The Children's Village is a charitable institution founded in 1851. The main campus of the Children's Village is located in Westchester County, New York. The campus is home to 15 residential cottages for youth who have struggled in the community behaviorally, emotionally, socially and academically.
As more information about the impact of trauma on child development has become available, it has been recognized that the young people at The Children's Village have been exposed to a myriad of adverse life experiences. Given this knowledge, it is important to recognize that what can appear on the surface as disorders of conduct or "delinquent" behavior, may actually be manifestations of emotional and behavioral dysregulation secondary to chronic exposure to traumatic events. The clinical leadership at The Children's Village realized the need to acknowledge the impact of trauma on our youth, and to develop a method of helping youth to recover. The Clinical Leadership Team investigated a number of different programs, and determined that TST would be the best fit with our setting.
Dr. Saxe came to campus for a two day seminar, and the decision was made to implement TST on campus. TST was implemented on a pilot basis in January 2008 and then incorporated into the entire residential program a few months later. Currently, TST is being used in for approximately 25-30% of the youth in each cottage program.
TST has been extremely useful as a method of organizing treatment planning to address the child's symptoms in the context of the social environment. Since TST was designed as a community based model, it had to be adapted for use in milieu treatment. It is clear that TST has been very useful in a number of ways. It has: given us a way of including direct care staff in a more integrated way into treatment planning; it has helped us to distinguish ‘acting out" behavior from trauma related behavioral dysregulation; it has given us a useful treatment language to help us conceptualize the work; and it has allowed us to design more effective treatment plans which take into account not only the needs of the child, but the needs of the social environment in which that child lives, both in the cottage and in the family.
We have modified some of the forms and procedures to incorporate an evaluation of the impact of the therapeutic milieu, as distinct from the impact of the family and the outside community. This has been an extremely useful, though challenging, process of self realization and growth for the members of the TST teams. It has forced us to look for triggering stimuli within our own programs, which may be contributing to a young person's emotional or behavioral dysregulation. This process has helped us to recognize "traumatic re-enactments" between youth and staff, which so often occur, but can be very difficult to see. From an organizational/systems perspective, this process can also help to elucidate the existence of a parallel process which may lead to a "collective disturbance."
We are implementing TST in our foster care program as well. All foster care administrators, case workers and clinicians have been trained in TST, and are looking to stabilize both biological and foster home environments. Training for foster parents is currently being developed as well.