Melody (not her real name) was removed from her home at age four after neighbors reported that she was left alone for several days. She was put into a traditional foster home and not with Community Treatment Solutions. Psychological tests showed that Melody was significantly delayed in her language skills and she often had enuresis and encopresis. She had virtually no hygiene habits and was malnourished. An evaluation of the home environment discovered that Melody’s mother made a living by prostituting.
At age 9, Melody came to Community Treatment Solutions after she was again removed from her mother’s home, this time for physical abuse and neglect. At intake, it was determined that Melody’s mother was prostituting again but that this time, in order to avoid leaving Melody alone, she was working out of her home. Melody came to CTS dirty, made no eye contact and pulled clumps of hair out of her head. She continued to present as significantly developmentally delayed. If an adult sat close to her, her entire body would shake and she would move away.
As part of the CTS initial assessment process, CTS prefers to have supervised visits after admissions and for the first 30 days, between a youth and her abusing parent. This enables the clinician to better evaluate the relationship and communication between parent and child as well as teach the parent new parenting skills. In Melody’s case, we were ordered to allow unsupervised visits out of the treatment home because Mom and Melody had “a good relationship.” On their first unsupervised visit, Mom and Melody went to a movie together. On the second, Mom was going to take Melody to a mall. They never came back.
Melody was readmitted to CTS this summer, at age 17. She was admitted to the CTS human trafficking program, Better Access to a Safe Environment (BASE). We learned that Melody had been a victim of human trafficking off and on since she left us at age 9. Her mother was her handler. Melody had not been in school for the last three years, she made no eye contact, was angry and oppositional. While it normally takes a clinician 48 hours to do a thorough evaluation of a youth, it took weeks to accomplish this with Melody since she refused to talk and she gave contradictory information. Her medical evaluation indicated evidence of sexually transmitted disease and she had stopped having periods. Melody saw this as positive because this meant that she did not have to use birth control. However, Melody had relinquished custody of a daughter who was two years old at time of Melody’s admission to CTS. Melody was also diagnosed as with juvenile diabetes and a severe case of eczema. While in the shelter before she was admitted to us, she exhibited “strange behaviors” according to the shelter notes. These behaviors included head banging, refusing to eat and talking to herself. She still wet the bed at night.
The CTS thorough multidisciplinary team, which included the psychiatrist, clinician, case manager, pediatrician, treatment parent and Melody, determined that Melody was a victim of complex trauma. Melody had been abused and neglected by her mother, witnessed her mother being physically abused by her Johns, was sexually, physically and emotionally abused by the people for whom she performed sexual acts, emotionally abused by her pimp and bullied by her peers for wetting the bed. In addition, Melody was medically compromised and had not had any health care in over three years. While her behaviors appeared to be symptoms of psychiatric and psychological disorders, we found that in reality, they were symptoms of this trauma and her medical conditions. Complex trauma outcomes refer to the range of clinical symptomology that appears after exposure to trauma. These symptoms extend far beyond Posttraumatic Stress Disorder and manifest themselves in impairment of multiple domains such as a) self-regulatory, attachment, anxiety, and affective disorders in infancy and childhood; (b) addictions, aggression, social helplessness and eating disorders; (c) dissociative, somataform, cardiovascular, metabolic, and immunological disorders; (d) sexual disorders in adolescence and adulthood; and (e) revictimization (Trauma Child Traumatic Stress Network).
The treatment team prioritized Melody’s needs and strengths. Due to the fact that Melody was so difficult to engage and ran away on a regular basis, it was more difficult than usual to identify her strengths and to address the first priority, her medical issues. We did see a pattern in her runaway behavior though. She always came back. If she ran away on the weekend she always came back on Monday morning. If she ran during the week she came back before the end of the fourth day because she knows that CTS is able to keep beds open for a youth for only four days after they AWOL. So the treatment team set up all her appointments for her “comeback” day. The treatment parent cleared her calendar for the day so she could be available for Melody. She welcomed her “home.” This continued for three months until Melody stopped running away.
Once Melody was more accessible, the team began to address the treatment and medical priorities. As her blood sugars stabilized so did her mood swings and bed wetting. Medication cleared her other medical conditions. We enrolled her in school. As Melody become more physically stable we began her psychotherapy. We facilitated Melody’s participation in a journaling program, she joined the drill team, she took dance lessons and she went to yoga. Progress in therapy was slow because there were too many things that Melody did not want to relive or remember. CTS clinicians are experts in interventions with youth who have been traumatized so the clinician took cues from Melody as to how much she could tolerate.
Melody is going to be discharged from CTS soon. She has received her GED, scoring 720 out of a possible maximum of 800. Melody has been accepted to the police academy. She has been in contact with the agency where her daughter has been placed in an attempt to regain custody. Melody is focused, happy and hopeful for her future as well as her daughter’s.