Complex Trauma Training, Natalie Turner, 01.11.12

Transcript Complex Trauma Training, Natalie Turner, 01.11.12

Understanding Complex Trauma: Strengthening Supporting Learning Environments through a Trauma Sensitive Lens

CLEAR Collaborative Learning for Educational Achievement and Resiliency January 11 th , 2012

Complex Trauma

        The exposure to continuous trauma in childhood Both the being exposed to and having to adjust to this constant stress Begins early in life Occurs during most important time of development Children must be ready to react to the environment which takes energy away from healthy development Unpredictable Chronic Often occurs in episodes Copyright 2011 WSU Area Health Education Center

Trauma As A Fact Of Life

 In one large study, 90% of respondents reported at least one lifetime traumatic event with the average number of 4.8 traumatic events in their lives (Breslau et al., 1999)   ◦ ◦ Reports of adverse events in childhood predict risk of ◦ Lifetime physical health problems Mental health problems Health risk behaviors ◦ Subsequent intimate partner victimization Remember, the outcomes of trauma are not written in stone. Resilience, healthy relationship, and intervention can increase a child’s chance of success significantly Copyright 2011 WSU Area Health Education Center

“Children are like wet cement. Whatever falls on them makes an impression."

– Hiam Ginott

4 universal brain principles

Our brains are designed to benefit from rich and supportive intimate social relationships.

Brain function must occur in a certain order. We feel and then we think.

Brain systems change with use throughout life. ◦ Persistent stress is toxic to the brain.

What we don’t use as our brain is developing, we lose.

The brain cannot mature when it must respond to persistent threat

• • • • • The brain must focus on survival rather than normal development Can lead to delays in language and reasoning Can lead to difficulty with learning because of always looking for danger Trouble connecting reason with feelings Many of the “human” brain functions like reason and impulse control get lost because these brain functions are “use it or lose it” Copyright 2011 WSU Area Health Education Center

Threat Appraisal and Detection in Traumatized Children

Implications Of Trauma On Biological Threat Response System

 If we are using our trauma lens, we see that behavior is biological because it is filling a need. All behavior is functional. This means that when we look at the behavior in a child or adult, blame has no place.

Labels we often give trauma affected kids

 Lazy  ADHD        Manipulative Antisocial Defiant Rebellious Uninterested Oppositional Liar   Uncaring Others?

Overall Trauma Impact on Development

       Difficulty understanding what they feel and how to cope with it Difficulty expressing what they feel Difficulty understanding the link between behavior, feelings, and experience     Difficulty maintaining comfortable arousal Feel like they can’t impact their world   Difficulty planning, problem-solving, organizing information, and delaying response to stimuli.

 Believe they are not capable or competent Negative self-concept Blame themselves for not succeeding Difficulty reading social cues Overly rigid or too diffuse boundaries Lack of trust or over-dependent on others Difficulty sustaining attention and concentration And more Copyright 2011 WSU Area Health Education Center

Implementation Science and Innovation Success

Odds for Academic and Health Problems with Increasing ACEs

Academic Failure Severe Attendance Problems Severe School Behavior Concerns Frequent Reported Poor Health Three or More ACEs N =248 Two ACEs N=213 One ACE N=476 No Known ACEs =1,164

3 2.5

1.5

1.0

5 2.5

1.0

6 4 2.5

1.0

4 2.5

1.0

Odds Ratios for School and Behavioral Problems with Increasing ACEs in the RTL Population

Academic Failure* Poor Attendance School Behavior Behavioral Health Problems Four or More ACES N=663 Three ACEs N=756 Two ACEs N=1,141 One ACE N=1,612 No Reported ACES N=1,020

2.0

1 1 1 -- 5.3

3.0

2.5

1.6

1 3.1

1.5

1.6

1.2

1 6.5

2.0

1.8

1.2

How do ACEs affect student performance?

ACEs and Percent Initial Attendance in Grades K-12

100% 98% 96% 94% 92% 90% 88% 86% 84% 82% 80% Percent Initial Attendance K-12 No Reported ACEs N=578 91% One ACE N=800 90% Two ACEs N=537 88% Three ACEs N=409 88% Four or More ACEs N=383 85% Copyright 2011 WSU Area Health Education Center

The ARC Model

Trauma Experience Integration Affect Identification Executive Functions Self Dev’t & Identity Dev’tal Tasks Modulation Affect Expression C

ompetency Self-

egulation

Caregiver Affect Mgmt.

Attunement Consistent Response

Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

Routines and Rituals A

ttachment

The 3-part model

Thus forcing the child to put energy into survival rather than healthy development, leaving them with developmental deficits What a child has come to understand is dangerous Will lead to a physical and/or behavioral response that tries to fill a need and find safety Copyright 2011 WSU Area Health Education Center

How do I ‘do’ ARC?

    Not a ‘recipe’- more of an art Changes to meet the needs of individual children Doesn’t just target an outcome, targets an understanding of “why” Evaluation of a child’s needs must be on going as needs may change

Attachment

 Caregiver affect management- Keep Calm and Carry On  Attunement- Accurately read another’s cues and respond appropriately  Consistent Response- If you do A, I will do B  Routines and rituals- Provide a predictable sequence of events

Self-Regulation

   Affect Identification- The ability to identify an emotion and tell it apart from other emotions Modulation- The ability to maintain a comfortable, appropriate level of arousal Affect Expression- The ability to share emotional experience with others and with self in a safe and healthy way

Competency

   Executive functions- Learning to act with thoughtfulness as opposed to reacting based solely on emotion and arousal Self Development/Identity- Coming to know the intricacies of oneself in an accepting way, especially as it pertains toward personal growth Trauma Integration- Finding ways the self is fragmented, identifying how to make a conscious choice, and processing specific events

Caregiver Affect Management

    The main idea: Support staff in understanding, managing, and coping with their own emotional responses, so that they are better able to support the children in their class Before a caregiver can help a child manage emotional experiences, the caregiver must manage their own emotional experiences Foundational skill of the ARC model Caregiver affect management directly impacts a child’s experience of environment Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

Attunement

   The main idea: Support staff in learning to accurately and empathically understand and respond to children’s actions, communications, needs, and feelings  Attunement is the capacity to accurately read the emotional, cognitive, behavioral, and physiological cues of another that are both verbal and non-verbal and respond appropriately  Children who have experienced complex trauma often lack the skills to easily identify and communicate what they are feeling and cope with difficult emotions the iceberg and respond to what is underneath Identifying student’s triggers and danger response Reflective listening skills  How do we interpret the meaning behind behavior? Look pass the top of Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

Consistent Caregiver Response

    The main idea: Support staff in building predictable, safe, and appropriate responses to children’s behavior in a manner that acknowledges and is sensitive to the role of past experiences in current behavior Predictability builds sense of safety in environment Limit setting as potential trigger for feeling powerless Predictability over time allows children to relax vigilance and control and put their energy into normal development Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

Routines and Rituals

     The main idea: Support staff in building routine and rhythm into the daily lives of children and families Again! Predictability builds sense of safety Routine vs. ritual Target building routine particularly around areas of vulnerability Transitions can be especially difficult Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

Affect Identification

  The main idea: Work with children to build an awareness of internal experience, the ability to discriminate and name emotional states, and an understanding of why these states originate  Children who have experienced poor caretaking and poor emotional support may have never developed healthy ways to identify what they are feeling Children may miscue others as a way of protecting themselves from emotions that feel unsafe  Limited skill set may be easily overwhelmed by state of arousal Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

Modulation

    The main idea: Work with children to develop safe and effective strategies to manage and regulate physiological and emotional experience, in service of maintaining a comfortable state of arousal “Children who experience unresponsive, inconsistent, or abusive caretaking may fail to develop healthy age appropriate skills and instead must rely on primitive regulation strategies.” Young children rely on their caregivers to modulate for them, thus helping develop these skills These strategies may include:  ◦ ◦ Failure to regulate Over-regulating/constricting Children who can’t modulate may compensate by ◦ Over-controlling or shutting off emotional experience ◦ Manage emotional experience with physical stimulation ◦ Turning to external methods to alter or control physiological experience.

Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

Affect Expression

   The main idea: Help children build the skills and tolerance for effectively sharing emotional experience with others.

The ability to effectively communicate feeling is directly related to the ability to build relationship and master important developmental tasks.

When children’s emotional environment is rejecting, angry, or indifferent, they often learn their emotions are shameful and should be kept hidden.

  Hiding emotions may help children who have experienced complex trauma feel more in control and able to navigate feeling unsafe.

Trauma may impact affect expression in children by: ◦ Failure to share emotions ◦ Emotions emerging in unhealthy ways ◦ Communicating emotions ineffectively ◦ Over-communication

Strengthen Executive Functions

   The main idea: Work with children to act, instead of react, by using higher order cognitive processes to solve problems and make active choices in the service of reaching identified goals Include impulse control, purposeful decisions, considering consequences, understanding outcomes, problem solving, etc.

Executive functions are sacrificed in developing individuals who are trauma affected. Instead, the danger response is activated ◦ ◦ ◦ arousal Provide a sense of control and ability to impact the world Bring conscious thought to actions Increase likelihood of developing high resilience  The development of executive functions can: ◦ Serve as a way to modulate intense Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

Self-Development and Identity

  The main idea: Support children in exploring and building an understanding of self and personal identity, including identification of unique and positive qualities, development of a sense of coherence across time, and support in the capacity to imagine and work toward a range of future possibilities “Children who are routinely rejected, harmed, or ignored internalize an understanding of self as unlovable, unworthy, helpless, or damaged.”   ◦ ◦ ◦ understanding of preferences and values identifying personal traits is an on-going process throughout life State-dependent self-concepts may develop, where children feel their identity changes with their experience in the moment Focusing on the immediate moment limits a child’s perception of self to what is rather than what could be  Self development includes: ◦ understanding self as separate from others Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

Trauma Experience Integration

   The main idea: Work with children to actively explore, process, and integrate historical experiences into a coherent and comprehensive understanding of self in order to enhance their capacity to effectively engage in present life The ultimate goal for trauma affected individuals is to “build [capacity] to harness internal and external resources in service of effective and fulfilling navigation of their life, across domains of functioning, as they define and meet self-identified personal goals.” 2 ways: ◦ Integration of themes of fragments of self and the associated early experience ◦ Process specific events Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

“The world breaks everyone and afterwards many are strong at the broken places.”

~ Ernest Hemingway

Some Do’s and Don’ts of Having a Trauma Sensitive Lens

 ◦ ◦ ◦ Do ◦ Notice your tone, body language, and word choice Paraphrase before you correct Be consistent Remember that behavior comes from need ◦ Practice calming yourself before you respond ◦ Respond to every child as if there’s a possibility they’ve experienced trauma ◦ ◦ Praise efforts not character Remember that every interaction you have with a child tells them something, either positive or negative, about who they are  Don’t ◦ Panic ◦ ◦ Yell, grab, or intimidate Feel like you have to ‘fix’ a child’s trauma if they share with you ◦ Sum up the child’s character with a negative label ◦ Feel like you have to do it perfectly- being trauma sensitive takes practice and patience ◦ Blame, either the parents or the kid- Everyone is doing the best they can to cope all the time ◦ ◦ Mistake “Won’t” for “Can’t” Think you have to like every kid Copyright 2011 WSU Area Health Education Center

What traumatized kids need…

        Predictability ◦ Routines ◦ Consistent response from their caregiver Understanding ◦ Caregiver works to learn child’s triggers and sense them when they’re going to happen Emotional coaching ◦ Help understanding when they’re feeling something ◦ Help with calming their body down or energizing it ◦ Help expressing feelings in a safe way Patience Expectations Praise that focuses on their specific action rather than character A chance to talk about what they’ve experienced A safe haven and a secure base Copyright 2011 WSU Area Health Education Center

Things to ponder…

    How are you already using a trauma sensitive lens and be curious about each of your families in your professional role?

What are the costs of having a trauma sensitive lens in your role?

What are the benefits of having a trauma sensitive lens in your role?

What are other things you’d like to try that would support being trauma sensitive in your organization?

If you’d like more information

     www.nctsn.org

http://www.traumacenter.org/research/asc ot.php

http://extension.wsu.edu/ahec/trauma/Pag es/ComplexTrauma.aspx