Liz Unruh (Host): Hello, listeners, and thanks for tuning in to the Well Within Reach podcast brought to you by Riverside HealthCare. I'm your host, Liz Unruh. And joining me today is Kelsy Kerrigan, who's an outpatient clinician at Riverside's Pathways Program.

Now, for a quick break to talk about myChart.

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Host: And we're back. So, thanks for joining us today, Kelsy.

Kelsy Kerrigan: Hi, thanks for having me.

Host: So, I know this is not your first time on our podcast, but it has been a little while. So, can you remind people a little bit about yourself and what you do here?

Kelsy Kerrigan: Yeah, yeah. So, I'm a licensed clinical professional counselor. I have been doing therapy for a little over a decade. I began my career in residential treatment with my boys with abusive behaviors and pretty extensive trauma history. I came to Riverside about three years ago. And I work in our Pathways Program, which is our partial hospitalization program and intensive outpatient program. So we do group therapy with kids as young as six all the way up to, you know, however old a person can get.

Host: Yes. Yeah. And, your background is why, we asked you to come on our podcast today because we're going to be talking about trauma-informed approaches and that group therapy setting for the children, and you work with that population often. So, my very first question for you. What exactly is a trauma-informed approach, and why is it important when working with children in a therapeutic setting?

Kelsy Kerrigan: Yeah. And really I think it's important with everyone. The field is moving towards trauma-informed just care in general. We're starting to realize how pervasive trauma is, the extensive impact it has on generations and health and welfare. So, in a therapeutic setting, specifically with children, it kind of helps move the shift of like, "Well, what's wrong with you? Why are you being aggressive? Why are you being attention seeking?" to "What happened to you and what do you need?" So, what things that are normally a problem are now we look at them as adaptive ways that these kids have learned to survive and get their needs met when they previously couldn't?

So, it's kind of grounded in understanding that trauma exposure impacts everything. It impacts your biology, it impacts your neurology, it impacts you socially, psychology, developmentally. And trauma-informed care, especially with kids, it can help reduce shame, a lot of things that we do to treat children and get them to do the things we want them to do are kind of just short term compliance space when really then these kids are still hurting and grow up to hurt other people. And then, we just kind of continue this cycle of trauma and re-victimization and intergenerational problems that we're starting to see. So, it really helps, hopefully, interrupt some of these cycles and get to the root cause so they can grow up to be healthy members of society.

Host: Yeah, I think that's important to remember, you know, not just being like, "Okay, we're going to fix you because you're broken," but like, "Why are you broken? How can we help you become a better member of the society?" So obviously, this is a different therapeutic way to approach group therapy. Can you explain like how this is different than other ways you would approach?

Kelsy Kerrigan: Yeah. So, I think when we think of therapy, a lot of times we think about the talking part, the cognitive behavioral therapy. What I'm thinking then is impacting how I'm feeling and that changes my behaviors. And it requires a lot of self-reflection, which, one, is hard for a lot of people to do, but kids especially, they're just not there developmentally. And there are trauma treatments that are kind of focused on the thinking and they're good and they're evidence-based. But we call that a top-down approach where we're looking at how can we connect our thoughts to make changes, when a lot of the newer and really, really effective trauma approaches, especially with children, are called bottom-up approaches. So, that's looking at things like knowing that trauma kind of lives in our bodies, it's impacting our biology, we're just reacting to a lot of things, and we don't know why. So, it's focused more on looking at what's going on physically increasing these responses that you have, so that eventually you can then control your responses and long-term make changes to your thoughts and behaviors. So, that would be things like yoga, EMDR, for example, versus cognitive behavioral therapy.

Host: That's definitely interesting. I like the thought of the bottom-up instead of coming down. Like, you're looking at an over you going down. You're like looking, "Okay, what's the root of the problem?"

Kelsy Kerrigan: Yeah.

Host: You're talking about people are like, "I'm a plant. Looking at my roots, why am I that way?"

Kelsy Kerrigan: Yeah. And that very basis of like way deep in our brain, that survival center of our brain that's just like on alert all the time trying to survive when we've had trauma or in chronic stress.

Host: Yeah, for sure. How would you describe like a typical group session for children?

Kelsy Kerrigan: I think everyone probably does things a little bit different. For me and in group settings, there are some challenges which we can talk about too. But at least for us in our children's groups, we like to do a lot of yoga. We do a lot of yoga and breath work. We do sensory work. I mean, the kids, we do have requirements to meet, so we do do some talking, but we also do a lot of moving. We do a lot of play and art.

The main thing that we're looking at is we really want to make sure the kids are always feeling safe. They feel like they can predict what's going on. They feel connected to the adults in the room. That relationship is really key. And we meet them where they're at too. So, we're not going to force them to do anything. We're going to give them options. We're going to give them choices while letting them know we're still the adults and we're in charge. We're going to take care of you no matter what.

Host: Yeah. And that kind of leads to my next thought here. So, there are those different diverse needs of population in group setting. And every group is obviously going to be different, because there's going to be different people in it. So, how do you kind of address that and kind of level it out so that one person's not getting all of the attention?

Kelsy Kerrigan: Yeah, it can be really challenging. But at the core, kids need to feel safe. And people in general, I mean, this isn't just for kids. This is what everyone needs. People need to feel loved and they need to feel safe, and they need to feel that they have some sort of control. So, if we are always looking for the why of these kids' behavior, like what is the reason they're doing it, what do they need, we can hopefully address all of the diverse behaviors. So, maybe a kid is not feeling safe and this kid feels safe if he's able to sit up by the teacher and maybe get a hug. And another kid feels safe if they sit at the back of the room with no one behind them. So, I think just trying to always keep in mind what do they need to feel safe, loved, and in control, and that's how we try to anyways.

Host: Yes. Yeah, I'm sure it's difficult. We're going to take a quick break to talk about finding a primary care provider.

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And we're back to continue our conversation about the trauma-informed approaches in group therapy. So, are there any unique challenges that children with trauma might face in a group therapy session?

Kelsy Kerrigan: Yeah. I mean, a really common one that I notice is, again, we've talked about safety a little bit, that feeling of safety. So, just because they are safe doesn't mean they feel safe. So acknowledging that, we often have kids come in that just don't feel safe. Research also shows that people that have been exposed to trauma read social cues differently. So, they'll see anger where there is no anger quicker than someone without a significant trauma history. So, we have a lot of kids that don't feel safe. They misinterpret a lot of social cues. So, thinking other kids are making fun of them, picking on them, leaving them out. So, trying to navigate that, because kids are already kind of bad at doing that. They're still learning how to be people, so helping them with that. Regulating everyone so they're all at different stages in their ability to control themselves. So, some kids can trigger other kids, depending if they're crying, yelling, banging, and just undiagnosed maybe like delays, academic problems. So, maybe we're not all able to complete the same activity in the same way, and they're not all the same ages either. So, if you have a six-year-old versus a ten-year-old, I mean, they're vastly different in their ability to understand things. So, that can be really hard too to make sure everyone's kind of understanding things and getting what they need. And also, just barriers to attendance. A lot of times these kids that have had chronic instability and trauma, it's occurring within the family settings and within their community as well. So, it can make it hard for kids to come consistently on time. They may not be getting fed before they come as well, so that creates kind of another layer that I wish we had more control over too.

Host: Oh yeah, for sure. I know you've touched on a few of these things talking about having someone sit maybe at the front of the room or the back of the room, and some other ways that you've addressed this too. But how do you ensure someone has that safe and supportive feeling if it's not an easy solution, like the moving them to the front of the room or the back of the room?

Kelsy Kerrigan: Yeah. And a lot of it can just be getting to know the kid. And sometimes, you know, it starts at meeting their basic needs. So if they're feeling cold, we go and get them a jacket. If they're hungry, we get them a granola bar or water. So just kind of sometimes meeting those basic needs. If their basic needs are met, then we can kind of go on to the next stage of what else do they need to be met, and that starts to help them feel a little bit better. Sometimes we incorporate the adults in their lives, too, to kind of ask questions on what has worked in the past. They're also allowed to bring comfort objects within reason, obviously, but dolls, pictures. Occasionally, we'll call home. And again, we try to give them choices, too. So, I let them know I'm not going to force you to talk about anything. I'm not going to make you do anything. I'd like you to, I think it'll help you, but I'm not going to force you to, and that helps too.

Host: Yeah. I think that's definitely big. I'm sure being forced to do things, especially right now, kids going back to school and being forced into like the routine of doing that, there's a lot of changes just happening.

Kelsy Kerrigan: And I mean, I don't want to be forced to do anything either. And then, I don't want to be threatened with punishment either because now this person's like, "What is their motive in it?" So, we try to avoid a lot of those things.

Host: Yeah. So, what role would you play in facilitating like a trauma-informed group therapy for children?

Kelsy Kerrigan: Really everything, because if you leave kids, even healthy functioning kids, to their own devices, I mean, you've seen a bunch of toddlers just play together. It's wild. So, kids as well, they are used to getting their own needs met, these traumatized kids. They know that the world or other adults can't be trusted or aren't going to respond if they speak up. So, they've gotten really creative with how they can do it. Not necessarily in the best way. So, they're going to keep doing that. They're going to push people away. They're going to fight people. They're going to steal stuff. They're going to run out of the room. The clinician means everything to making sure that this stuff is going well. Part of that is keeping yourself regulated, not only as a role model, but because if you are not regulated, you can't help them stay regulated and in control. And then, they maybe have seen dysregulated adults in their household, in their community too, and those adults have not been safe. So, really everything, we keep the schedule, we show them we're safe, and try to not let them take over the groups while still making sure that they do feel in control and like they have a voice too. So, it's definitely a balancing act.

Host: Yeah, I could see that. I know I just have one child at home, but trying to balance a room full of varying aged children is I'm sure a handful.

Kelsy Kerrigan: Yeah. It is entertaining. Kids are funny. Kids are really, really funny. So at the end of the day, it's pretty funny.

Host: Yeah. So, we've talked a lot about ways to make them feel safe and comfortable and supported. So, what are some of the signs that a child is benefiting from that trauma-informed therapy?

Kelsy Kerrigan: I think it depends where it was impacting their life in the first place. So, I've talked a lot about regulation. That's just their ability to kind of control their physical responses and their emotional responses and their bodies too. So, we have a lot of kids that come in that just are constantly moving, and they can't sit still and they can't regulate whether they talk, are they loud? Are they soft? So, some of that is just watching them be able to be a little more in control, which often means they feel a little calmer, which is nice. Not always on edge. They seem to be able to talk about things a little more, they feel safe opening up, they feel connected to us. They can speak some of the treatment language, not just because they're memorizing it, but because they're really learning it and using it. And again, just looking at their overall functioning. So, how are they doing in school? are they able to stay in class? Are they able to complete their homework? Are they still arguing at home with their family? Are they able to make and keep friends too? So ,we look at their social interactions a lot in group. Are they able to play with others appropriately now? Are they still kind of always fighting or feeling left out? So, those are some of the things we look for.

We also have weekly contact with the adults in their lives too, or the people that are caring for them to ask about those other areas of their lives. Sometimes the school settings as well, DCFS workers. So, I think sometimes people that work with children, that's not their favorite part of it, but it's definitely an essential part of making sure you're talking to the other adults in their lives.

Host: Yeah, for sure. And are there times where those other adults are involved in the therapy process besides just reaching out and seeing how they're interacting and doing the aspects you're not a part of?

Kelsy Kerrigan: Yeah, yeah. So, I mean, in our setting, it's a little more unique. If I was doing this in maybe an individual setting, they would be probably even more involved than they are. We would actually be doing sessions with the families as well or with the caregivers to do psychoeducation pieces. So, right now, we kind of do, we call them family meetings. So, it is a time that the families get together with the kids. They talk about what progress they've seen in the kids. So, no matter how much that kid is still struggling, we still want to acknowledge the positives. So, it's like find something. We can always find something even if it's that they're just continuing to try hard and show up. So, that's how we involve them. We have those meetings and try to recognize the positives, but also make it known that they still want the kid to improve on these specific things. And oftentimes the kids, they know what they need to work on. So, it's nice to kind of try to align them too and give them some feedback in that. We do that. I really try to do the best I can to educate them on the meaning of behavior, you know, not like focusing on the problem, but focusing on what does this kid need?

You know, kids aren't bad, they're doing the best they can. And if the adult can assume that the child's doing the best they can and not being malicious or attention-seeking or trying to be controlling, they're trying to meet these other needs that they have. Maybe they need to feel loved. Maybe they need to feel like things are predictable. Then, sometimes it can help the adults interact differently with them. And then also, we give them a lot of resources, you know. So, Rise and Thrive Wellness, they do courses in positive discipline for parents, which is also kind of based trauma-informed. So, that's really nice. And sometimes, we offer them their own treatment as well, because it's often a family issue, not just a child issue.

Liz Unruh (Host): It goes back to that cycle that we were talking about at the beginning, for sure.

Kelsy Kerrigan: Absolutely.

Host: Rise and Thrive is here in Kankakee, correct?

Kelsy Kerrigan: Yeah, yeah. They actually just had their grand opening, this week. They have a location in Kankakee and then they also have a location in the area. And often, the Positive Discipline Courses take place at the YMCA in Bradley.

Host: That's good to know. Just another resource that the community has available to parents.

Kelsy Kerrigan: Yes. Yes. It's wonderful.

Host: Yeah. So, wrapping up here, what advice would you give to other mental health professionals or even educators who want to incorporate trauma-informed approaches when they work with children?

Kelsy Kerrigan: So, lots and lots of education. So, part of that is probably addressing any of your own trauma, challenging your own views and biases on kids, because it can be challenging, and you know, people can get annoyed and on your nerves, but it's really important to change the way you're looking at things, because that's going to change how you interact with these clients. And it's also going to keep you calm in the moments when they're not calm. So, lots and lots of education, lots of your own treatment. And there's a couple models that they can look into as well. So, Bruce Perry is the developer of the Neurosequential Model and Stephen Porges does Polyvagal Theory. So, I know those are like big weird words that don't make any sense right now. But those are kind of really where the science is going with that bottom up trauma therapy, that I would encourage them to look into.

Host: Yeah, definitely. Google's your best friend. You can find those by Googling them.

Kelsy Kerrigan: Yes. Yes.

Host: Well, Kelsy, thank you so much for sharing all this great information. Thank you for tuning into the Well Within Reach podcast with Kelsy Kerrigan with Riverside Behavioral Health and your host, Liz Unruh.

To learn more about services provided by Riverside's Behavioral Health Department, visit our website at riversidehealthcare.org or call our central intake department at 844-442-2551.