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Dr Alberto Veloso who is a psychiatrist, paediatrician and Dyadic Developmental Psychotherapist has worked extensively in the foster care system and with children with ADHD or ASD or mental health needs. He wants you to know the importance of regulating your own brain and the need to take care of yourself first so that burnout and blocked care in your brain doesnt damage your child. It can truly lead to relationship breakdowns with your child.
So what can you do instead? Consider really understanding Dan Hughes and Jon Baylin's brain based parenting summary on how to strengthen your parenting systems. Use the power of a yarn and gathering all the people in your child's life to nut through issues as they arise. If you don't get a hospital admission after waiting hours at an emergency crisis centre, it may actually be for the best. Hospital admissions aren't always the safest spaces for children with a trauma background. Time spent co regulating in your relationship is actually doing the work. Some constructive advice to really help realise the power of co regulation and self care and why both are so, so important to make time for.
00:00 - Start 00:56 - Welcome 01:29 - Care is a team effort as its relationships that heal and often services are limited 03:03 - ADHD and ASD can be difficult to identify in children from a trauma background so focus on therapeutic care as the starting point 05:05 - Therapeutic care affordability and access challenges mean you need to be flexible. Caring for a carers brain is critical just like caring for your childs brain. You want to avoid blocked care or burnout which can lead to relationship breakdowns. If a child's brain is rigid or emotionally driven, chances are yours might be too. 11:50 - As an industry we need to acknowledge and put parents and carers first to avoid relationship breakdowns 13:11 - Solve problems with a yarn and group conversations 18:50 - Start talking about and actioning the 5 stages of how to strengthen parent child relationships from Dan Hughes and Jon Baylin released last year here (https://www.fcawa.com.au/wp-content/u...) 20:17 - Crisis management and in patient admission is not always the goal for children from trauma - use the time to self regulate your child. If they are self harming remind them you dont blame them and that you will work together to keep them safe. Always.
This is Sonia Wagner, representing PCA Families in one of our recordings that capture lived experience and best practice evidence based learning that assist kinship, permanent and adoptive parents/carers in supporting young people.
PCA Families has a zero tolerance of child abuse and follows child safe standards.
I would like to acknowledge the traditional custodians of the land and pay respect to elders past and present and express our intention to move together to a place of justice and partnership.
Today we are speaking with Dr Alberto Veloso who is a psychiatrist, paediatrician and practices in Dyadic Developmental Psychotherapy, a form of refletive therapy, based on Dr Daniel Hughes model, where the child, therapist and family work together exploring different understandings in a current safe relationship. Dr Alberto has worked extensively in the foster care system and with children with ADHD or ASD, and has supervised teams working with children’s mental health needs at Headspace.
00:56 Welcome Dr Alberto. Is there anything else you would like to share about yourself?
Thank you so much Sonia. I just want to say it has been wonderful to discover and be involved with PCA Families and the work you do because it really aligns with what we do to support parents and kids to look after their kids. So it’s a pleasure to be here.
01:29 I understand your focus is on the family, as distinct from individual therapy and counselling. Can you tell us about that?
One of the drivers for creating our service Relational Minds and the work that I focus on now is that I used to practice a lot as an individual practitioner, as a psychiatrist, and also my colleagues and psychologists and therapists. You would always have this problem where in treating the kid on their own you wouldn’t get much traction and you always get frustrated because you wished someone worked in the family. In all of our training in the psychiatry industry people always say it’s the relationship that heals. It’s always one of these phases. It doesn’t matter whatever therapy you use. So why don’t we work on relationships then. And there is third aspect which is the lack of access to services and therapy. So we said, what if we work with the parents and carers who are with these kids all day every day. What if we work with them to provide them with therapeutic experiences so it will be so much more effective than once a week with a therapist.
03:03 I understand that you see a lot of families struggling with children with ADHD or ASD in out of home care. How do you support those families?
As we know ADHD and ASD have become really prominent in our community and in our community conversations and the awareness of the symptoms and problems around ADHD and ASD. It has really increased over the last decade. Those carers in out of home care have been seeing this all the time. So now they are looking at maybe this is what we call ADHD or ASD. Its really tricky in the out of home care space because we know that the children have experienced trauma that affects their emotional development. So it becomes really tricky to identify is this part of ADHD or ASD or is this part of their trauma. What we say is this is really difficult. Its impossible to categorise the trauma as different from the genetics and typical neurodevelopment. So how we support families is that regardless of what the ending diagnosis is we create a therapeutic environment. Once we get though that we can create a therapeutic environment and then work through the usual ways of managing ADHD or ASD or supporting young people. We can still get benefits with their symptoms but do it in the context of their trauma and do it in the context of this difficult out of home care system they are in.
05:05 You have developed a therapeutic model that seems affordable and works, particularly when you are operating in remote areas or are managing burn out and blocked care. Can you tell us more about that?
Affordability is such a challenge. For me there is a bit of a double layer. Just to access any services is tricky. Being able to access NDIS funding which relies on specific diagnoses and of course many in out of home care wont qualify for a diagnoses of ADHD or disability funding. So affordability becomes really tricky. One of the ways we try to manage that is to create a team because the second problem is how do you get access to a child psychiatrist or a paediatrician.
So I work in a regional town of Mildura with Headspace and Relational Minds. The problem there is to get into a GP can take weeks and to get into a Paediatrician can take 6 to 12 months and then there are costs involved. So we have tried to get inventive and weve tried to hold a policy that finance should not be a reason why a family can’t get care. Then we need to go and find our brokerage partners or talk to other people to find a way to get help. There are so many ways so that you can get help but you need to be flexible to get help.
Why is flexibility important? We talked about burnout and blocked care. One of the things I have been trying to promote understanding of recently is about caring for a carers brain. We talk about the child’s brain being emotionally driven and there are logical systems that don’t function for that child. Guess what parents have the same nomallian brain too. So just like the childs brain when responding to trauma will work much more emotionally and rigidly if the carer has experienced blocked trauma from the child. Guess what happens to the carers brain. The same thing happens.
For example, a parents brain normally wants to be near their child. There is something about that relationship that brings you joy and you want to be in their proximity. If you have had difficult experiences for long enough that part of your brain will shut down. I want listeners to think about times where for some strange reason you don’t want to be near your child anymore. Or if you don’t feel happy or feel joy in the presence of your child. Your brain then automatically starts to think negative things about your child. I have met carers that say when a child walks into the room they have to stand up because they are defensive just in case something happens. They love their child but there is something happening in the parents brain that they cant help. We need to acknowledge this more. The parent and carer feel like they have to keep going to find support and services and feed their child and manage all the other things.
One of the last things to fall apart for a parent or carer is their executive functioning system. How many parents or carers feel like they now have ADHD. I can’t remember things anymore. I can’t seem to get myself organised when I used to be able to do that. This is back to that ADHD question. Certain things that those children have gone through and that have impacted their brain have affected the parent or carer. So its really really crucial that we make things affordable and provide support for the carers so we take the weight off their shoulders so that they can focus on the relationship and building connection with their child. I think that’s the challenge for the industry. For so long families have had to do everything. Sometimes as soon as child protection closes, suddenly you are out on the open water, sometimes without a raft. The stress that comes with that. So we need to acknowledge that a parent or carers brain can react in a traumatised way and it then may lead to blocked care and the answer to it is self care and support. Just like we say to parents and carers, you build connection with the child so that those logical brain systems will repair and kick in to rebuild the brain, parents and carers have to do the same for yourself. But my experience is that parents and carers are not as good at putting themselves first. They get told a hundred times to put themselves first and even that is not enough.
11:50 Its almost offensive to be told put yourself first?
In the event what we want to do is prevent burnout and ruptures that are terminal for the parent child relationship or arrangement. Its something that we really need to acknowledge. As I mentioned before I’ve seen parents that have had kids for 15 years and then that relationship breaks down and ends. That is so tragic for the carer and the child. If we had acknowledged that caring for parents and carers is just as important as caring for the child, I would hope we would prevent things like that. Of course there are other things like funding and services to support that. We are trying to solve as much as we can in our little drop of the ocean.
13:11 When we talked you mentioned a 15 year old that was self harming and the importance of getting everyone together to talk it through and tell some stories to get perspective.
I think that’s a really good point. What do we do when we are trying to solve a problem with anything in our lives? What does our brain need? Translating the science. Again sometimes the brain can access a quick solution but other times it doesnt. Sometimes we really cant solve a problem. Whether it’s a finance problem that we have or some other problem. Sometimes just sitting down having a conversation with someone and nutting it out. I work a lot with the Indigenous community. The yarning process with Aboriginal people is one of the most helpful ways to solve a problem.
What does that actually mean? Yarning about the problem means sitting down, trying not to find a solution for the problem, just talking it through and looking at all the different angles. Of course someone needs to guide that and come up with an action plan as otherwise you can yarn for years. Sometimes you just need someone to coordinate the conversation. Often this is our biggest role. If a parent comes to us with a problem, whether its self harm or something else, we might say lets sit down and have a yarn with all the parties and see what comes up. After that there will usually be, almost without fail, one step that leads to the next step. It might not be a clear solution. For example, when we talk about issues with school such as the problem or frustration that our school system doesn’t take into account how difficult our children’s brains are and there are not enough teachers or supports around. Brainstorming. We often forget to brainstorm. Its difficult because it takes a level of openness. We need to encourage openness to say everyone is doing their best here. As a carer we need to go into the school without all guns blazing saying hey you aren’t doing a good enough job. That teacher who also has another 25 kids will also get defensive. Its also important for the teacher not to blame the parent as well. We have to know we are all doing our best. Can we get together and what else can we try. Let’s get together and talk about how we survive.
17:00 That process of yarning and understanding the problem does so many things. It creates solutions, it helps carers feel supported, it is one of the forms of self care, it can address the issue of blocked care. It can help the child realise they are being thought of and that there are a group of healthy minds thinking about them. There are so many benefits to putting minds together. Again it is relationships that leads to the solutions.
17:50 The other thing you mentioned is that by having that yarn you are learning more about the background to the parent or carer as well as the child.
Its important to have a focus. Each of these yarns has a focus. When I’m leading these yarns I always set the tone by saying a couple of things. The child is doing their best. The parent or carer is doing their best. We are doing our best to support the carer. Let’s start with that assumption that everyone is doing their best and start with that assumption and lets see if we can get somewhere.
18:50 Are there any resources that may be helpful for families that you would like to reference?
The Australian Childhood Foundation have been really prominent in propagating their understanding of Childhood Trauma. Dan Hughes and Jon Baylin released a document last year. Start to think about openly. What if my brain is actually doing things that I cant help. Just like all of my support team are saying the remember your child is doing their best I need someone to do that for me. That’s a good read and these podcasts and others like it. Even though you may have heard it before.
20:17 Anything else you want to mention today?
Managing the crises and the roles of hospitals and things like that. I think its important to know that there is always a crisis service out there for you. It may be frustrating when you go to hospital with a self harming or suicidal child and you get told its ok you can take them home. This is where that openness and yarns are really helpful. Help me understand why this is happening. It’s really hard to do that in the moment because you are really worried about your child but its really important to know that there are systems out there. One of the things I often get asked about is the hospitals and in patient admission. I work in hospitals a lot and it’s really something that we would like to provide to families as a respite or as a break. But there are other things that come with that. Because of resources and the way things are working, sometimes it’s actually not the safest place. I’ve seen lots of children go in and come out in a worse condition. Or find that transition from that environment to home really difficult. One of things is I advise all the families I work with to always maintain safety. Its always ok to go to hospital and sit there for 7 hours if its needed to regulate your child. Id rather do that than put your kid in hospital. Despite the impact on work and sleep and all the other things. Id much rather do that more times and do that repeatedly than have them admitted in as a patient. Children that have been traumatised really struggle in that environment. The nuances they have to manage with other people that are really unwell in there. Its hard enough to manage their relationships at school. Imagine in an intense cage with really unwell people. Sometimes its ok to be in that sense. But the purpose is to change the environment so that your child’s regulatory system comes back online. That’s probably one of the important messages from a doctor and hospital perspective that you often wont hear about. If there are opportunities for conversations about this we can be more open to it.
Again it is about the relationship and everything seems to come back to the relationship. Again the message is I don’t blame you for wanting to cut yourself or wanting to die. This is what parents brains might really struggle with. That’s the message. I don’t blame you for this but we are going to do whatever it takes to keep you safe. If I have to sit with you here for 5 hours that is exactly what Im going to do Yes the other health practitioners and services might have other suggestions and other things to say. But you and I together are going to keep you safe.
It takes a lot of self regulating though to get to that point. That’s where its not easy to do on your own and you may need to involve other people. You can see the layers.
Thankyou for the advice and your time today.
