How to help your child navigate the emotional aftermath of a traumatic event

By Dr. Sheila Modir, pediatric psychology post-doctoral fellow at CHOC Children’s

It’s difficult for adults to make sense of a tragedy, so consider how difficult it can be for children. To help parents support their children as they navigate trauma either in their own lives or process a tragic event they see on the news, consider the five E’s of helping a child navigate the emotional aftermath of a traumatic event: 

  • Explore what your child already knows in a gentle and calm manner. You can start with a neutral question inquiring about how their school day was or if anything happened while they were at school.
  • Explain what has happened in a way that your child can understand based on his/her age.
    • This is the time to address any misinformation your child might have picked up at school and help them understand that a scary thing did happen, but also reassure their sense of safety as schools and adults work hard to keep their children safe on daily basis.
    • Limit information that you provide to your child to the questions that they ask you, so that you avoid overwhelming them with information that they may not already have been exposed to.
    • You can provide examples of ways you and others in your community keep your child safe every day (i.e., how when you drop them off at school in the morning and you look both ways before crossing the road, how doctors are working hard to help the children that have been hurt).
  • Express to your child that feelings are normal and it is okay to feel sad, mad or angry when a tragic event occurs. Remember to reduce media exposure after a traumatic event, as repeated exposure to the event has been associated with psychological distress and intensifying already heightened emotions.
  • Emotionally model for your child healthy expression of feelings as children take their cues from their parents. Describe how you cope with your distressing emotions to your child (i.e., When I feel scared when something bad happens to me, I talk about it with someone who makes me feel safe or I take three deep breaths).
  • Ensure stability by continuing to adhere to your child’s daily routine. This will provide them with a sense of reassurance and safety during a chaotic time. Engaging in a daily routine is not meant to ignore what has happened, rather to continue to provide the child with structure, stability, and predictability.

If you are struggling to help your child process a traumatic event, or if you feel your child could benefit from additional support, ask your pediatrician for a referral to a pediatric psychologist or psychiatrist.

Below are a few additional resources on coping with trauma that I often share with my patients and their families:

Helping Children Survive the Aftermath– Florida International University

Mobile App: PTSD Family Coach– U.S. Department of Veterans Affairs

Responding to a School Crisis– The National Child Traumatic Stress Network

Resources for Parents and Caregivers– The National Child Traumatic Stress Network

Helping Traumatized Children: A Brief Overview for Caregivers– Child Trauma Academy

Tragic Events: Parent Resources – The Fred Rogers Company

Learn more about mental health services at CHOC

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Veteran Nurse to Help Lead CHOC Mental Health Inpatient Center

After spending time with a relative with a mental illness, Dani Milliken knew as early as age 6 that she wanted to help people who struggle with mental illness when she grew up.

“From that point on, I dreamed of working as a psychiatric nurse,” Dani says. “I am so fortunate that I get to come to work every day and love what I do. My passion in life is psychiatric nursing; it always has been and it always will be.”

mental health nurse
Dani Milliken. clinical director of CHOC’s inpatient mental health center

Dani will put that passion – as well as a wealth of experience in establishing a pediatric inpatient mental health unit – to good use as clinical director of the CHOC Children’s Mental Health Inpatient Center, set to open next spring.

Before joining CHOC in June, Dani helped design and operationalize a pediatric inpatient mental health unit at Nationwide Children’s Hospital in Columbus, Ohio. Previously, she spent four years at Twin Valley Behavioral Healthcare, a state-owned and -operated inpatient psychiatric hospital in Ohio. There for four years, she served in a variety of roles, most recently as assistant director of nursing.

Dani hopes her work at CHOC will set the standard of care for psychiatric nursing across the country, as well as help remove a stigma that persists around patients with mental illness and the clinicians who treat them.

“Unfortunately, there can be incredible amounts of stigma surrounding not only the patients on an inpatient psychiatric unit, but also the staff that works there,” she says. “I look forward to teaching everyone about quality psychiatric treatment, and what it means to be a real psychiatric nurse.”

Dani earned her bachelor’s degree in nursing from Mount Carmel College of Nursing, and went on to receive her master’s degree in nursing administration. She is currently working toward a doctorate in health care administration.

Though much of her free time is spent getting settled in Orange County after a cross-country move, Dani looks forward to hiking and biking with her husband and dog, as well as quilting and sewing.

In her short time at CHOC, Dani already has been impressed with the culture of collaboration, accountability and respect.

“I am inspired at the amount of teamwork, collaboration and respect that I have encountered during meetings with various disciplines,” she says. “All of these things speak loudly about the level of quality care being delivered to patients here at CHOC. I am thrilled to be a part of this amazing team!”

Upon its opening, CHOC Children’s Mental Health Inpatient Center will be the first pediatric inpatient mental health center in Orange County to accommodate children younger than 12.

With 18 private rooms in a secure and healing environment, the center will provide a safe, nurturing place for children ages 3 to 18, and specialty programming for children younger than 12.

The center is the cornerstone of CHOC’s efforts to create a pediatric system of care for children, teens and young adults in Orange County with mental illness. One in five children – about 150,000 in Orange County – will experience a diagnosable mental health problem.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

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Meet Dr. Alyssa Saiz

CHOC wants its patients and families to get to know its specialists. Today, meet Dr. Alyssa Saiz, a postdoctoral fellow in pediatric psychology and neuropsychology.

Q: What is your education and training?
A: I attended Pepperdine University to complete my doctorate in clinical psychology. My clinical internship was at the University of Health Science Center San Antonio. I am currently near the completion of my two-year postdoctoral fellowship in pediatric psychology and neuropsychology.

Q: What are your special clinical interests?
A: My clinical interests are working with children and teens with depression and self-harming behaviors, as well as somatic symptom and related disorders. I also am developing my specialty in pediatric neuropsychology. I love being able to help people during the most confused and vulnerable time in their life, and hope to give them a future they can thrive in.

Q: How long have you been on staff at CHOC?
A: Three years.

Q: What are some new programs or developments within your specialty?
A: CHOC is in the process of building both an intensive outpatient program and Mental Health Inpatient Center for children and teenagers through the Mental Health Initiative. This is very exciting because the services provided by both of these programs are greatly needed in our community and will help us provide even better comprehensive and intensive mental health care.

Q: What are your most common diagnoses?
A:  Somatic symptom disorders, depression, and anxiety.

Q: What would you most like community/referring providers to know about you or your division at CHOC?
A:  As a department, we are growing and evolving with the community, working on research developments and supporting CHOC’s mental health initiative – all for the happiness of the population here. We are here to serve them, and working hard with them in mind each day. For me personally, I would love for people know how much of a passion this is for me – I’m here doing this work because I truly love it, and admire the courage of my patients and coworkers.

Q:  What inspires you most about the care being delivered here at CHOC?
A:  The aspiration to always give more and provide better services to the children and families we work with, as well as the commitment to training the future generations of medical and mental health professionals.

Q: Why did you decide to become a doctor?
A: I am insatiably curious and always wondering how to improve a situation. I also love to connect emotionally with people and understand their journey. So naturally, I was always drawn to psychology as an area of study and found myself looking for opportunities to work with children and teenagers who were experiencing hardship or mental health concerns.

Q: If you weren’t a physician, what would you be and why?
A: I would be a florist or have a ranch for rescued animals. Both very different paths, but in the end they’re creating beauty to enhance someone else’s life and provide joy.

Q: What are your hobbies/interests outside of work?
A: I love to cook (usually anything pasta or cheese-filled) and be outside (hiking, walking my family’s dog, and being in the sun). I am also currently learning Spanish, which I am very excited about!

Q: What is the funniest thing a patient has ever told you?
A: When I told a young patient I was going to get her mom from the waiting room, she replied, “Well, she’s probably getting coffee. She can’t live without coffee!” I can relate. Kids hear and take in everything!

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

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Meet Dr. Elisa Corrales

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Elisa Corrales, a pediatric psychologist.

Dr. Elisa Corrales
Dr. Elisa Corrales, a pediatric psychologist at CHOC Children’s

Q: What is your education and training?
A: I completed my bachelor’s degree at the University of California, Davis where I majored in psychology. I earned my master’s and doctorate degrees in clinical psychology at The University of Rochester in New York. While there, my research interests included studying factors of resilience in maltreated Latino children and identyfying patterns of neuroendocrine functioning and behaviroal outcomes in maltreated and non-maltreated populations. After graduate school, I completed both my predoctoral internship and postdoctoral fellowship at Childrens Hospital Los Angeles (CHLA), where I gained specialized training in parent-child interaction therapy, individual child and family therapy, and the diagnosis and treatment of children with various developmental disabilities including autism spectrum disorders. At CHLA, I also completed the Leadership Education in Neurodevelopmental Disabilitites (LEND) Training Program and gained vast experience working with interdisciplinary teams and pediatric populations.

Q: What are your administrative appointments?
A: Currently, I am working as a pediatric psychologist in CHOC’s co-occurring clinic, which specializes in working with children who face both a chronic medical condition and mental health concerns. I recently joined one of our primary care pediatricians in a clinic focused on ensuring the safety and well-being of children and families in Orange County who have been referred to social services often for suspected child abuse or neglect. In this clinic, I provide needed mental health consultation, psychoeducation, case management and support.

Q: What are your special clinical interests?
A:  Throughout the years, I have specialized in working with children who often present with difficult or severe behavioral issues. I also specialize in treating children who have been victims of trauma or child maltreatment.

Q: How long have you been on staff at CHOC?
A:  One year.

Q: What are some new programs or developments within your specialty?
A:  As part of CHOC’s mental health initiative, the psychology department will be starting the intensive outpatient program within the next year. This program will be dedicated to working with children who are struggling with complex issues. The aim of the program is to prevent re-hospitalization.

Q: What are your most common diagnoses?
A: The majority of children I work with are often stuggling with issues of depression and/or anxiety.

Q:  What inspires you most about the care being delivered here at CHOC?
A: A few years ago, my youngest child suddenly and unexpectedly became very ill and I found myself living at CHOC for approximately two weeks. It was one of the most frightening and emotionally difficult times in my life, but I was able to experience firsthand the amazing care provided by both the CHOC medical and mental health teams. Despite the fact that we were one family among many in the unit, my family was always treated with compassion and sensitivity; everyone who walked in the room was dedicated to helping my family. I am forever grateful for the support I received, and after that experience I decided that the CHOC team was without a doubt one that I wanted to join.

Q: What excites you most about CHOC’s mental health initiative?
A: I am excited that we will be able to help even more children in Orange County and provide specialized care to populations of children in critical need.

Q: Why did you decide to become a doctor?
A:  Before I applied to graduate school, I was working as a probation officer in the Sacramento County juvenile hall. I worked with children on a daily basis who were in need of mental health treatment and not incarceration; after this experience, I was committed to working with struggling youth.

Q: If you weren’t a physician, what would you be and why?
A:  I would love to be a chef or attend culinary school.

Q: What are your hobbies/interests outside of work?
A: I love dancing —salsa and cumbia are my favorite. I also love cooking.

Q: What have you learned from your patients?
A: Never underestimate resilience in children. In the face of extreme adversity, many children can succeed and will accomplish just about anything.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

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Mindfulness Tips for Teens

Teens’ mental health is as important as their physical health. It’s not always obvious when a teen is struggling emotionally, but recognizing the symptoms and seeking early and effective mental health services are important to prevent more serious mental health issues.

Parents should talk to their teens and foster a relationship based on open communication. Seek to understand how your child is feeling, without judgment, before you try to fix the problem.

As a pediatric psychologist at CHOC Children’s Hospital, Dr. Mery Taylor helps teens and their families who are facing a variety of mental health challenges. Typical concerns or issues teens seek treatment for include:

  • Anxiety
  • Depression
  • Difficulty coping with stressors such as: chronic illness, a life or family change, a social or school concern, and grief and loss
  • Disruptive behavior disorders, including attention deficit/hyperactivity disorder (ADHD) and oppositional defiance disorder (ODD)
  • Eating disorders

“Throughout my ten years at CHOC, a majority of teens I have worked with have come to me for pain issues, anxiety, depression, eating disorders and difficulty coping with stress,” says Taylor. “I have also seen an increase number of transgender youth and parents seeking services.”

mindfulness
Dr. Mery Taylor, pediatric psychologist at CHOC Children’s

What is mindfulness?

Practicing mindfulness, or relaxation techniques can help teens build coping skills to address issues, such as anxiety disorders. It’s very easy to get wrapped up in our emotions and not see our way out of them, says Dr. Taylor.

“The more we attend to the fear, the more power it gets and we can become paralyzed about what to do, or avoid aspects of our life in attempt to manage the anxiety. We can get stuck on a cycle of trying to avoid our anxiety and forget to live life. At times, we allow our negative thoughts and emotions to dictate our actions without stopping to assess if they are valid and irrespective of the consequences. For example, we might avoid going to school because we don’t feel we have studied enough for a test and then end up missing out on important instruction for another class. Mindfulness makes us stop for a minute and check in with ourselves,” says Dr. Taylor. “Mindfulness asks us to be curious of our thoughts and feelings without judgment or action—to just be in the moment. Developing acceptance and compassion for the painful parts of our inner emotional life can weaken the power of the anxiety. Once weakened, we can better manage our fears.”

Tips for practicing mindfulness:

  • When something is bothering you, shift that attention to yourself, rather than what you’re reacting to.
  • Stop for a moment to center yourself, by addressing and labeling those sensations (fear, worry, anger). Validate these feelings to ourselves can help to lessen our fight or flight reaction.
  • Now turn to your attention to your body. Identify the sensations going on in your body. All emotions are experienced as sensations in our body.
  • If you find yourself attending to the thoughts or feeling again, gently bring your focus to your body sensation (e.g., muscle tension, heartbeat, etc.).
  • Practice relaxation techniques to calm the nervous system, to stop the nervous reaction and respond more cognitively. For example:
    • Autogenic relaxation. Autogenic means something that comes from within you. Visualize a peaceful setting. You can repeat a phrase such as, “I am relaxed” to invoke muscle tension release. Focus also on breathing slowly and evenly.
    • Progressive muscle relaxation. In this relaxation technique, you focus on slowly tensing and then relaxing different muscle groups in your body. You can start with clenching your hands into a fist and then relaxing them. Focusing on the difference between muscle tension and relaxation, will help you become more aware of physical sensations.
    • Form a mental image of a place that find to be peaceful and calming. To relax imagine yourself exploring this place. Try to incorporate as many senses as you can, including smell, sight, sound and touch on your journey. If you imagine relaxing at the beach and feel the cool sand on your felt, and sound of the crashing waves
    • You probably already know other things that calm you (e.g., listening to music, taking a shower, walking your dog, etc.). You can do those things too.

Parents can help facilitate mindfulness.

“Being non-judgmental is a big part of mindfulness,” says Taylor. “It’s important to accept that we do what we can, and that we have limitations. It’s important to acknowledge everything you have going on in your life that’s happening at once, and to give yourself a break.”

“A parent might acknowledge and normalize the anxiety associated with college applications as a way to show compassion and thereby minimizing the urgency that the teen feels. Once more calm, the teen can focus on the college application, instead of attending to the distressing thoughts and feelings.”

Parents hoping to teach mindfulness practices to their teens are also encouraged to model the behavior themselves, says Taylor. Remind teens that practicing mindfulness can also improve concentration at school and improve performance.

CHOC believes mental health treatment should be fully integrated with physical health treatment. Our psychology team works closely with patients’ medical teams to attend to emotional, behavioral and developmental needs through inpatient and outpatient therapy. Our goal is to foster the whole well-being of the teen and family.

CHOC psychologists have recorded a library of guided imagery audio tracks to help children and teens relax, manage pain, ease fears and anxiety, fall asleep easier and more:

Experience guided imagery as a healing tool

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