Dr. Purvis passed away last month after a battle with cancer, but in her sixty six years, she changed the lives of countless children and dramatically expanded CASA's ability to serve children. A renowned child development expert and a fierce advocate for what she called "children from hard places," Dr. Purvis developed a model of trauma-informed care, care that understands a child's history and views their treatment through that lens, which she utilized for children who had been adopted. CASA was able to partner with Dr. Purvis and the TCU Institute on Child Development to implement their therapeutic model, called the Trust-Based Relational Intervention, or TBRI, for use with children in foster care.
TBRI is a research-based, holistic model developed with an extensive training curriculum for caregivers of children who have experienced trauma. It is a way for them to look at children suffering from the residual effects of trauma, and their behavior, with a different perspective. Because of the effects of trauma on brain development, children often act out in unexpected ways. "What appears to be inexplicable behaviors are often survival and coping strategies," explained Dr. Purvis. "They act this way simply because they don't know any other way."
Her research showed these coping mechanisms manifested in a variety of different ways; anxiety, lack of trust, intense fears, selective mutism, aggressive outbursts and avoidant behaviors to name a few. She found that severe trauma affects brain growth on a physical level, leading children who have been abused or neglected to suffer in their development of cognitive processing and emotional regulation. Higher level brain growth is stunted, leaving some children at as little as half their age in cognitive functions. Lower level brain functions, which control instinctive flight or fight responses overdevelop as a response to trauma.
Dr. Purvis believed that no child was beyond help and her research into neurological development showed children with trauma could exhibit profound growth, but that it wouldn't happen through traditional discipline, which just triggered the same trauma reactions. Instead, the care of children who have experienced trauma needs to focus not on correcting their behaviors but on addressing the underlying causes. To do this, adult caregivers must first question their own control strategies as they ask kids to give up theirs, to address the ways they deal with conflict (and there will be conflict) and to explore the factors that affected their own development.
This is because the core of TBRI's model for helping children recover from trauma lies in earning trust and building relationships, then using that connection to empower children to shape their behavior. Children who are abused and neglected are denied the healthy relationships that lead to felt safety (Dr. Purvis said that abuse tells children "I don't like you," while neglect tells them "you don't exist." Both are incredibly damaging to a child's sense of felt safety and their development.). Without the ability and capacity for trust, they experience debilitating fear, which triggers a need for control.
Forging relationships that build the capacity for trust requires a caregiver to cede that control to a child. When first meeting children, Dr. Purvis would bring a container of bubblegum and tell the child they could always ask for a piece and she would give it to them, and if they asked for a another, she would give that to them too. This was a simple action with a profound effect. It signaled to a child that they had a voice and that people would listen, something many children who experienced trauma of abuse and neglect did not have before. This voice, and the relationship it helps to build, is essential to a child's healing, so TBRI-trained caregivers follow the example of Dr. Purvis' bubblegum. They avoid saying "no" to a child and, whenever possible, instead, present options to give the child some control of the situation. When a child asks to have ice cream for breakfast, the caregiver will, instead of denying the request, offer alternatives. "Would you rather have cereal or eggs?" When children feel they have control, their fight or flight instinct isn't engaged and they feel safe.
When a child feels safe, feels that their needs are being met and that they have control, then they can heal and correct behavior. The relationships they've built with their caregivers can give them what they need to thrive and the brain can grow in the places that were damaged. It was important to Dr. Purvis' work to keep children from hard places not just safe, but happy, because her research shows that it takes 400 repetitions of a behavior to build a new synapse but only 12 repetitions if it is done with a feeling of joy and safety. At TCU's Institute of Child Development, caregivers teach the children they serve through play. By focusing on a child's joy, she showed that trauma-informed caregivers could rebuild the damaged pieces of a child's brain.
But while relationships are key to a child's growth, the intervention Dr. Purvis designed is a holistic model. Trauma-informed care isn't just in a caregiver's direct actions but extends to the environments where children from hard places reside, at home or school, because an environment that is too chaotic will trigger the same fight or flight responses. As such, TBRI-trained placements learn to be more flexible to a child's needs and more patient. They focus on the physical causes of a child's stress, ensuring that children are constantly hydrated, that they get snacks every two hours, have sensory activities to calm them and that they get enough sleep.
Working with Dr. Purvis was monumental for CASA of Travis County. Before TBRI, we only had a limited degree of understanding from which to advocate for children suffering trauma. Dr. Purvis' research and the modalities that she created give us the vocabulary to articulate what children from hard places need, because we are able to better understand their behaviors and what underlies those behaviors. We can better tailor the services for which we advocate in a way children aren't able to ask for. And it means that we can articulate those needs, not simply to a judge, but to caregivers and placements. Dr. Purvis' work means that children in our care have a chance for better outcomes, to heal from their trauma and to lead happier, more fulfilled lives.
If you want to learn more about Dr. Purvis' work, a great place to start is by checking out the resources on the TCU Institute of Child Development's website.
May Advocacy 2016