Presentation on theme: "Karen Rice, PhD, LSW, ACSW Marc Felizzi, PhD, LCSW"— Presentation transcript:
1TRAUMA-INFORMED PRACTICE: ASSESSING & TREATING CHILDREN FOLLOWING A DISASTER Karen Rice, PhD, LSW, ACSW Marc Felizzi, PhD, LCSWAssistant Professors Department of Social Work Millersville University
2TRAUMAA Psychophysical reaction to an event which is experienced as overwhelmingAn event that arouses a strongemotional reaction in thoseexposed to it(Rothschild, 2000)
3Symptoms of traumaHyper-arousal: state of alertness, expecting the danger to recur, feels as if danger is still presentIntrusion: Trauma interrupts daily life (e.g. flashbacks, re-enacting the traumatic event)Emotional constriction: Feeling numb, dissociating, feeling a disconnect between events and their meanings. Feelings of “unreality”Avoidance behavior: A means of preventing a confrontation with danger(Briere & Scott, 2006)
4TRAUMA TYPESAccording to the National Child Traumatic Stress Network (NCTSN) there are 12 types of trauma children might experienceCommunity and school violenceComplex traumaDomestic violenceEarly childhood traumaMedical traumaNatural disastersNeglectPhysical abuseRefugee and war zone traumaSexual abuseTerrorismTraumatic griefCommunity violence: predatory violence (robbery, theft, rape, beatings, shootings)School violence: threats, injuries, fightsComplex trauma: multiple or prolonged exposure to traumatic events (i.e., abuse, DV, neglect) that often leads to repeated trauma in adolescents/adulthoodDomestic violence: 3 to 10 million of children in US are exposed to DV annually and most are under the age of 8 yearsEarly children trauma: any trauma that occurs to children between 0-6 yearsMedical trauma: reactions children have to pain, injury, serious illness, medical procedures, or treatmentsNatural disasters: natural catastrophe or fire, flood, or explosion child experiencesNeglect: not receiving basic needsPhysical abuse: causing or attempting to cause physical pain or injuryRefugee and war zone trauma: exposure to war, political violence, or tortureSexual abuse: wide range of sexual behaviors (involving and not involving contact) between child and older personTerrorism: intent to inflict psychological damage on adversaryTraumatic grief: grief following death of person who is important to child and when child perceives the experience as traumatic
5Trauma and the brain The brain responds to external influences Brain controls the nervous system & is linked to other parts of bodyDuring a traumatic event or flashback, amygdala becomes activated, and hippocampus shuts down, which interferes with the ability to “make sense” of event(Rothschild, 2000)Triune Brain
6Trauma and the brainSystems of the brain process experiences by receiving & responding to perception of stress (flight/ fight/ freeze)-Amygdala: stores emotions & reactions to traumatic events; present at birth (implicit memory; experienced in body or senses)-Hippocampus: processes data as a narrative, makes sense out of experiences, matures about age 3 (Explicit memory; linguistic)(Rothschild, 2000)Freezing: Can be the body’s response to stress “playing dead”Dissociation: Not sure why it occurs, may be related to the brain’s response to trauma to allow one to not fully experience a horrible eventMemories created through:Encoding: Etching the event into your brainStorage- Hippocampus store event, gives time & place contextRetrieval- Recalling the memories as you remember them
7Trauma and the brainLimbic system produces cortisol, which is used to return body to equilibrium after stress/ traumaIncreased cortisol levels seen in trauma victims(Rothschild, 2000)
8TRAUMA AND CHILDREN Developmental Trauma Attachment Biology Mood regulationDissociationBehavioral controlCognitionSelf-concept(Child Welfare Committee, 2008; NCTSN; van der Kolk, 1996)Attachment - difficulty relating to and empathizing with othersBiology – hypersensitivity to physical contact, insensitive to pain, unexplained physical symptoms, increased medical problems,Mood regulation – difficulty regulating emotions, difficulty knowing and describing feelingsDissociation – may withdraw from outside world and demonstrate amnesia-like statesBehavioral control – poor impulse control, self-destructive behaviors, aggression against othersCognition – difficulty focusing on and completing school tasks, learning difficulties and problems with language developmentSelf-concept – disturbance of body image, low self-esteem, shame, guiltInability to regulate moods, which places at increased risk for further abuseImpairs ability to describe eventLack of trust results in inaccurate or incomplete information about eventDull affect may make professionals question child’s statementsAltered world view may result in destructive behaviors2.Inability to regulate mood may result in threatened stable placementLack of trust may lead to rejection of caregiver or superficial attachmentsEarly experiences with attachment may lead to lack of empathy toward othersNew family may inadvertently trigger reminders to trauma3.Impacts cognition and ability to learn, focus, and succeed in schoolAbility to regulate emotions can impact ability to function within family, in regular classroom, and with peersGuilt and self-blame may lead to sense of hopelessness, which impairs motivation to succeed in social and educational settingsDue to lack of trust, child may isolate self from family, peer, social, and emotional supportsLack of positive coping strategies may lead to high-risk, destructive behaviors
9Children’s cognitive reactions Confusion, disorientationFear of separation from family/ petsRecurring dreams or nightmaresPreoccupation with disasterTrouble concentrating or remembering things (schoolwork)Difficulty making decisionsQuestioning spiritual beliefs(Rothschild, 2000)
10Children’s behavioral reactions to trauma Sleep problemsCrying easilyAvoiding reminders of disasterExcessive activity levelIncreased conflicts with familyHyper-vigilance, startle reactionsIsolation or social withdrawalFocus on disaster/ worry another will occurLack of interest in usual activities, even playing with friendsReturning to earlier behaviors, such as baby talk, bedwetting, or tantrumsIncrease in teens' risky behaviors, such as drinking alcohol, using substances, harming themselves, or engaging in dangerous activities(Rothschild, 2000)
11Children’s physical reactions to trauma Fatigue, exhaustionGastrointestinal distressAppetite changeTightening in throat, chest, orstomachWorsening of existing medicalconditionsSomatic complaints(Rothschild, 2000)
12approaches to treatment of traumatized children CounselingPsychodynamic-Trauma-Focused TherapyCognitive Behavioral Trauma-Focused Therapy (CB-TFT)Trauma Focused TherapyPsychotropic MedicationExposure TherapyRelaxation TherapyCreative Arts Therapy
13Goal when working with children who experienced trauma Establish sense of safetyRegulate affectReestablish attachmentEnhance brain’s executive functionReframe and integrate traumatic experience(Malchiodi, 2008)
14Establish sense of safety Where do you feel safe?Sense of safety essential to resolving trauma experienceAsk questions to assess:“Where do you fee the safest?”“Who do you feel the safest with?”“What do you do to feel safe?”(Malchiodi, 2008)Can use expressive arts therapy to process these questions---ask to draw picture of “safe place;” ask to show on body outline what safety “feels like;” make an image or image those people with whom feel safestVisual----using soda bottle, shake to demonstrate the pressure individuals under following a traumatic experience; goal is to teach how to release that pressure without creating “mess”; this is done by slowly releasing content and then “putting on the breaks”
15Regulate affect Important to address body’s response to trauma Trauma prevents normal expression of cognitive processesGoal is to empower individuals to regulate reactions to stressful eventsQuestions to ask:“How big or small is your hurt?”“If your hurt could talk, what do you think it would say?”“If your hurt could listen, what would you say to it?”(Malchiodi, 2008)What is body’s physiological response to the trauma?Children and adolescent have problems with attention, comprehension, and overall learningTeaching children how to be observers of their body’s sensations and learn what they can do with their bodies and minds to react in less stressful manger when trauma-inducing situations occurActivities: relaxation, mindfulness, drawing on body outline where “feel” trauma“Magic Box”---helps children regulate their emotions/feelings. Each child in group places an item in the “magic box” from his/her life he/she would like to get rid of. The box is then closed, locked, and packed away. This allows youth to place something traumatizing from his/her life in a safe place.
16Reestablish attachment Identifying institutions to foster supportive relationships is essentialFoster and build supportive networksStrengthen friendships and peer support(Malchiodi, 2008)Immediate response efforts should emphasize teaching effective coping strategies, fostering supportive relationships, and helping children understand the disaster event.Schools and other community, state, federal organizations can play an important role in this process of providing stable, familiar environmentChildren’s relationships with others/peers can offer ways to cope with adversity and can decrease isolation---in cases where families were relocated due to disaster, it is important for children to develop supportive relationships with their teachers and classmates. One way to enhance those relationships is to have children work in small groups asking them to cooperate on completing task.
17Enhance brain’s functioning Provide youth with opportunity to discuss disaster-related eventsPromote positive coping and problem-solving skillsEmphasize strengthening resiliency toTake decisive actions; do not avoidAvoid blowing event out of proportion(Malchiodi, 2008)When teaching problem-solving skills be sure they encourage children to develop realistic and positive methods of coping that increase ability to manage their anxiety and to identify which strategies fit with each situationResiliency is behavior that can be learned (comprises behaviors, thoughts, and actions that can be learned and developed in anyone). When focusing on strengthening resiliency, ask youth what they did in the past that helped them cope when they were frightened or upset. Share how other communities experienced disasters and then recovered.
18Reframe and integrate traumatic experience Telling one’s story gives trauma survivors a voiceStories link past, present, and futureReparative nature to “restory” one’s life(Malchiodi, 2008)Video---Smallest WondersWe tell stories because we hope to find or create significant connections between things…link past, present, and future in way that tells us where we have been, where we are, and where we are going. They give meaning to life and provide guidance and wisdom….”restorying” our life is reparative. Focus on the strengths rather than weaknesses.Exercise….Sadako and the Thousand Paper Cranes…works well when working with group of youth who experienced group trauma (community violence, terrorism, war, disaster) as allows them to identify memorial project to create that commemorates those lost yet provides outlet for individual healing. This project allows for group work and processing and reinforces community building
19Issues associated with specific disaster: fires Emotional and physical exhaustionSurvivor guiltFear and anxietyLingering distress(Malchiodi, Steele, & Kuban, 2008)Survivor guilt can occur if someone’s home unharmed while others destroyedGreater symptomatology associated with more frightening experiences during fire and with great levels of damage to community and homesSights, sounds, and smells of fire often generate fear and anxietySame sensations can generate distress in months following disaster
20Focus of treatment-specific to fires Provide perceptions of safety and securityProvide opportunity to discuss feelings and concerns to correct misperceptions and to offer reassuranceProvide predictable activities and normal routinesProvide and maintain interpersonal connectionsEncourage healthy behaviorsEducate and encourage parents/caregivers to model positive coping skillsReduce exposure to events that increase stressEncourage participation in less stressful eventsDevelop response plan that addresses psychological impact(Malchiodi, Steele, & Kuban, 2008)Normal routines enhances safety and securityFriendships and social activities help maintain interpersonal connectionsHealthy behaviors include sleep, exercise, and proper nutritionPositive coping skills include nurturing behaviors, consistency, and clear limits---help children practice these skillsReduce exposure to repeated viewing of images of disaster and encourage participation in games, reading, creative expression, or athleticsDisaster response plans should address psychological impact of trauma on individuals and how will respond immediately following event as well as in long-term
21Questions“Trauma stays with us even though the trigger may appear to be out of sight”(Rothschild, 2000)