Alaska Behavioural Health Child & Family Clinic:

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.  ARC was developed for children and adolescents who have experienced complex trauma, together with their caregiving systems.  The term ‘caregiving system’ is understood to encompass 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 individual and organisational levels.  ARC identifies and seeks to address childhood competencies and skills shown to be negatively impacted by attachment disruptions and / or traumatic stress. The ultimate goal of ARC is to support children, adolescents and their caregivers in moving from a survival-focused state to one of empowerment and active engagement with the world.

ARC has three principal intervention domains and 8 treatment targets within these, as below:

1) Attachment:

This domain focuses on strengthening the caregiving system via enhancing supports, skills and relational resources for adult caregivers. Key intervention targets include:

• 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 to create a sense of safety.

2) Regulation:

This domain supports children and caregivers in developing awareness and skills for identifying, understanding, tolerating and managing internal experiences. Intervention targets include:

• Supporting awareness and understanding of feelings, physiological states and associated thoughts and behaviours.

• Building increased capacity to tolerate and manage emotional and physiological experiences.

• Supporting communication of emotional experience within relationships.

3) Competency:

This domain focuses on enhancing resilience in stress-impacted populations. Key targets include:

• Increasing opportunity for choice and empowerment, which builds executive functioning.

• Encouraging exploration of self and identity, enabling children to develop coherence and build a narrative around their life experiences and future.

Overarching all three of these domains is the final ARC building block – Trauma Experience Integration.  This area focuses on developmentally tailored strategies to address traumatic memory, triggered states and trauma related cognitions.

During our conversation, Amanda shared that a large portion of Alaska Behavioral Health’s clients are care-experienced. She explained that in the U.S, children in foster care have the option to stay with their foster families until the age of 21, enabling ongoing access to a caseworker and funding for medical and educational needs. However, this option depends on young people having a positive 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)