1. Dr. Steve Parese Danbury, NC Insights and Strategies for Staff Who Work With Troubled Youth Leave Me Alone!” Getting Through to Traumatized Youth

2. Do you work every day with “Difficult Kids?”

3. 1. What is childhood trauma, and how does it impact behavior? 2. What self-defeating patterns are common among troubled youth? 3. What can we do to therapeutically manage traumatized youth? Today ’ s Agenda

4. 01/24/2011 4 “Are You a Survivor?” What does it take to survive through hard times?

5. 5 1. How to survive a bull stampede Worst Case Scenario SURVIVAL QUIZ (a) Lay down and curl into a ball. (b) Run alongside the bulls. (c) Kneel in the street and pray for Divine Intervention!

6. 6 1. How to survive a bull stampede Worst Case Scenario SURVIVAL QUIZ (a) Lay down and curl into a ball. (b) Run alongside the bulls. (c) Kneel in the street and pray for Divine Intervention!

7. 7 2. How to signal rescuers when lost (a) Light three fires in a triangle shape during day. (b) Wait until nightfall and light one large fire. (c) Bang out SOS in Morse Code on pots and pans Worst Case Scenario SURVIVAL QUIZ

8. 8 2. How to signal rescuers when lost (a) Light three fires in a triangle shape during day. (b) Wait until nightfall and light one large fire. (c) Simply dial 911 on your satellite cell phone, silly! Worst Case Scenario SURVIVAL QUIZ

9. 9 3. How to take a punch to the head Worst Case Scenario SURVIVAL QUIZ (a) Turn at the last minute and take it on the jaw. (b) Move into the blow, take it on the forehead. (c) Push your best friend in front of you and let HIM/HER “take one for the team!”

10. 10 3. How to take a punch to the head Worst Case Scenario SURVIVAL QUIZ (a) Turn at the last minute and take it on the jaw. (b) Move into the blow, take it on the forehead. (c) Push your best friend in front of you and let HIM/HER “take one for the team!”

11. 11 4. How to purify water on the trail Worst Case Scenario SURVIVAL QUIZ (a) Add a dash of salt, boil, then drain into container. (b) Boil water vigorously for 1 minute. (c) Add sassafras leaves and allow to sit in sun 4 hours.

12. 12 4. How to purify water on the trail Worst Case Scenario SURVIVAL QUIZ (a) Add a dash of salt, boil, then drain into container. (b) Boil water vigorously for 1 minute. (c) Stop by your local 7-11 for a bottle of Aquafina!

13. 13 5. How to defend vs grizzly bear attack Worst Case Scenario SURVIVAL QUIZ (a) Drop to the ground and cover the back of your neck. (b) Make eye contact and slowly back away. (c) Set out a bottle of honey and make soft happy sounds!

14. 14 5. How to defend vs grizzly bear attack Worst Case Scenario SURVIVAL QUIZ (a) Drop to the ground and cover the back of your neck. (b) Make eye contact and slowly back away. (c) Set out a bottle of honey and make soft happy sounds!

15. 01/24/2011 15 So again… “Are You a Survivor?”

16. 01/24/2011 16 SURVIVING Many difficult youth are simply SURVIVING in a hostile world.

17. Grrrrrrrrr.... In your groups: List 6-8 typical problem behaviors, especially those that really get on your nerves.

18. Working with traumatized youth requires “COURAGEOUS PATIENCE” -- Dr. Sandra Bloom

19. Psychological Insight #1 Many troubled youth are survivors of years of traumatic life events. Some of their most difficult and annoying behaviors may stem from deeper issues, and so require more subtle interventions than simple punishment.

20. What is childhood trauma, and how does it impact behavior? Part 1

21. Psychological Trauma: Lasting and debilitating psychological condition resulting from traumatic events which completely overwhelm an individual’s ability to cope with emotions involved. What is Childhood Trauma? Childhood Trauma: Psychological trauma stemming from severe and often repeated incidences of physical, sexual, or psychological abuse, chronic neglect, or exposure to violence during early childhood.

22. 18% of all adult men 26% of all adult women Have had sexually or physically abusive childhood experiences How Prevalent is it? 5.8 million children referred to CPS in 2007 794,000 confirmed victims of severe physical, sexual, or psychological abuse or neglect. 1,760 deaths as a result of abuse, 50% infants.

23. 1. DIRECT RESULTS OF ABUSE/NEGLECT : a. Physical injuries: Bruises, broken bones, & malnutrition What is the Impact? b. Psychological injuries: (PTSD) 1. Dissociation: Disconnect with reality. 2. Hyperarousal: Heightened psychological and physical tension. 3. Re-experiencing: Nightmares or flashbacks.

24. What is the Impact? 2. INDIRECT RESULTS OF ABUSE/NEGLECT a. Long term physical changes 1. Disabilities: 20%-25% permanent physical injury/disability, and 10%-25% developmental disability. 2. Brain damage: Malnutrition, TBI or prolonged sexual abuse --> 7%-8% smaller brain size. 3. Hormonal changes: Irreversible changes to catecholamine levels in blood even years after the abuse.

25. What is the Impact? 2. INDIRECT RESULTS OF ABUSE/NEGLECT a. Long term mental, emotional, & behavioral 1. TODDLERS & YOUNG CHILDREN (ages 2- 5) a. Deep anxiety: Fear of separation; excessive clinging; crying, whimpering, screaming.

26. What is the Impact? 2. SCHOOL AGE CHILDREN (ages 6-11) a. Internalizing symptoms: Extreme withdrawal; irrational fears; depression, anxiety or guilt. b. Externalizing symptoms: Irritability and impulsivity; outbursts of anger and aggression.

27. What is the Impact? 3. ADOLESCENTS (ages 12-17) a. Internalizing symptoms: Avoidance; depression & withdrawal; sleep problems; suicidal thoughts; self-injurious behaviors. b. Externalizing symptoms: Fighting peers; unprovoked aggression; direct defiance; substance abuse; criminal behavior.

28. What is the Impact? 4. GENDER DIFFERENCES: a. Girls = internalizing symptoms (dissociation, surrender, self-harm). b. Boys = externalizing symptoms (hyperarousal, flight-or-flight, aggression). c. Victims of sexual abuse = avoidance of physical contact or oversexualized behavior

29. Kelly Clarkson Because of You

30. I will not make the same mistakes that you did…

31. I will not let myself cause my heart so much misery

32. I will not break the way you did (you fell so hard)

33. I've learned the hard way to never let it get that far

34. Because of you, I never stray too far from the sidewalk

35. Because of you, I learned to play on the safe side so I don't get hurt

36. Because of you, I find it hard to trust not only me but everyone around me

37. Because of you… I am afraid

38. And it’s not too long before you point it out I lose my way

39. I cannot cry because I know that’s weakness in your eyes

40. I’m forced to fake a smile a laugh every day of my life

41. My heart can’t possibly break When it wasn’t even whole to start with

42. Because of you, I never stray too far from the sidewalk

43. Because of you, I learned to play on the safe side so I don't get hurt

44. I find it hard to trust not only me but everyone around me Because of you,

45. Because of you… I am afraid

46. I watched you die I heard you cry every night in your sleep

47. I was so young you should have known better than to lean on me

48. You never thought of anyone else you just saw your pain

49. And now I cry in the middle of the night for the same damn things

50. Because of you, I never stray too far from the sidewalk

51. Because of you, I learned to play on the safe side so I don't get hurt

52. Because of you, I tried my hardest just to forget everything

53. Because of you, I don’t know how to let anyone else in

54. Because of you, I’m ashamed of my life because it’s empty

55. Because of you… I am afraid

56. Because of you… Kelly Clarkson “Because of You” Breakaway (2004 )

57. Key Point #1 Many troubled youth have been deeply impacted by traumatic events in their early childhood years. These events often change children emotionally, physically, even biochemically... and directly affect behavior in teen years.

58. What self-defeating patterns are common among troubled youth? Part 2

59. Psychological Insight #2 Troubled youth see themselves and the world from a fundamentally different perspective, one which creates a self-fulfilling prophesy of failure and rejection.

60. Video Clip Stolen Tools Scene “Marvin’s Room” What does Hank do to deliberately push his aunt away? What does she do to connect with him anyway?

61. Psychological Dynamics 1. AGGRESSIVE FEELING: Anger World is DANGEROUS. To survive, always strike first. BEHAVIOR: Fight, threaten, yell, control or intimidate others, damage property.

62. Psychological Dynamics 2. PASSIVE-AGGRESSIVE FEELING: Resentment World is UNFAIR. To survive, hide your real feelings. BEHAVIOR: Sarcastic, mean, undermine authority, gossip, manipulate others

63. 3. AVOIDANT FEELING: Overwhelmed World is UNFORGIVING. To survive, escape your problems. Psychological Dynamics BEHAVIOR: Isolate, shut down, get high, sleep, hurt self, refuse help, don’t show.

64. Psychological Dynamics 4. DEPENDENT FEELING: Anxiety World is SCARY. To survive, find a protector. BEHAVIOR: Whine, cling to authorities, demand help, do anything for friends.

65. Psychological Insight #3 Traumatized youth often engage helping adults in intense conflicts to avoid painful emotions and to assure failure on their own terms.

66. Negative Beliefs (about self and others) Negative Beliefs (about self and others) Stressful Problem Overwhelming Feelings Impulsive Behavior Conflict Cycle Based on a model created by Nicholas Long, Ph.D. Others’ Reactions

67. Negative Beliefs Reinforced by consequences Negative Beliefs Reinforced by consequences Stress Increases Feelings Intensify Behavior Escalates Reactions Worsen Conflict Cycle Based on a model created by Nicholas Long, Ph.D.

68. Negative Beliefs Reinforced by consequences Negative Beliefs Reinforced by consequences Stress Peaks Feelings Out of Control! Behavior Explosive! Consequences Severe! Conflict Cycle Based on a model created by Nicholas Long, Ph.D. POW! BAM! SPLAT! FULL BLOWN CRISIS!

69. Let ’ s read about Andy ’ s conflict with Mr. Johnson

70. Psychological Insight #4 Youth often react to stressful situations in predictable ways. Staff who use consequences to influence these students’ behavior may find themselves drawn into power struggles which lead to predictable failure.

71. Predictable Problems SITUATION: Avoidant Adrian forgot to bring in her permission form. She is standing near the girls room door, searching frantically in her book bag anyway. STAFF: “Hurry up & get to class, or I’ll write you up!” “I can’t believe how STUPID that was! They’ll never believe that I actually did it. They’ll probably just lecture me about not being responsible…”

72. Predictable Problems SITUATION: Avoidant Adrian forgot to bring in her permission form. She is standing near the girls room door, searching frantically in her book bag anyway. STAFF: “Hurry up & get to class, or I’ll write you up!” ADRIAN’S FEELINGS: ________________________________ HER BEHAVIOR: _____________________________________ STAFF’S LIKELY REACTION: ___________________________ Better Response: _____________________________________

73. Predictable Problems SITUATION: Avoidant Adrian forgot to bring in her permission form. She is standing near the girls room door, searching frantically in her book bag anyway. STAFF: “Hurry up & get to class, or I’ll write you up!” ADRIAN’S FEELINGS: ________________________________ HER BEHAVIOR: _____________________________________ STAFF’S REACTION: __________________________________ Better Response? _____________________________________ Overwhelmed, anxious Run off & hide in bathroom Send security to bring her to the main office

74. Predictable Problems SITUATION: Avoidant Adrian forgot to bring in her permission form. She is standing near the girls room door, searching frantically in her book bag anyway. STAFF: “Hurry up & get to class, or I’ll write you up!” “See? THAT’s why I hate this program! You forget your stuff ONE TIME and they send security out to drag you to the office…”

75. SITUATION: Dependent DJ gets beaten up on the way in today, and wanders into his first class 10 minutes late, still in pain. INSTRUCTOR: “You’re late DJ! Where have you been? Never mind, get to your seat and start your work.” “Why wasn’t anyone there to protect me? Why don’t they care what happened? Staff act like they care, but they don’t…” Predictable Problems

76. SITUATION: Dependent DJ gets beaten up on the way in today, and wanders into his first class 10 minutes late, still in pain. INSTRUCTOR: “You’re late DJ! Where have you been? Never mind, get to your seat and start your work.” Predictable Problems DJ’s FEELINGS: _____________________________________ HIS BEHAVIOR: _____________________________________ STAFF’S LIKELY REACTION: ___________________________ Better Response: _____________________________________

77. SITUATION: Dependent DJ gets beaten up on the way in today, and wanders into his first class 10 minutes late, still in pain. INSTRUCTOR: “You’re late DJ! Where have you been? Never mind, get to your seat and start your work.” Predictable Problems DJ’s FEELINGS: _____________________________________ HIS BEHAVIOR: _____________________________________ STAFF’S REACTION: _________________________________ Better Response: _____________________________________ Scared, hurt, anxious Whine, pout, demand help Tell him to “ grow up, ” ask him to leave if it gets disruptive

78. SITUATION: Dependent DJ gets beaten up on the way in today, and wanders into his first class 10 minutes late, still in pain. INSTRUCTOR: “You’re late DJ! Where have you been? Never mind, get to your seat and start your work.” “See? That’s why I don’t trust anybody -- cuz sooner or later even the nice staff stop caring if you get beaten up! @#$% him, I’ll find a NEW friend.” Predictable Problems

79. Key Point #2 At-risk children and youth often adopt negative mindsets which let them predict how people will react to them. Aggression, passive aggression, avoidance and dependency are examples of these self-defeating cognitive behavioral patterns which lead youth to fail, but on their own terms.

80. What can we do to more therapeutically manage traumatized youth? Part 3

81. What to do as STAFF 1. Promote emotional safety. Traumatized youth overreact to perceived threats. Prevent stress-related problems by promoting a calm, physically and emotionally-safe learning environment.

82. What to do as STAFF 2. Always keep self-control. Traumatized youth have trust issues with adults. Maintain your own self-control even when angry by depersonalizing issues and managing your own emotions.

83. 3. Actively protect youth. Traumatized youth are easily triggered. Protect children from retraumatization by stopping bullying and intimidation, whether by peers or other staff. What to do as STAFF

84. 4. Enforce rules calmly. Traumatized youth push the limits and expect abuse. Redirect minor misbehaviors and enforce rules without angry power struggles, shaming, or unnecessary punitive consequences.

85. 5. De-escalate crises. Traumatized youth have difficulty calming down. De-escalate emotional crises by helping youth to calm down and talk about emotions. What to do as STAFF

86. 6. Hands-off when possible. Traumatized youth are hypersensitive to physical touch. If absolutely needed, use only minimal physical force. Never uses angry threats or physical force to “manhandle” children for noncompliance.

87. 7. Talk out problems. Traumatized youth often block out events and fail to learn from problems. Thoroughly and calmly process crises with youth after stressful situations, especially after restraints. What to do as STAFF

88. 8. Ask for help if needed. Traumatized youth sometimes target particular staff with anger or fears. Recognize when to use other staff to help with problems beyond your own level of expertise. What to do as STAFF

89. What to do as an AGENCY 1. Create Safety Childhood trauma defenses are often triggered when youth feel anxious or uncertain. Create physically and emotionally safe learning environments, free of bullying, intimidation, or ridicule.

90. What to do as an AGENCY 2.Teach social skills Traumatized youth often lack the critical thinking and social skills needed to resolve problems and build better relationships. Help youth get along with others and solve problems by actively teaching these skills in classes and in one on one interactions.

91. What to do as an AGENCY 3. Teach stress mgm’t skills Traumatized youth often lack the stress coping skills to handle distressing issues without overreacting. Help youth manage themselves by teaching them how to control their feelings and cope with stress.

92. What to do as an AGENCY 4. Teach self-advocacy Traumatized youth are often unable to stand up for themselves without reacting in extremes by fighting or fleeing. Help them learn self-advocacy skills so that they can develop a healthy level of independence.

93. Key Point #3 Traumatized youth often overreact emotionally to minor stresses, and can sometimes draw even caring adults into destructive power struggles. In situations like these, it is far more helpful to concentrate on calming and reassuring youth than using consequences to “teach them a lesson.”

94. From Dr. Haim Ginott “ I ’ ve come to the frightening conclusion that I am the decisive element in the classroom. It ’ s MY personal approach that creates the climate; It ’ s MY daily mood that makes the weather…

95. “As a teacher, I possess a tremendous power to make a child's life miserable or joyous. “I can be a tool of torture or an instrument of inspiration. “I can humiliate or humor, hurt or heal.

96. “ In all situations, it is MY response that decides whether a crisis will be escalated or de-escalated… or a child humanized or de- humanized. ” -- Dr. Haim Ginott

97. Dr. Steve Parese THANK YOU! Dr. Steve Parese For more information about staff training this content, email me SBParese@aol.comBParese@aol.com or visit: WorkinItOut.com TACT2.com