My second fellowship meeting was with Amanda Nalewaja, (LCSW), Clinical Operations Manager at the Alaska Behavioural Health Child and Family Clinic.
Amanda introduced me to the Attachment, Regulation and Competency (ARC) framework. The ARC framework was developed for children and adolescents who have experienced complex trauma, together with their caregiving systems. The term ‘caregiving system’ is understood to encompasses primary (e.g. biological, kin and foster parents) and organisational (e.g. teachers, youth services, residential home) care.
ARC is a flexible framework that can be applied at both an individual and organisational level. ARC identifies and seeks to address childhood competencies and skills shown to be negatively impacted by attachment disruptions and / or traumatic stress. ARC’s overarching goal is to support children / adolescents and caregivers to move away from a place of survival to an empowered and future oriented position of engagement with the world.
ARC has three principal intervention domains and 8 treatment targets within these, as below:
Attachment: Strengthening the caregiving system via enhancing supports, skills and relational resources for adult caregivers.
What this might look like in practice (intervention targets):
Supporting caregivers to recognise and manage their own emotional states.
Enhancing attunement in the caregiver-child relationship.
Developing consistency and appropriateness of caregiver response.
Implementing predictable routines and rituals.
Regulation: Developing awareness and skill in identifying, understanding, tolerating and managing internal experience.
What this might look like in practice (intervention targets):
Supporting awareness and understanding of feelings, physiological states and associated thoughts and behaviours.
Supporting increased capacity to tolerate and manage emotional / physiological experience.
Supporting communication of emotional experience in relationship.
Competency: Addressing key factors associated with resilience in stress-impacted populations.
What this might look like in practice (intervention targets):
Increasing opportunity for choice and empowerment (building executive functions)
Exploration of self and identity (building coherence through the development of a narrative around key life experiences, future orientation).
Overarching all of the above domains is the final ARC building block – Trauma Experience Integration. Trauma Experience Integration encompasses developmentally tailored strategies to address traumatic memory, triggered states and trauma related cognitions.
Amanda discussed that a big proportion of the Alaska Behavioural Health client base were care-experienced. She explained that in the US, children in foster care had the option to choose to stay with their foster family until the age of 21 (enabling continued access to a case worker and to funds for medical treatment and education). However, this was dependent on children having a good experience of foster care. We acknowledged that even if young people did remain in care until the age of 21, this was still an incredibly young age to be moving into an ‘adult’ world without support.
(With thanks to Amanda for her time and to Jessica Cochran, Alaska Behavioural Health, for organising the visit)
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