories that fuel that behavior. SITCAP® provides a powerful framework for helping those who have been traumatized engage in program activities to allow them to experience themselves as safe and empowered. They will no longer be victims but survivors and thrivers, ready to flourish. They will experience themselves differently and thereafter view their experience in ways that are manageable.

Developed and used since 1990 and field-tested in schools and community agencies, SITCAP® is supported by the latest scientific advances in brain science and has been featured in leading journals and numerous books on childhood trauma.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form without the prior written consent of Starr Commonwealth.

This publication is intended as a general guide. It covers what can be highly technical and complex subjects and is sold as is, without warranty of any kind either expressed or implied respecting the contents of this publication. Starr Commonwealth shall not be liable to the purchaser or any other person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by this publication.

NOTICE TO NON-PROFESSIONALS: The information contained in this book is not intended as a substitute for consultation with health care professionals.

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About the Authors William Steele, MSW, PsyD founded The National Institute for Trauma and Loss in Children in the early 1990’s. He has developed, published and produced numerous books, articles, trauma-specific intervention programs and resource materials. He has trained well over 40,000 professionals. After the Gulf War he was one of the first Americans selected by the Kuwait government to provide trauma intervention training for their newly formed mental health staff. Whether in the aftermath of the bombing of the Federal Building in Oklahoma, the tragedy of 9/11, the ravages of the tsunami, the devastation of Hurricanes Katrina and Rita, or the critical incidents that occur in schools and communities, Dr. Steele’s programs and resources are helping thousands of children, families and professionals every day.

Pamela Lemerand, PhD, received her Educational Psychology degree from the University of Michigan and a Masters degree in Human Development and Family Relations from Wayne State University. She is currently the coordinator of a district-wide student assistance program. With a strong background in early elementary and pre-school, she is the author of numerous articles and the program, Student Assistance Family Education Program: A Comprehensive Elementary School Student Assistance Model, The Johnson Institute, Minneapolis, 1993.

Deanne Ginns-Gruenberg, MA, BSN, LLP, RPT-S, is a nurse, a limited license psychologist and registered play therapist supervisor in private practice. A former Peace Corps nurse in South America, she was awarded Nurse of the Year, 1993 at the nationally recognized Children's Hospital of Detroit. Her work with traumatized children over the past twenty years in hospital, school, and clinical settings motivated her to open the Self Esteem Shop. Today it enjoys a national reputation among professionals as having one of the most comprehensive selections of books dealing with issues facing children today.

Caelan Soma (formerly Kuban), PsyD, LMSW is the Chief Clinical Officer for Starr Commonwealth. She provides oversight for all clinical operations and research at Starr Commonwealth.Dr. Soma provides trauma assessment and trauma-informed, resilience-focused intervention for youth utilizing evidence-based practices, including Starr’s SITCAP® model programs. She has been involved in helping with the aftermath of disasters such as Sandy Hook, Hurricanes Katrina and Rita and others. She is has authored several books, the most recent, 10 Steps to Create a Trauma-Informed School and Healing the Experience of Trauma: A Path to Resilience. She is an internationally acclaimed speaker and trainer. She received her doctorate in clinical psychology at California Southern University, where she received the 2013 CalSouthern President’s Award.

Additional Consultants and Contributors Melanie Steele, MA worked as a Bereavement Counselor and has over thirty years of experience working with children individually and in group settings.

Linda Pallos, MEd, NC is a former Special Education teacher and Learning Specialist providing loss, grief, and trauma management for children.

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Special Thanks The following foundations and corporations have made this program possible. The children who benefit will thank you for bringing them this opportunity.

Blue Cross/Blue Shield The Colina Foundation The Earl Beth Foundation The Whitney Foundation The Young Woman's Association The York Children's Foundation

The authors wish to express their appreciation to Michael Horwitz, ACSW, past Executive Director of the Children's Home of Detroit, who provided the opportunity to prepare this program.

An additional number of school and agency professionals played a critical role in shaping, revising, and finalizing the program so that it fulfills:

• the requirements of conducting such a program in a school, community, or agency setting.

• the needs of facilitators for structured, well detailed descriptions of step by step activities, multi-media approaches, specification of potential problem areas, and the rationale behind the importance of different program activities.

• the special needs of traumatized children.

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And Thanks To...

We thank the following for the tremendous amount of time they invested in field-testing this project, and for their many suggestions and overall support: Audrey Bauza Diane Cassady Beverly Curtis Kay Dyer Shirley Farnsworth Bruce Ford Patricia Garbacz Denna Groth Jan Hinton Lynn Hunt Jacque Jacobs Lynne Krajenke Jacqueline Liguzenski Kathleen LaPorte Peggy Maycock Becky Morr Dorris Paille Mariann Piro-Lupinacci Betsy Quick Ann Roemer Peggy Schneider Linda Sherman Kelly Thomas Susan Wilk Colleen Williams Gary Zey

Plymouth-Canton Schools Hamtramck Schools Children's Home of Detroit Taylor Public Schools Lake Shore Schools Flint YMCA Lakeshore Public Schools Livonia Public Schools Evergreen Counseling Services Livingston County CMH Independent Behavior Consultant Evergreen Counseling Services Wyandotte Public Schools Lakeshore Public Schools Children’s Home of Detroit Livonia Public Schools Lakeview Public Schools Redford Union Schools Taylor Public Schools Redford Union Schools Plymouth-Canton Schools Plymouth-Canton Schools Southgate Schools Wayne Westland Community Schools Flint YMCA Lakeview Public Schools

A special thank you to the school social workers at the Taylor School District, and the Guidance Center in Southgate, Michigan, for their hard work and dedication to making this the first evidenced-based trauma intervention program study of it’s kind.

Our final thanks goes to Mr. Thomas Kage, consultant at Wayne County Regional Educational Services Agency. He was responsible for getting the word out, taking care of meeting accommodations, for training, and follow-up activities.

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What the Experts Have Said About I Feel Better Now! "...definitely helps traumatized children in a concrete and supportive way."

Peggy Schneider, MA – Elementary Counselor "...most beneficial and needed program for traumatized children.”

Jan Hinton, MA, LPC – Psychologist "Extremely versatile and adaptable to the different kinds of trauma that children experience."

Lynne Krajenke, ASCW – Clinical Therapist "I will be using this program again and again."

Lynn Hunt – Clinical Social Worker "...invaluable in helping children verbalize their painful losses."

Donna Groth, MSW – SchooL Social Worker "...easy to use and very beneficial to me in my work with traumatized children."

Shirley Farnsworth, MA – School Psychologist "One parent wrote a letter of appreciation for the program to our Board of Education and School Superintendent."

Gary Zey, MA – Elementary Counselor "...wonderful opportunity for children to resolve issues they have had to bury within themselves."

Dorris Paille, M.Ed – Elementary Counselor "Well organized, easy to follow, easy to implement, wonderful materials."

Audrey Bauza, M.Ed – Elementary Counselor

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Table of Contents Part One: The Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Part Two: The Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Part Three: The Format. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Part Four: The Facilitator. . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Part Five: Facilitator Instructions . . . . . . . . . . . . . . . . . . . . . 21 Session One - Group Intake Assessment. . . . . . . . . . . . . . . . .25 (session with parents and children) OPTIONAL - Debriefing Sessions Debriefing Session with Individual Child ONLY . . . . . . . . 31 Session with Parent ONLY (after Debriefing Session) . . . . 37 Session with Parent and Child (after Session w/Parent) . . . 41 Session Two - This Is Me (group session) . . . . . . . . . . . . . . . 45 Session Three - Safety and Worry (group session). . . . . . . . . . 49 Session Four - Hurt and Fear (group session) . . . . . . . . . . . . . 55 Session Five - Anger (group session) . . . . . . . . . . . . . . . . . . 61 Session Six - Memories and Fun Wish (group session). . . . . . . 67 Session Seven - You Are Not Alone (group session) . . . . . . . . .71 Session Eight - Goodbye and I Am a Survivor . . . . . . . . . . . . . 75 (group session) OPTIONAL - Parent and Child Final Session Final Session with Parent and Child . . . . . . . . . . . . . . . . 79 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

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Part One

The Need The Words of a Child Tell It All In 1994, the CBS program, 60 Minutes, covered a children's group that was formed at a Los Angeles elementary school because so many children had witnessed violent deaths. The group met for twelve weeks.

One of the boys, a nine year old, who had witnessed his uncle run over his mother in his car and kill her, described one of his drawings to correspondent Morley Safer. At one point the boy said, "I feel better now." When Morley Safer responded with "Why do you feel better now?" he said, with obvious simplicity, “Because I'm in the group."

Traumatized children need: 1) To know they are not alone with their terror and grief.

2) To hear the stories and see the reactions of peers also traumatized by either a violent or non-violent yet traumatic death.

3) The opportunity to express their terror, fear, sadness, and even yearning to have their loved one back.

4) A vehicle which allows them to express these feelings safely in a format which comes far more naturally and innately than questions like "How do you feel?" or "How mad are you about what happened?"

5) To be educated as to the normalcy of their reactions as well as to reactions they might yet experience as a result of their trauma.

6) The opportunity to re-attach emotionally to the adult world which they often perceive to have betrayed them by letting this happen.

7) To have trauma-specific attention needed to help them find relief from their terror and develop a sense of power over that terror.

8) To replace the terror and the sadness with happy memories.

I Feel Better Now! is a group program is designed to meet these needs. Š Starr Commonwealth 1998

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Terror On Top of Grief Trauma reactions are different from, and in addition to, grief reactions.

Only recently has it been verified that children are vulnerable to experiencing posttraumatic stress disorder (PTSD), a disorder once attributed to only adult survivors of war.

The one word that best describes grief is sadness; the one word that best describes trauma is terror. Terror induces reactions not often seen in children who are grieving. These reactions can include: • Having trouble sleeping, being afraid to sleep alone or be left alone even for short periods of time.

• Being easily startled (terrorized) by- sounds, sights, smells similar to those that existed at the time of of the event - a car backfiring may sound like the gun shot that killed someone. For one child, his dog pouncing down the stairs brought back the sound of his father falling down the stairs and dying.

• Becoming hypervigilant - forever watching out for and anticipating that they are about to be or are in danger.

• Seeking safety spots in their environment, in whatever room they may be in at the time. Children who sleep on the floor instead of in their bed after a trauma do so because they fear the comfort of a bed will let them sleep so hard they won't hear the danger coming.

• Becoming irritable, aggressive, acting tough, provoking fights.

• Verbalizing a desire for revenge.

• Acting as if they are no longer afraid of anything or anyone (and in the face of danger, responding inappropriately) verbalizing that nothing ever scares them anymore.

• Forgetting recently acquired skills.

• Returning to behaviors they had previously stopped i.e. bed wetting, nail biting, or developing disturbing behaviors such as stuttering.

• Withdrawing and wanting less to do with their friends.

• Developing headaches, stomach problems, fatigue, and other ailments

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not previously present.

• Becoming accident prone, taking risks they had previously avoided, putting themselves in life threatening situations, reenacting the event as a victim or a hero.

• Developing school problems including a drop in grades and difficulty concentrating.

• Developing a pessimistic view of the future, losing their resilience to overcome additional difficulties, losing hope, losing their passion to survive, play, and enjoy life.

While these changes are not unusual, they often go unnoticed or fail to bring a helping response from adults. These changes can and do become permanent when the child does not receive appropriate help. Often children suffer silently for years with their terror until one or several of these changes become so intense and problematic that someone says something.

Unfortunately, years later few people are likely to associate these reactions to the child's earlier trauma. The help given often misses the mark. This further increases the child's sense of helplessness and failure.

Trauma - Not Just an Outcome of Violence The epidemic of suicide among children in the 80's taught us to look at children differently, to understand their vulnerability, to de-myth the notion that children are resilient and protected from feeling over-whelmed, suicidal, hopeless or helpless.

The epidemic among children today is violence. Exposure to violence has stripped away yet another layer of a once serene, happy view of life to reveal a clearer look at the unprotected, unsophisticated, poorly limited coping skills of children when exposed to the sudden loss of a parent, sibling, friend, or peer. When that loss is accompanied by violence or by elements which are usually too graphic for any child to see or fantasize, the trauma induces terror.

A child's brother or sister is murdered; as a witness, they will be trauma-

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tized. But even when they are not a witness, fantasies about what happened can be as traumatic. A child who is a survivor of a car crash that kills one of the passengers will be traumatized. A child who watches his trailer home melt under intense fire while hearing the screams of his family trapped inside will be traumatized. A child who does not witness but has his best friend die in a fire can be traumatized by his own images and fantasies of what happened. A child whose parents go through a tumultuous divorce can also be traumatized by his loss and the fear of what is to come.

Children Can Be Traumatized 1) By violent or non-violent incidents as surviving victims, for example, of physical abuse.

2) As witnesses to traumatic events such as domestic violence, house fire, car accidents, drowning, or critical injury.

3) Because of a tumultuous divorce, separation from a parent or terminal illness.

4) Because they are neither victims nor witnesses but simply related to the victim as a loved one, peer, or friend.

When traumatized, not only do they experience grief as a reaction to their loss, but also terror which induces PTSD reaction. These trauma reactions frequently go unrecognized and unattended.

When Left Unattended, What They See is Not Good When left unattended, a child's view of themself and their world becomes critically damaged - distorted, weakened, and fragile; too fragile to grow up healthy.

Let's look at how a happy, non-traumatized child sees herself. On the next page Figure 1 is a happy, non-traumatized four-year-old's drawing of herself. We see a child who is happy and has a personality. Her picture is strong and well defined. This is how she looks at herself and her world.

What happens to a happy child who has been traumatized? On the lower

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right Figure 2 is a self portrait drawn by another four-year-old. This child witnessed the rape of her mother. Notice how weak her drawing is when we compare it to that of the non-traumatized child. There are no definitive legs, feet, or hands. Without legs and feet she can't run, can't stand her ground. Without hands she can't fight back or reach out and grab on.

It is almost as if the child is malformed, incomplete. The eyes are hollow as if life has been stolen from them or what she sees in her world is too awful to look at. This is a traumatized child. As an adult it is so much easier to believe that children are safe, that they are

Figure 1

immune to overwhelming terror. However, we know that what they draw is what they see and how they feel. We also know that sometimes we can look at children from the outside and they seem to look as if they are doing okay. But for the child on the inside looking out, the picture can be quite different.

A child exposed to violence, such as a witness to murder, assault, domestic violence, is likely to be traumatized. Yet an event does not need to be violent to leave a child traumatized.

Figure 2

On the following page Figure 3 is a drawing by a four-year-old child following the divorce of his parents. Not every divorce will leave a child traumatized, yet many do.

The loss of a parent, the fear or terror of future possible losses, the parents’ behavior during or after the divorce can leave a child terrorized.

We see remarkable similarities in these last two children's drawings

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because of the terror they experienced; one because of witnessing such a violent event, the other because of losing a parent.

Children are Vulnerable When asked, children may say they are fine. Or, they may never verbally bring up the traumatic event or their reactions, leaving adults to believe the child is not thinking about it or bothered by any of their reactions to it. These adults then believe they shouldn't bring it up lest they make Figure 3

them remember. This avoidance can further trau-

matize the child.

Often many parents, as well as professionals in the position to help traumatized children, fail to recognize that children are vulnerable to the kinds of posttraumatic stress once attributed only to adult survivors of war. Many still believe that children are too young, too unknowing to be seriously affected. Many minimize the reactions of children and believe they'll grow out of it. Others simply do not know what to look for or fail to recognize changes in the child as symptoms of posttraumatic stress.

I Feel Better Now! offers structured activities to give traumatized children, as well as their parents, the education needed and the opportunity to come to terms with their terror - to move from the status of victim to that of survivor.

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Part Two

The Structure The Reason for Structure When we are fearful of some perceived or real threat, what do we want?

When we feel as if we are losing control, what do we want? When we are so anxious we can’t think straight, what do we want? When we are feeling overwhelmed, what do we want? What we want and desperately need is for someone to prepare us for what might happen next. At a more basic level, we do not want more surprises or anything new to deal with on top of everything else.

Imagine yourself as a parent in crisis, feeling confused, overwhelmed, and fearful of losing control. It has been suggested that you seek professional help. You have never had counseling before, but you agree to an appointment. That decision has now presented you with an entirely new set of unknowns that further intensify your anxiety. When you walk through that counselor’s door and first sit down, what is going to be the most helpful, most comforting introduction that the counselor can provide? Will it be a brief greeting and then the question, “So tell me what brings you here?”

No, this does not lower anxiety.

In a crisis state what we need is structured information so that we can feel somewhat prepared for what we are about to do or for what is about to be done to us. By structuring the intervention process, you can reduce the parent’s anxiety and also establish yourself as a sensitive intervenor who respects the parent’s right to know what they are about to receive from you.

It can return a level of control to the parent. It can remove many of the unknowns and myths that parents generally have about counselors and therapists, and allow them to begin to focus on, and even anticipate, an early resolution. With anxiety levels reduced, parents can focus their ener-

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gies on resolving the crisis.

Why this Approach is Encouraged It has been our experience that counselors and helping professionals in general find this process difficult to implement. This is partially due to training that tends to ignore or shy away from such a direct approach. It is also partially due to the helper’s anxiety that discussing such issues before moving into the problem areas, given the emotional state of the client, is often too much for family members in crisis to manage. The fact is that this structuring helps the parent to better manage their emotions, and so we strongly encourage its practice as a valid intervention strategy.

This kind of structuring may seem like more than enough, but family members really appreciate and respect the information and preparation. Rarely are those in crisis told what is about to happen by intervenors, whether they be counselors or physicians. Nor are clients usually empowered by counselors as to their participation in the counseling process, or communicated to with such directness about the expected length of counseling, the possible outcomes, their role as it relates to interactions with the intervenor, or the reassurance available should the process not work as planned. For these reasons we strongly encourage the use of this structuring process.

Domestic Violence and Other Violent Situations When Intervention is Attempted Immediately In domestic violence situations or sexual abuse, family intervention is immediate. In most cases the primary interviewers are police and child welfare workers whose purpose is to secure the safety of all involved, as well as collect evidence for prosecution.

In Ohio, the Children Who Witness Violence Program has a unique relationship with police which allows the staff of Children Who Witness Violence to begin immediate intervention. The purpose of this team is to provide crisis intervention, assessment and referral services. Staff are trained in trauma recognition/intervention, as well as crisis intervention. Over a period of three

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visits the opportunity is provided to educate the parent as to the impact that violence has had on the child, and to help the parent with their own reactions and victimization. Obviously some intervention flexibility is needed during this critical period, yet information provided by the team about their expectations remain critical to stabilization and follow-through by the parent.

In listening to the experiences of the professionals involved in this intervention, it was brought out that often, while interviewing the children, the parents would be in another room with one of the staff, but overhear their child tell about his reactions and how the violent incident impacted him.

Starr emphasizes that giving the child an opportunity to make us a witness to his experiences is a necessary component of recovery. These parents indirectly were being made witnesses. The result of even this indirect witnessing motivates some parents to be more responsive to the team recommendations.

If you, as a professional, are in a position of being involved with the family the day of, or two to three days following the incident, the generic statements provided will help to give the parent the structure needed to reduce their anxiety and help make them more amicable to your recommendations.

NOTE: We strongly recommend that you find a way to make the parent a witness to how domestic violence has impacted the child. In our structured intervention process this takes place in the seventh session. For emergency intervention as with the Children Who Witness Violence Program it can happen as the parent overhears their child telling their story. Video-taping the child interviews and playing these back for the parent would allow the parent to be a witness. Using an observation room where the parent can watch the interviews behind the two-way mirror would also be valuable. The parent, in most cases is simply more responsive to your suggestions after witnessing their child tell their story.

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Part Three

The Format This program was initially field-tested in both school and agency settings.

The school counselors, social workers, psychologists, and agency clinicians played a critical role in shaping, revising, and finalizing the program. Most recently, the I Feel Better Now! program was used in an evidence-based research project in a core-city school with children in grades 2-6. Results proved to be remarkably statistically significant.

Group Size I Feel Better Now! is a group program for up to eight children per group.

Session Format The Session Format is used to provide a structured, systematic progression of activities and objectives supporting and building on one another.

Although the Leader's Guide identifies eight specific sessions, any session may actually take two meetings to complete. It is important to understand that each group of children will be different. Some children will draw and process quicker than others. Some children, for example, may want to spend more time on fear activities than other children.

A session, therefore, refers to the objectives to be achieved using the activities described in that session.

In field-testing, the testers found that all the activities were, in fact, wonderful strategies for engaging the children and helping them with the various elements of their traumatic issues. The field-testers were reluctant to eliminate any of the activities. Some sessions took two meetings to complete.

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The program is for the benefit of the traumatized children. If they are really involved in a particular activity, do not be concerned about completing that session in one meeting. It can be continued and carried over to your next meeting.

NOTE: If you are limited to eight meetings only, the program can be and was completed by some of the field-testers in that time frame without minimizing the benefit to the children. Because of very busy school calendars, eight meetings may be all you can provide at one time. Those who were in that situation arranged to bring the children back together for follow up meetings because the children expressed the desire to stay together and continue meeting as a group.

In field-testing, 95% of the testers found that the program, using all its activities, could be completed in 8-10 meetings, depending on the children's responses.

Session Length Meetings in school settings ran 40 minutes unless conducted after school.

Those conducted after school or in agency settings can run from one hour to 90 minutes. Keep in mind that the children will dictate the pace at which they move through the activities. Each session definitely provides plenty of activities to cover a 40 minute period. The children may want or need to spend more time on some issues. If you are limited to a 40 minute meeting, continue with the remaining components of the session at your next meeting.

NOTE: After you have conducted the program for the first time, you will have a much better sense of timing and what activities work best for you. Our field-testers strongly encouraged us not to remove any of the activities because of their value. They also encouraged us to keep the activities in the order they appear. They suggested we let you know that you will find the entire process of tremendous value to the children, and its structured, systematic explanations just the kind of support you need to make it just as beneficial for you.

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Process The group process is based upon an educational model of teaching, exploring, guiding, normalizing, and the reframing of experiences. Feelings are addressed in order to be normalized, not analyzed.

Drawing, story telling, relaxation, imagery, and other activities are the major processes in which children will be encouraged to engage.

This program is not therapy nor should it be a substitute for therapy. It is meant to offer support and to help normalize their reactions, thereby reducing or minimizing the trauma's impact. Some children may need more.

They may need additional intervention.

Parental Involvement Parental involvement is encouraged. Traumatization is just as terrifying for them. They need to learn what it does to their child's cognitive functioning, behavior, perception of self and the world, and their emotional well being.

A section of the program offers guidelines for engaging parents.

Group Membership Children participating should be six through twelve years old. The closer in age of the children in the group the better. The program is not designed for children with severe emotional or behavioral problems which would either be disruptive to the group process or a barrier to participating in activities designed to encourage children to talk about their experiences.

NOTE: Some field-testers had children representing the complete age range in their group. What they found is that essentially two age groups emerged, with one of approximately 6 to 10 year olds and another of 10 to 12 year olds. At the same time, they found that the older children strongly supported the younger children. This became a valuable asset for all the children.

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We do not encourage such an age span, but some settings may dictate this arrangement. It does work and it is effective, but it takes some experience on the part of the leaders. A couple of groups with four and five children had a combination of 1st through 5th graders and also found that 5th graders became very supportive of the younger children. This smaller size group, even with the age difference and differences in incidents, did do well because of the commonality of their reactions to their trauma (mother burned in car fire, grandfather died of heart attack while with grandson, mother’s suicide, father killed by drunk driver).

Member Incidents Children in this group have been exposed to traumatic incidents as victims or witnesses, or indirectly as family members, peers, or close friends of victim(s). The incidents may be violent or non-violent although it can be difficult to determine when a non-violent incident and/or loss is traumatic.

NOTE: Victims of sexual/physical abuse should not be included in the group as sexual/physical victimization necessitates confidentiality and the same exposure in order for children to be comfortable with one another.

Factors which Predispose Children to Trauma Inducement: 1) An event that is sudden and unexpected.

2) Visually or graphically disturbing image due to seen or imagined condition of the victim, such as knowing a family member burned to death in a house fire.

3) The actual witnessing of the incident or death including anticipated death such as cancer.

4) Being unable to help stop and/or change what took place, or believing they should have or could have stopped it.

5) When the child's behavior matches those trauma reactions previously listed.

Individual incidents/experiences can vary among group members. Most

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field-test groups covered a range of violent and non-violent incidents.

Children removed from parents and placed in foster care are an exception and need to be grouped together.

Setting The program is designed for use in a school or agency setting.

Consideration was given to school time, staffing, population, ease of use, cultural sensitivity, multi-media use, concise session objectives, activity directions, and choice of activity.

Materials Needed Play-Doh, crayons, color pencils, 8.5� x 11� plain paper along with butcher paper or an old sheet for wall murals are needed. We do not recommend water colors or paints as these items necessitate close monitoring. Also needed are the Starr booklets, You Are Not Alone, and What Parents Need to Know which are all included in the complete program.

A hand held, non-breakable hand mirror will be helpful along with a scrapbook type binder for each child to hold his/her drawings. The Activity Workbook contains sheets you may photocopy for members to draw and write on and place in their I Feel Better Now! book.

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I Feel Better Now! Workbook

William Steele, PsyD, MSW Caelan Soma, PsyD, LMSW Pamela Lemerand, PhD Deanne Ginns-Gruenberg, MA, BSN, LLP, RPT-S

13725 Starr Commonwealth Road, Albion, MI 49224 www.starr.org | info@starr.org

© 1998 Starr Commonwealth

I Feel Better Now!

Table of Contents Facilitator Sample Letters and Forms . . . . . . . . . . . . . . . . . . . . . . .1 Parent Handouts and Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Children’s Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Optional Debriefing Worksheets. . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Children’s Worksheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

NOTE: Workbook pages may be duplicated, however, all references to Starr Commonwealth must remain on all copies.

© 1998 Starr Commonwealth

www.starr.org

Facilitator Sample Letters and Forms

Š 1998 Starr Commonwealth

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I Feel Better Now!

Sample Letter of Introduction to Parents

Dear

,

We would like to give you an opportunity to involve your son/daughter in the I Feel Better Now! program.

This program is for children who have experienced a significant loss or traumatic incident. Attached you will find a description of what can happen when children are traumatized. . The program is eight weeks long.

We believe this program will be very beneficial for The group will meet once a week beginning

.

We would like to sit down and show you parts of the program and why we believe it will benefit _____________________. Please call me at

before

.

You may also sign below, giving permission to involve your child in the I Feel Better Now! program.

Sincerely,

Parent Signature

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Š 1998 Starr Commonwealth

www.starr.org

Sample Letter of Introduction to Parents Dear Parent or Guardian, Beginning the week of January 8, I will be conducting educational support groups for children who have experienced a significant loss for a traumatic incident. The I Feel Better Now! groups will meet once a week for eight weeks, at a time arranged with the classroom teachers. The groups are not therapy. They are a way of providing support, and providing an environment in which children's reactions to a loss can be normalized, thereby reducing the impact of the loss or trauma.

Children react to loss differently than adults. Children experience grief in brief moments, and often appear not to be grieving at all. If they express any sadness at all, it is likely to be brief and without emotion.

The next moment the child is likely to be off playing with a toy or a friend. To an adult, it appears that the child has not been affected by the loss. A child's grief is more likely to come out in behavior problems, aggression, whining, or other behaviors that seem unrelated to the loss.

When the loss involves trauma, the child must cope with the trauma before and in addition to the loss issues. The following factors tend to intensify the loss and predispose a child to experience trauma: 1) The loss was sudden or unexpected. (The loss may be death of a loved one, or the loss experienced through separation or divorce).

2) The child was unable to stop or change an incident that took place, and/or the child believed they should have or could have prevented it.

3) The loss was visually or graphically disturbing due to the real or imagined condition of the victim.

(For example, knowing a family member was disfigured in an accident, burned in a fire, or suffered a lot of pain).

4) The child actually witnessed a death, or witnessed domestic violence.

5) There has been a marked change in the child's behavior.

The I Feel Better Now! support group offers structured activities that give the child as well as the parent or guardian information and coping strategies with which to process the trauma. Children will be placed in groups with children who have experienced similar losses. Children who have experienced trauma due to the death of a loved one will be in a different group than children who experienced trauma because of a difficult or unexpected divorce. Following the program, there will be a feedback session for parents. “How do I know if this group would be appropriate for my child?� If your child has experienced a loss due to a difficult divorce or separation; a terminal illness in the family; death of a loved one; or if your child or a member of your family has been the victim of violence, the group may be appropriate for your child.

The group would especially be helpful if any of the trauma inducing factors mentioned above were present, or if your child is experiencing any of the behaviors mentioned on the back of this letter. If you are in doubt, please call me. Together we can decide if the group would be appropriate for your child.

If you are interested in having your child participate in the I Feel Better Now! support group, please complete the attached permission slip and return it to me by . If you would like more information, please call me at .

I am looking forward to the opportunity to work with you and your child.

Sincerely,

Š 1998 Starr Commonwealth

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I Feel Better Now!

Sample Release Form

Neighborhood Elementary School Permission Slip

(name of child) has my permission to participate in the I Feel Better Now! support group for children who have experienced trauma or Loss.

Parent/Guardian Signature

Daytime Phone

Teacher/Grade

Neighborhood Elementary, 2100 Hill Street, Neighborhood, MI 313-555-1212

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Š 1998 Starr Commonwealth

www.starr.org

Sample Letter to Parents Following Sessions Dear Parent or Guardian, Our Trauma and Loss Group for lower grade students met Wednesday for the second time. Our goal for this session was to normalize feelings that children commonly have after experiencing a traumatic loss. We talked about some of the feelings that children might experience after a difficult loss. Some of the feelings that the children mentioned were: feeling scared and worried (that something bad might happen to someone else in their family, or that someone might try to hurt them too); feeling confused (not understanding why it happened or whose fault it was); feeling angry (at people who did it, and angry that it happened); and feeling embarrassed (that their family was different). The goal was to help normalize those feelings, to help them see that other children in their situation have had similar concerns and worries.

For children who have experienced a traumatic loss, extreme fearfulness is a very normal response.

Children may want to sleep on the floor rather than sleep in their own beds because they are so fearful. It is helpful for children to hear that other children have also been frightened, that being afraid does not mean that there is something wrong with them.

Children grieve differently than adults. Adults experience their sadness over a long period of time.

Children experience sadness in fleeting moments. It is normal for the child's sadness to appear briefly, with the child then returning to play activities or laughing as if nothing had happened. As adults, we may misinterpret their playing and think that they are not grieving or that they do not "understand� what has happened.

Another goal was to help the children understand that it is normal and okay to remember or want to hear about fun times they had with the person before they died or was seriously injured. Also, it is okay to have fun now, even though we miss the person and wish the incident had never happened. The children drew pictures of themselves doing something fun with the person who had died or was seriously injured.

We ran out of time, so they will share their pictures with the group next week.

Today we mentioned that the reason we call the group the I Feel Better Now! Group was because a child in a similar group was asked why he liked the group, and he replied, "Because I feel better now."

Immediately, one of the children in our group said: "I do too. That's why I like coming. I feel better.� Other children agreed. The children have been wonderful. We hope that your child is benefiting from participating in the group. Please feel to call me at

at anytime if you have questions or concerns.

Sincerely,

Š 1998 Starr Commonwealth

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I Feel Better Now!

Child Individual Summary Form Keep an ongoing record by adding to your notes on this sheet, or copy this form as necessary.

Name

Date

Number of sessions completed

Verbal comments reflective of mood/concerns/issues facing/feeling status

s Behaviors reflective of moods/concerns/issue facing/feeling status

Behavioral/verbal differences between wtart of group and current status (related to comments above)

Issues to return to/provide additional assistance with/consider for further assessment/referral/discuss with parents

Facilitator signature

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Š 1998 Starr Commonwealth

www.starr.org

Group Summary Form To be used per meeting. This will assist you with debriefing the meeting. Please take 15 minutes immediately following your meeting to write down your thoughts. If a longer period of time elapses, even your most important impressions will be lost.

Date

Session #

Attendance:

Activities

1) 2) 3) 4) Participant Responses Responses which validate progress, identify problem areas, suggest need for further exploration, etc.

Š 1998 Starr Commonwealth

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