1. Erika McElroy, Ph.D. Associate Director of Behavioral Health Services Kempe Center for the Prevention and Treatment of Child Abuse and Neglect University of Colorado

2. Objectives  Learners will be able to define basic understanding of trauma-informed integrated healthcare  Learners will be able to identify one way in which trauma can impact child development  Learners will understand the impact that child maltreatment has on psychosocial functioning, and identify one intervention for use in their practice

3. Types of traumatic experiences  Child abuse  Child neglect  Domestic violence  Dog bites  Car accidents  School and community violence  Other examples?

4. AAP Definition  “A trauma informed practice is defined as an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma.  Trauma Informed Practice emphasizes physical, psychological and emotional safety for patients, providers, and helps survivors rebuild a sense of control and empowerment.”

5. NCTSN Definition  “A trauma-informed system is one in which all parties involved recognize and respond to the impact of traumatic stress on those who have contact with the system including children, caregivers, and service providers. The system infuses and sustains trauma awareness, knowledge, and skills into their organizational cultures, practices, and policies. They act in collaboration with all those who are involved with the child, using the best available science, to facilitate and support the recovery and resiliency of the child and family.”

6. NCTSN Definition (cont.) A service system with a trauma-informed perspective is one in which programs, agencies, and service providers:  (1) routinely screen for trauma exposure and related symptoms;  (2) use culturally appropriate evidence-based assessment and treatment for traumatic stress and associated mental health symptoms;  (3) make resources available to children, families, and providers on trauma exposure, its impact, and treatment;  (4) engage in efforts to strengthen the resilience and protective factors of children and families impacted by and vulnerable to trauma;  (5) address parent and caregiver trauma and its impact on the family system;  (6) emphasize continuity of care and collaboration across child- service systems;  (7) maintain an environment of care for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff resilience.

7. Is Your SBHC a Trauma-Informed System? Child Behavioral Health Family Medical/ Dental School DDHS Law Enforcement Legal

8. Trauma & Child Development

9. Impact of Trauma on Physical Development  Fight or flight response can be constant  Brain abnormalities Brain becomes wired to be hypervigilant Brain can misread environmental cues  Challenges with self-regulation that can become chronic

10. Impact of Trauma on Mental Health Development  Depression  Anxiety  PTSD  Aggression  School problems  Sleeping and eating dysregulation

11. Impact of Trauma on Social/Emotional Development  Poor attachment with caregivers  Poor socialization  Poor self-efficacy

12. Child Maltreatment  Acts of Commission (Child Abuse) Physical Abuse Sexual Abuse Emotional Abuse/Psychological Maltreatment

13. Child Maltreatment  Acts of Omission (Child Neglect) Physical neglect Emotional neglect Medical neglect Educational neglect Inadequate supervision Exposure to violent environments

14. Consequences of Child Maltreatment in children  Disruptions in attachment, behavior, social skills, emotional and psychological functioning  Children in foster care Large percentage have a diagnosable emotional disorder and/or a substance abuse problem Nearly a third have severe behavioral, emotional, or developmental problems Many suffer from posttraumatic stress disorder (PTSD)  Maltreated children may have learning disorders requiring special education more than other children

15. Adverse Childhood Experiences (ACE)  The ACE study was conducted on more than 17,000 adults in the 1990’s who were undergoing a comprehensive physical examination and chose to provide information about childhood experience of abuse, neglect, and family dysfunction  Seven categories of ACE: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned

16. Impact of Adverse childhood experiences on adults Examples of health outcomes  Health quality of life  Chronic obstructive pulmonary disease (COPD)  Liver Disease  Ischemic heart disease  Smoking, including early initiation of smoking  Adolescent pregnancy  Severe obesity

17. Impact of Adverse childhood experiences on adults Examples of mental/behavioral health outcomes  Sleep difficulties  Depression  Suicide attempts  Risk for intimate partner violence  Substance Use Alcoholism and alcohol abuse Illicit drug use

18. Protective Factors for Child Maltreatment According to the CDC, protective factors buffer children from being abused or neglected. There is scientific evidence to support the following protective factors: Supportive family environment Supportive social networks Community Protective Factors Communities that support parents and take responsibility for preventing abuse

19. Protective Factors for Child Maltreatment Research is ongoing to determine whether the following family factors buffer children from maltreatment  Nurturing parenting skills  Stable family relationships  Household rules and child monitoring  Parental employment  Adequate housing  Access to health care and social services  Caring adults outside the family who can serve as role models or mentors

20. Take- Away Tools

21. Strengths and Protective Factors  Very often there is too much of a focus on pathology – how the trauma “damaged” a child/family  What does the family do well?  What supports do they have in place?

22. Our Wellness & Health  Service professionals need to be a priority too!  Secondary Trauma/Vicarious Trauma/Burnout  What is one thing currently in place in your SBHC that supports wellness, health and positivity?

23. On-Line Resources & Training  American Academy of Pediatrics: www.aap.org www.aap.org  International Society for Traumatic Stress Studies: www.istss.orgwww.istss.org  Centers for Disease Control and Prevention: www.cdc.orgwww.cdc.org  National Child Traumatic Stress Network: www.nctsn.orgwww.nctsn.org