1. Collaborative Learning for Educational Achievement and Resiliency
Understanding Complex Trauma: Strengthening Supporting Learning Environments through a Trauma Sensitive Lens
CLEAR
Collaborative Learning for Educational Achievement and Resiliency
January 11th, 2012
Introductions
Why we’re here- brief glimpse into what complex trauma is
We’re in your buildings working with teachers and staff to try and facilitate a school-wide understanding of how trauma impacts the kids you work with every day
What you should expect:
To leave wanting more- we won’t cover this in depth- this is an introduction
To feel uncomfortable
To have more questions

2. 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
We don’t decide whether or not something should have been traumatic- its about our response to it.
It is the ultimate irony that at a time when children are at their most vulnerable, we assume them to be at their most resilient. (Siegel)
Copyright 2011 WSU Area Health Education Center

3. 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
This is something that touches all our lives in some way. Even if we grow up in a safe and healthy place, eventually we’ll know and care about someone who has experiences like this.
Not a “them” problem.
Copyright 2011 WSU Area Health Education Center

4. Person as an iceberg analogy
Copyright 2011 WSU Area Health Education Center

5. “Children are like wet cement
“Children are like wet cement. Whatever falls on them makes an impression."
– Hiam Ginott
Every interaction you have with a child tells them sometime about themselves
Copyright 2011 WSU Area Health Education Center

6. 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.
Adapted from Bruce Perry:
What we know about the human brain. 90% of our development occurs in the first 3 years of life, then continues into our early 20’s.
Copyright 2011 WSU Area Health Education Center

7. 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”
Social, emotional, and cognitive development are integrated in brain development because each draws on common, interrelated neural functions. Emotional health and social competence provide a strong foundation for emerging cognitive abilities, but early mental health problems can impair learning along with emotional well-being
The brain doesn’t want to learn- the brain wants to survive- medina
Dissociation- watching myself like a movie
Copyright 2011 WSU Area Health Education Center

8. Threat Appraisal and Detection in Traumatized Children
Where the average person begins to sense threat
Where someone who has experienced trauma begins to sense threat
Called hypervigilence
Copyright 2011 WSU Area Health Education Center

9. 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.
Understanding the biological risks points to some of the actions we can take as caring adults
You can’t make the assumption that just because they’re old enough, that they’ll “know better”. Don’t make the assumption that just because a child can repeat a rule to you that they can follow it. We’re talking about the difference between can’t and won’t.
Don’t therapy doesn’t work
Copyright 2011 WSU Area Health Education Center

10. Labels we often give trauma-affected kids
Lazy
ADHD
Manipulative
Uncaring
Antisocial
Others?
Defiant
Rebellious
Uninterested
Oppositional
Liar
We’ve all used these. Having a reaction to someone who is exhibiting frustrating behaviors at the top of their iceberg doesn’t mean we’re not being trauma sensitive, it means we’re human. Its natural to react. The difference is beginning to shift the meaning we make of these behaviors from “This kid is doing this too me” to “This kid is coping with something right now.”
Doesn’t mean we like every kid.
Copyright 2011 WSU Area Health Education Center

11. Overall Trauma Impact on Development
Difficulty understanding what they feel and how to cope with it
Negative self-concept
Blame themselves for not succeeding
Difficulty expressing what they feel
Difficulty understanding the link between behavior, feelings, and experience
Difficulty reading social cues
Overly rigid or too diffuse boundaries
Difficulty maintaining comfortable arousal
Lack of trust or over-dependent on others
Feel like they can’t impact their world
Difficulty sustaining attention and concentration
Difficulty planning, problem-solving, organizing information, and delaying response to stimuli.
And more
Believe they are not capable or competent
Not a complete list, but some of the heavy hitters.
Copyright 2011 WSU Area Health Education Center

12. Implementation Science and Innovation Success
Part of common work is thinking of the systems within these activities
We have to start with teachers but if the system doesn’t come along in support, change is exceptionally unlikely

13. 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 3 5 6 4
Two ACEs
N=213
2.5
One ACE
N=476
1.5 2
No Known ACEs =1,164
1.0
Behavior as a function of need
Copyright 2011 WSU Area Health Education Center

14. Behavioral Health Problems
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
2.0
5.3
3.1
6.5
Three ACEs N=756 1
3.0
1.5
Two ACEs N=1,141
2.5
1.6
1.8
One ACE N=1,612
1.2
No Reported ACES N=1,020
---
Copyright 2011 WSU Area Health Education Center

15. How do ACEs affect student performance?
Copyright 2011 WSU Area Health Education Center

16. Affect Identification Trauma Experience Integration
The ARC Model
Caregiver Affect Mgmt.
Attunement
Consistent Response
Routines and Rituals
Affect Identification
Modulation
Affect Expression
Dev’tal Tasks
Executive Functions
Self Dev’t & Identity
Trauma Experience Integration
Competency
Very brief overview today- the focus of further trainings will be to deconstruct this and put it back together in a way that is pertinent to the work you do.
Self-Regulation
Attachment
Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

17. What a child has come to understand is dangerous
The 3-part model
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
Thus forcing the child to put energy into survival rather than healthy development, leaving them with developmental deficits
Tractor story- car crash
Not about the event- about how we respond to it. There is no inherent ‘trauma’ in any one thing- its about whether or not that person is experiencing an overwhelming inability to cope with what is going on.
Think back to the 911 call- we talked about behaviors you might see the next day. Now we’re talking about viewing those behaviors in a deeper way- as a function of behavior.
Safety-seeking behavior: not necessarily acting out. One kid described his as “Doing my best to never be seen”
Copyright 2011 WSU Area Health Education Center

18. 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
If ARC were a play, it wouldn’t be the script and you wouldn’t be the actor. ARC would be the story between the lines and you would be the director trying to flush it out.
ARC states that humans do what make sense to them in the moment. Behavior is not random- it comes from somewhere. If we dig into the “why” then we can understand why it makes sense to that person. Think about that 3 part model- All we tend to see are the adaptive strategies, but those strategies were formed because they needed to be formed, not just to make our day a little more frustrating.
Understanding gives us the chance to realize the bx is not about us, it is about protect whatever is under the surface with that iceberg. So when ask why and find an understanding for where a bx is coming from, it naturally lends itself to depersonalization. This becomes a self care strategy.

19. 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
It is safe to assume that in every single block, caregiver affect management and attunement will be necessary.

20. 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

21. 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

22. 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
Remember that ice berg? Don’t be the Titanic!!!
The main goal of this block is not just to be able to understand and monitor your emotional responses, it is to build a system of support around caregivers in their environment. Feelings are best understood through processing and sharing with others in a reflective way and to do this, caregivers need an environment that provides this.
For most of us, the problem is not with consistent or constant regulation. For most of us, we have a certain set of specific triggers that challenge our ability to regulate.
Developmentally, we must consider what children need from us and how their need impacts our ability to regulate. Young children who have experienced trauma are nearly 100% reliant on their caregivers to modulate for them. This looks different than middle childhood where we as caregivers help kids modulate by being near them and coaching, rather than doing it for them.
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

23. Attunement
How do we interpret the meaning behind behavior? Look pass the top of the iceberg and respond to what is underneath
The main idea: Support staff in learning to accurately and empathically understand and respond to children’s actions, communications, needs, and feelings
Identifying student’s triggers and danger response
Reflective listening skills
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
Attunement is the capacity of one person to accurately read another person’s cues and respond appropriately.
Think of the difference in the richness of music from a piano to a keyboard. When you strike a piano, the cord the key strikes vibrates, causing other cords to vibrate softly along with it. This creates a depth of sound. When you strike a keyboard, you get a very stale note because there isn’t this resonance.
This is how attunement works. In interactions where we work to attune to the other, we are looking to understand the space they are in and communicate this understanding.
There are 4 levels of attunement: cognitive, emotional, behavioral, and physiological.
This means not just looking at what we can observe, but understanding what is feeding the observable behavior.
Attunement goes hand in hand with emotional regulation. Have you ever noticed that the better we understand a person, the more patience we have with them? When we understand what is going on within another, it helps us act instead of react. This has a lot to do with the difference between feeling like we have to correct behavior and asking ourselves the question, “what is the need that this strategy is filling?”
Attunement is not just important with kids- in any relationship, it is attunement that communicates to the other person that you understand. Have you ever felt the difference between someone saying to you, “Yeah I get it,” but not feeling gotten and someone saying nothing to you but you feeling totally understood? That’s attunement.
The key here is accuracy.
Misattunement happens. Especially with trauma affected kids because they may have greater difficulty giving cues that accurately express needs or identify what is going on within them. Attunement, like many ARC skills, isn’t a switch we turn on in ourselves. It is something we practice.
Example: facebook status that said, “As I sit here by the lake surrounded by family and dear friends that have brought so much joy to my life, I am again reminded that even when a year like this last one brings about significant change, I can always find something to be thankful for.” The first comment below? “What lake?”
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

24. 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
When caregivers provide predictable responses over time, it can give kids the chance to let go of some of the need for control and put more resource into normal development.
Our ideas of what is an ‘appropriate response’ often comes from our own history. So this means that we generally respond to others in a way that makes sense to us; whether this makes sense to the other person is a different question.
We know that all children need predictability and trauma affected kids who are used to living in an unpredictable world may adapt to that world by trying to control it. If they can control it, they can predict it, which is a way to seek safety.
In particular, limit setting and praise may be triggers for kids living in chaotic environments. Limits can be perceived as a threat to the child’s attempts to control and predict their world. The consequences of limit-breaking can also be a trigger. Praise may be a trigger for a child who has come to have a self-concept that they don’t have worth.
Think about some of the times that kids in your classroom may feel powerless- not necessarily about just limits, but also can be those places where they feel different than their peers. For example, picture day. How do you consistently respond to a child who can’t participate in a ritual like picture day because their family doesn’t have the resources for pictures? How might this feeling of powerlessness influence how a child may be more triggered in that situation?
Becoming aware of a child’s personal triggers can help caregivers become sensitive to places where they’ll have to tailor their consistent response to that child and/or anticipate need to move into other ARC blocks.
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

25. 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
We will cover this block in much more depth.
Consistent routines can build predictability, which can increase feelings of safety and decrease fear of being vulnerable. Predictability is a big theme in ARC and this makes sense not only for trauma affected kids but for all kids- when we can anticipate what will happen, we don’t have to be on guard.
Establishing routines isn’t structure for the sake of structure- it is about meeting the goals of predictability, modulation, and creating safety. There needs to be a balance between firmness and flexibility so routines can be evaluated for effectiveness.
Transition is one of the most important times to establish routine-
Should include ‘breaks’ that are different than discipline where a child who is becoming dysregulated has the opportunity to try to modulate and re-enter the routine.
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

26. 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 may miscue others as a way of protecting themselves from emotions that feel unsafe
Children who have experienced poor caretaking and poor emotional support may have never developed healthy ways to identify what they are feeling
Limited skill set may be easily overwhelmed by state of arousal
A big element in this block is skill building and teaching. But for a child to be open to learning to express their emotions, it takes a huge amount of trust and that trust comes from the relationship, the belief that the other person can manage their own emotions, and the feeling of being listened to and heard. Think of the primary principle of this block as trying to build safe relationships that support understanding who the child is.
A lot of this block involves brainstorming with kids- “When you’re upset, what can you do? Who can you go to?” The ideas may change for each kid.
It is also important to note that the time to introduce this is not when a kid is already upset. If a kid is using their adaptive strategies to manage emotion, it means they’re in a vulnerable space. Forcing a child to become more vulnerable without prior discussion of your intention to do this may serve as an additional trigger.
So practicing this may look in part like the routines/rituals block. You can build routines on a daily basis.
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

27. 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
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
“Children who experience unresponsive, inconsistent, or abusive caretaking may fail to develop healthy age- appropriate skills and instead must rely on primitive regulation strategies.”
Turning to external methods to alter or control physiological experience.
Young children rely on their caregivers to modulate for them, thus helping develop these skills
These strategies may include:
**First place I’ve ever heard the word modulation.
**Good for all children as the ability to modulate is not something we are born with, it is something we practice and learn how to do within the context of relationship with others.
**Children who have been through trauma often have difficulty modulating emotions in a safe and effective way. 2 historical factors play a part in this- lack of healthy attachment figure to model and teach these skills and the internal stress response that creates overwhelming levels of arousal.
**Involves being able to purposefully change your arousal level to what is appropriate for the situation. This can mean increasing arousal from being low or constricted or decreasing arousal from being high or escalated.
Includes 5 abilities-
Identify initial emotional or physiological state and the degree to which it is comfortable
Identify and connect with subtle changes in state
Identify what it feels like in the body to experience subtle changes in state
Identify the ways that different emotions impact the body, energy, and arousal
Identify and use strategies to manage these state changes
**What a person considers comfortable arousal may be very different from what is considered effective.
**In order for modulation to be effective, a person must never feel coerced or forced to use modulation tools.
Shift can start out slow and it is best to practice modulation when arousal levels are comfortable.
**Can’t help someone calm down if you’re not also calm.
Kids at different developmental stages will modulate differently and have different levels of skill.
**Be particularly gentle with kids who tend to ‘numb out’ as re-engagement can be a trigger.
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

28. 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
Humans do what makes sense to them in the moment.
This block is not just about how kids express themselves, but how they do so in a safe, healthy, appropriate way. A kid may have learned that yelling when they’re angry is an effective way to express anger, but that doesn’t make it safe or healthy.
When a child’s attempts to communicate emotion are met with anger, rejection, and/or indifference they learn two things:
Shame- My emotions are wrong, bad, or unimportant.
Secrecy-if I share my emotions something bad will happen.

29. 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
Serve as a way to modulate intense arousal
Provide a sense of control and ability to impact the world
Bring conscious thought to actions
Increase likelihood of developing high resilience
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
The development of executive functions can:
**This block is not only about supporting kids in their belief in their ability to make choices and impact their world, it is also about helping them learn to step back and think about the choice they’re about to make.
**The thing we say to kids when we’re in this block isn’t “No!” Its “What are you trying to accomplish? What do you think might happen if you do X?” This builds connection between the action they’re doing or about to do and the outcome.
**This may directly impact how we treat misbehavior, because it suggests not saying “You have to change,” but why they did the behavior. The behavior is adaptive for some reason and makes sense to the person doing it because humans do what makes sense to them. So when we understand the “Why” of the behavior, we can connect the child’s adaption with the outcome. Then we can show them that they have more choices available.
Its also about providing positive support and catching kids when they’ve made good choices. This suggests that when kids are “caught doing something right,” they can begin to understand the difference between appropriate and inappropriate choices.
Praise should be situation specific.
Giving choice- “You can sit here and do X or you can go talk to this person.”
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

30. 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
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
“Children who are routinely rejected, harmed, or ignored internalize an understanding of self as unlovable, unworthy, helpless, or damaged.”
Self development includes:
understanding self as separate from others
This can be individual identity or group identity.
4 kinds of self-
Unique self- all the stuff that makes me who I am and different from others. The things that feel important to me, that I let influence me, motivate me, and so on.
Positive self- the things I can feel proud of
Cohesive self- taking a person’s history and present experience and putting it together in a cohesive picture
Future self- ideas of what the future looks like for this person. It doesn’t have to be reality based in younger kids because it’s more about experimenting with all the ways we can see ourselves and trying on different pictures.
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

31. 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
ARC is a model that provides an avenue for anyone to learn how to let go of adaptive strategies learned because of the assumption of danger. It doesn’t do this by revisiting the event, processing the event, or by discussing the event. It does this by directly addressing the resulting adaptive strategies, not the memory or experience of the event itself.
So, what that means with this block is that you can do the ARC model without ever touching this block. Discussing or processing traumatic experiences is always up to the individual and their own decision to talk about something they’ve through. So, with this block, keep in mind that it’s always possible to lend an ear and help someone talk something out, but it isn’t really the goal of ARC. You can do ARC without ever touching this block.
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents

32. “The world breaks everyone and afterwards many are strong at the broken places.” ~ Ernest Hemingway
Copyright 2011 WSU Area Health Education Center

33. Some Do’s and Don’ts of Having a Trauma Sensitive Lens
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
Define paraphrase
Copyright 2011 WSU Area Health Education Center

34. 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
Not always going to be your role- the difference is having that lens and being curious about what need a kid might be displaying in this moment
Copyright 2011 WSU Area Health Education Center

35. 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?
Copyright 2011 WSU Area Health Education Center

36. If you’d like more information
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“Brain Rules” by John Medina
“Helping Traumatized Children Learn” report and policy agenda by the Massachusetts Advocates for Children
Copyright 2011 WSU Area Health Education Center