Connect, Co-regulate, Co-reflect, using Trauma Informed Practice in SEMH provision

In this article, Dr Leanne Johnson discusses the 3 Cs Model of Trauma Informed Practice (TIP) – Connect, Co-Regulate and Co-Reflect.

One of the most professionally and personally challenging aspects of working with young people in Social Emotional and Mental Health (SEMH) provision, is supporting their recovery from trauma. It is also one of the most stimulating and rewarding outcomes to experience, in partnership with resilient, inspiring young people and the exceptional colleagues who support them.

The 3 Cs Model of Trauma Informed Practice (TIP) – Connect, Co-Regulate and Co-Reflect, is a comprehensive approach established on the current evidence base and experience, emphasising the importance of relationships that young people require in order to recover from trauma.

My aim was to create a simple and accessible model, to promote standardised practice across OFG’s 52 schools and residential provision. The model identifies the themes I believe are the most important considerations in a trauma informed approach.

TIP provides a deeper understanding of the underlying trauma individuals may have experienced.

A process through which staff can more deeply connect and support young people to help them develop skills in recognition, regulation and reflection.

The four-day training, accredited by the British Psychological Society (BPS), for the purposes of Continuing Professional Development, includes all staff from administration to leadership, teachers, teaching assistants, and residential care practitioners. It is bringing everyone together in an integrated and consistent way, to embed TIP as part of everyday practice, whatever your role is.

The training explores the important elements of working with individuals with lived experience of trauma. This includes the impact on ourselves, such as secondary trauma, transference and counter transference; the impact of trauma on young people; what trauma ‘looks like’ in the classroom or residential setting; and how to support recovery from trauma using the 3 Cs Model of TIP.  The Foundation Stage of training spends a day on each C of the model;  Connect, Co-Regulate and Co-Reflect.

Those with lived experience of trauma can develop strategies in their early environments which have helped them survive. These survival strategies can also have devastating effects on a child’s natural development. It can disrupt sensory development, can lead to disassociation, disrupted attachments  and difficulties with emotional and behavioural regulation; this impacts not only their cognition and ability to learn, but their concept of self and their identity.

We use Kim Golding’s Pyramid of Need, beginning with establishing a foundation of safety, both emotionally and physically and developing relationships, to providing comfort and co-regulation, building to empathic reflection and providing the resilience and resources necessary for them to be able to engage and explore their trauma.

The 3 Cs are integral to this:

Connect

‘Connect’ helps build relationships so young people feel ‘kept in mind’ throughout their day. Strategies include daily ‘Meet and Greet’ so they feel ‘seen’ and transition into school positively.

Praise can be overwhelming for traumatised young people and their fear may result in them sabotaging their success. More subtle, specific, unexpected praise helps support a growing acceptance of their achievements and builds self-esteem. 

A PACEful (Playfulness, Acceptance, Curiosity and Empathy) environment helps build relationships. The Connect phase emphasises the importance of adults approaching young people to repair relationships in a non-shaming way – to re-connect relationally as soon as is possible, to reduce fear of rejection.

Co-regulate

The environment needs to feel ‘safe’ to reduce hardwired survival responses. We support this with patience and providing consistency, repetition and predictability, structure and clear boundaries throughout the day.

‘Co-regulate’ helps colleagues to empower young people to develop skills to recognise and manage their emotions. Strategies include emotions coaching, and practical skills such as 5,4,3,2,1 Grounding Skills and Brain Stem Calming Approaches.

Careful consideration of more sensitive curriculum areas, for example, PSHE and topics such as Sex and Relationships, is important to not re-traumatise young people.

Co-reflect

‘Co-reflect’ supports by providing therapeutic boundaries that are emotionally containing, and integral to helping traumatised young people learn safe and effective ways of living their lives.

‘Co-reflect’ recognises shame as a barrier to openness, progression and learning. The shield of shame protects from a feeling of ‘badness’ and fear of rejection, which can be triggered by the slightest threat of being criticised (or rejected).

‘Co-reflect’ is not about a lack of boundaries, it is about providing choice and inclusive boundaries which are collaborative. The use of natural and logical consequences help young people learn how to reflect and to understand cause and effect,

Supporting young people with lived experience of trauma is rewarding and  also incredibly challenging. Forming positive and meaningful relationships can require huge persistence. We are mindful of the impact on those closest to young people, and we strive to ensure they are supported and well equipped to look after their own needs. This is critical to creating a reflective and responsive therapeutic environment.

Post-training, ongoing monitoring and management of the implementation of TIP is supported by the local Clinical Wellbeing Teams (CWT), who liaise with senior leaders. The CWT facilitate TIP consultation sessions about individual young people – to enable TIP informed discussions about their progress on their journey of recovery.

The Clinical Wellbeing Teams are also instrumental in supporting services with TIP reviews three times a year, with an OFG accreditation awarding Bronze, Silver or Gold levels of TIP practice.

Supporting colleague wellbeing, enables them to better support the children and young people in their care, whether in a school or residential setting. The CWT provide staff with monthly reflective practice groups focussed on wellbeing, where staff can ‘press the pause button together’. This provides time and space to recognise some of the complex relational processes, to help develop and protect a responsive, reflective and positive culture.  

By working in this way together we can support the journey of young people through their recovery of trauma and provide positive outcomes.

By Dr Leanne Johnson, Head of Trauma Informed Practice, Outcomes First Group

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Dr Leanne Johnson, Consultant Clinical Psychologist, is Head of Trauma Informed Practice at Outcomes First Group (OFG), a specialist provider of education and care for autistic children, young people and adults and those with complex needs.