As a clinician who has worked in clinical and non-clinical roles in juvenile hall, residential treatment, shelters, and with foster and adoptive families, I know firsthand how challenging it can be to receive adequate training and support to learn best practices in working with system-involved youth. In my experience, the lack of training in family-centered approaches led to programming that failed to provide comprehensive support to the adolescents, youth, and families with whom I worked. As I continue my career and learn more about trauma and resilience informed approaches, I realize family-centered work requires one to be adaptable, flexible, and empathetic. I often reflect on how these strategies could have impacted and improved my work in the past.

As a trainee, I worked with a young person using an evidence-based exposure model of therapy. I was excited to use these skills, as I had just learned the model. Eager to follow it with fidelity, I followed my supervisor's recommendation to complete one parent session before the youth shared her trauma narrative. During the session, it was clear to me that the parent was overwhelmed, dysregulated, and needed much more support. I wish I had been coached on being adaptable and updating my plan for this family by providing additional parenting support and referrals for individual services.

While collecting my pre-doctoral hours, I worked with Sandy*, an adolescent in foster care, whose foster mother, Kris*, expressed concern about the way Sandy expressed her affection. Sandy was a withdrawn and socially awkward adolescent who had experienced severe neglect from being left alone with her older siblings at a very young age, often with little or no food. Sandy and one of her siblings had been in Kris' care for three years. Kris expressed love and affection towards Sandy but felt it was not reciprocated. Instead of emphasizing a trauma informed approach by educating Kris on Sandy's reasonable distrust and loss of safety, I was supervised to emphasize to Kris that this was a part of Sandy's adolescence. In hindsight, I could have explained the impact of the trauma Sandy experienced, despite it having occurred when Sandy was young, and supported Kris in being patient and having reasonable expectations. Incorporating a flexible approach guided by this particular family's needs such as integrating more family therapy, family cohesion building activities, and referring Kris to a support group for resource parents would have also been beneficial.

I had another experience as a trainee when I was providing group therapy to a group of boys in juvenile hall. I was instructed to put together an anger management group and provide skills to the incarcerated youth. Even the topic of the group felt stigmatizing. Instead of focusing on developing coping or life skills, the focus centered on addressing a "problem" that young boys in juvenile hall have (anger) and how to support their disciplined behavior (management). I was specifically instructed to not emphasize emotional processing and regulation in the group. Now I am much more familiar with the importance of emotion regulation when building resilience, and I wish I had emphasized this skill, as well as an opportunity to model empathy. Since this experience, many clients have expressed the power of hearing someone say, "That sounds really challenging." In hindsight, incorporating the individuals' family experiences and their roles into this group would have also benefitted the youth and helped meet them where they were at.

My experience is not uncommon. I have since worked with hundreds of clinicians and trainees from around the country who have shared similar experiences. I now know how simple emotion regulation tools, such as the Feeling Thermometer, can be adapted to be used when providing care to a child or to create a shared language with a family. This shared language can have a huge impact on family communication, particularly during challenging moments.

As providers, we must support one another and emphasize building on best practices. By sharing and adapting to updated terminology, expressing flexibility in working with individuals and families, and showing empathy to our clients and ourselves, we can improve the treatment we provide to adolescents and youth.

Enroll in Enhancing Family Engagement Through Adaptive Practices on the Wellbeing for LA Learning Center and explore ways providers can integrate a family-centered and trauma informed approach into their work with families.

*Names and details have been changed.