1. Children Exposed to Trauma: Immediate and Lifelong Impacts Are Common
Angela Keen
Survivors, Inc.

2. Trainer Angela Keen Supervisor of Direct Services, Survivors, Inc.
Victims’ Services Professional with 17 years experience
Keystone Crisis Intervention Team (KCIT) Certified Trainer
KCIT Team Member since 2005
KCIT 2015

3. Survivors, Inc. Envisions an end to domestic violence and sexual assault. Our mission: Domestic violence and sexual assault violate the sanctity and the safety of our relationships, homes, and communities. We provide comprehensive services and advocacy to those seeking lives free of violence.  

4. RESOURCE QUICK response to hospital or police department
24 hour hotline or
Secure Shelter
Safety Planning individualized & can include PFA

5. SERVICES Supportive Individual & Group Counseling Legal Advocacy
Bilingual & Bicultural Staff
Children’s Support Group & Activities
Significant Other Support
Emergency Shelter
Transitional Housing
Community Education

6. Participants will:
Articulate physical and emotional reactions to trauma
Recognize trauma impacts on learning, physical health and human development
Be familiar with the ACE Study
Make connections between individual trauma exposure and community health
Identify trauma informed practices to implement in community work

7. Trauma Is Common
“Knowledge about the prevalence and impact of trauma has grown to the point that it is now universally understood that almost all of those seeking services in the public health system have trauma histories.”
(SAMHSA)

8. Trauma Individual Trauma:
A “blow to the psyche that breaks through one’s defenses so suddenly and with such force that one cannot respond effectively.”
- Kai Erickson, In the Wake of a Flood, 1979
Collective Trauma:
A “blow to the tissues of social life that damages the bonds attaching people together.”
ALKB
Discuss definition of community
Make the point that community is fluid and situationally based
Discussion we have when we’re diagramming disaster with host

9. Fluctuating Equilibrium
Normal Stress
Eu-stress
Distress
ALKB
Eu-stress = good stress
Distress = bad stress
Daily fluctuations in everyday life.

10. Impact of Trauma on Equilibrium
ALKB
A critical incident or traumatic event throws us outside of our normal/established boundaries; we will have trouble rebounding initially. Proper attention in the aftermath of a critical incident will help individuals return to pre-existing boundaries or establish new boundaries, a new “normal”.

11. Sensory Path: Everyday Functioning Brain
Cortex- Neo Cortex
ALKB
Thalamus
Amygdala
Hippocampus

12. Trauma is a sensory experience
It is not cognitive!
ALKB

13. Sensory Path: Traumatized Brain
Cortex- Neo Cortex
ALKB
Thalamus
Amygdala
Hippocampus

14. During a Traumatic Event
The pathways between the right and left brain experience a disconnect.
Right Brain Left Brain
ALKB
Making Sense
Problem Solving
Decision Making
Language
Impulse Control
Memory
Sensory
Affect Regulation

15. Fight, Flight, or Freeze? ALKB
You will see an accident as recorded by an viewer. Please know that all involved survived.
Look for:
Emotional and physical reactions of those involved.
Debrief:
What physical reactions did you see from those who watched what happened?
What physical reactions did you see from those who provided assistance?
What emotional reactions did you see/hear from who watched what happened?

16. Crisis Reactions PHYSICAL Frozen Fright Numbness
Deer in the Headlights
Disorientation
Confusion
EMOTIONAL
Shock – Disbelief – Denial
Can’t believe this is happening
Feeling helpless
Questioning
Loss of control
BEHAVIORAL
Withdrawal
Inability to move
Inability to make decisions
Staring into space
Inability to speak
Time slows or stops
Problem communicating thoughts
Unresponsive to others
ALKB
Small group work:
Frozen fright is often referred to “deer in headlights”; what are the physical, emotional and behavioral reactions that would accompany that?
What did you see/hear in the video?
KCIT 2015

17. Crisis Reactions PHYSICAL Fight, Flight or Adapt Heart rate increases
Senses more acute
Adrenalin rush
Urination
Defecation
Regurgitation
Tunnel vision
Muffled hearing
Autonomic System takes over
EMOTIONAL
Cataclysm of Emotions
Not Linear – Mixed
Fear/Terror
Anger/Rage
Confusion/Frustration
Guilt/Self Blame
Grief/Sorrow
BEHAVIORAL
Ready to Fight or Run
Survival behaviors
Decisions not moral or values based
Regression in some learned behaviors
Somatic complaints
Poor problem solving
Overly sensitive
Emotional outbursts
Disassociation
Controlling
Loss of appetite
Exaggerated startle response
ALKB
Small group work:
Fight or Flight: what are the physical, emotional and behavioral reactions that would accompany that?
What did you see/hear in the video?

18. Crisis Reactions PHYSICAL Exhaustion Yesterday-Today-Tomorrow
Past-Present-Future
Exhaustion sets in
Creating more adrenalin
Under activity
EMOTIONAL
Reconstruction
Time begins anew as they start life after the traumatic event
Possible long term reactions
Anxiety
Depression
Numbing
Less trusting
Disassociation
BEHAVIORAL
Surviving or Coping
Getting back to a new state of equilibrium
Insomnia
Irritability
Poor problem solving
Drug or Alcohol
Eating disturbance
Sexual dysfunction
Obsessive
Compulsive Behaviors
ALKB
Crisis is time limited by nature/definition; eventually they need to sleep and re-group.
Review and tie back to first two phases of crisis reaction.
KCIT 2015

19. Maslow’s Hierarchy of Needs
Self Actualization
Self-esteem
Love and Belonging
Cognitive Functioning
Safety and Security
Basic Survival Needs
KCIT 2015

20. Loss of Equilibrium in Trauma
Adaptive Capacities Stressors
A traumatic event throws an individual outside of their normal range of daily functioning. Individual equilibrium may temporarily become unbalanced as stressors outweigh adaptive capacities.
Basic Survival needs
Safety & Security
Cognitive Functioning
Love and Belonging
Self-esteem & Meaning
Self Actualization
KCIT 2015

21. Stressors: Good and Bad
Stressors can be good and bad (as previously referenced). Each person learns to operate within a healthy range balancing these daily stressors.
KCIT 2015

22. Trauma is any event that leaves a person feeling hopeless, helpless, fearing for their life and/or their safety.
ALKB
The KCIT model responding to individuals and communities experiencing a traumatic event focuses on helping those affected to re-establish a sense of safety & security and restore hope for the future.

23. Trauma is the unique individual experience of an event or enduring condition, in which:
The individual experiences a threat to life, bodily integrity, or sanity
The individual’s coping capacity and/or ability to integrate his or her emotional experience is overwhelmed

24. Trauma Impairs Feeling internally connected over time to caring others
Experiencing oneself as deserving and worthwhile
Managing Feelings:
Recognize, tolerate, modulate, integrate feelings

25. Potential Impact of Repeated Trauma
Decreased ability to…
Manage feelings
Utilize feelings
Self-soothe
Connect with others
Thoughtfully plan
Trust others/reach out for and respond to help
Develop Empathy

26. Potential Impact of Repeated Trauma
Increased…
Avoidance, constriction, dissociation
Tension, anxiety, emotional unpredictability/over reaction
Use of drugs, alcohol, other addictions to manage feelings
Need for control, aggressive behavior
Risky behaviors

27. Disrupts the ability to return-to-center.
Traumatic Stress
Shifts people away from emotional safety, emotional balance and predictability.
Disrupts the ability to return-to-center.

28. Human Development Across the Lifespan
Erikson
Psychosocial Stages defined by successful completion/mastery of developmental conflicts.
Piaget
Cognitive development progressive reorganization of mental processes; biological and environmental influences.
Maslow
Hierarchy of Needs
Refer to Handout

29. Maslow’s Hierarchy of Needs
Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), doi:

30. Developmental Impact of Trauma
Children develop sense of trust in world from relationships with early caretakers
Learn from trusting others to internalize feelings of trust & safety
When mistreated, sense of self affected, world viewed as unsafe

31. Developmental Impact of Trauma
Neurobiology disrupted; Ability to comfort & protect oneself impaired
Systems of meaning, feelings about self & ability to trust in others & oneself deeply affected

32. ACE Study More than 17,000 adult participants 25 studies since 1998
CDC & Kaiser Permanente’s Department of Preventative Medicine in San Diego Partnership
Average age 57
80% White; 10% Black; 10% Hispanic/Latino
“solidly middle class”

33. Adverse Childhood Experiences
Emotional Abuse
Physical Abuse
Sexual Abuse
Mother abused
Raised in single parent family
Household member incarcerated

34. Adverse Childhood Experiences
Household member abusing drugs/alcohol
Household member chronically depressed, suicidal, mentally ill, psychiatric hospitalization
Emotional/Physical Neglect
Not raised by both biological parents

35. ACE Study Results
Trauma is far more prevalent than previously recognized.
The impacts of trauma are cumulative and often occur in clusters.
That unaddressed trauma underlies a wide range of health problems and social problems.
ACEs are related to risky health behaviors in childhood and adolescence.

36. 1 or More ACEs Increase Risk of:
Cancer
Heart disease
STDs
Liver disease
Smoking
Alcohol abuse
Obesity
Drug dependence
IV Drug Use
Early intercourse, pregnancy

37. 1 or More ACEs Increase Risk of:
Depression
Anxiety disorders
Hallucinations
Sleep disturbances
Memory disturbances
Anger problems
Domestic violence risk
Job problems
Relationship problems

38. ACE Study Results
Exposure to ACEs is associated with increased risk of depressive disorders up to decades after their occurrence.
54% of women and 36% of men with depression had ACE score of 4 or higher
Compared to 18% of women and 10% of men with 0 ACE Score

39. ACE Study Results
20% to 70% increased likelihood of alcohol use initiated during mid adolescence ( years).
7 to 10 fold more likely to report illicit drug use problems.
Physical abuse and verbal abuse were most strongly associated with body weight and obesity.
ACEs accounted for a 20% to 70% increased likelihood of alcohol use initiated during mid adolescence (15-17 years).
People with ACEs were 7 to 10 fold more likely to report illicit drug use problems, addiction to illicit drugs, and intravenous drug abuse.
Physical abuse and verbal abuse were most strongly associated with body weight and obesity.
Exposure to ACEs is associated with increased risk of depressive disorders up to decades after their occurrence.

40. Childhood trauma has long-term, damaging consequences.
ACE Study Results
Childhood trauma has long-term, damaging consequences.

41. Trauma exposure impacts community health.
Small group brainstorm.

42. How can you help?

43. Trauma Informed Care
Most individuals seeking public behavioral health services and many other public services, such as homeless and domestic violence services, have histories of physical and sexual abuse and other types of trauma-inducing experiences. (SAMHSA)

44. Trauma Informed Programs/Services are:
based on an understanding of the vulnerabilities or triggers of trauma survivors
so that these services and programs can be more supportive and avoid re-traumatization

45. Changing Lenses
What’s wrong with you?
vs.
What’s happened to you?

46. Resiliency & Coping Resiliency:
A person’s inherent capacity to moderate and recover from a traumatic experience.
Don’t underestimate the level of resiliency an individual or community may have. The goal is to support that resiliency and/or those resiliency traits.
KCIT 2015

47. Resiliency & Coping Coping:
When a person constantly changes cognitive and behavioral efforts to manage specific extern/internal demands that are taxing or exceeding the resources of that individual.
KCIT 2015

48. Biological Vulnerabilities
Resiliency & Coping
Biological Vulnerabilities
+ Perceived Stressors
– Coping
= Severity of Impact
Biological Vulnerabilities = genetic, illnesses, accidents, drugs
Perceived stressors = defined by individual history, values, needs, strengths, support
Coping = includes coping skills, resiliency, history, support systems, education structured environments (Sounds much like adaptive capacities?)
When combined, the sum total will influence how sever the critical incident impacts the individual.
KCIT 2015

49. “The solution of adult problems tomorrow depends in large measure upon the way our children grow up today.” Margaret Mead

50. RESOURCES National Center on Domestic Violence, Trauma & Mental Health
Substance Abuse & Mental Health Services Administration
Keystone Crisis Intervention Team
Centers for Disease Control

51. Contact Information
Angela Keen, Supervisor of Direct Services
Esther Waybright, Community Education Specialist
Survivors, Inc