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Trauma Informed Care Carol Warmbier, LISW Brenda Gerdes, LISW Penny Nordstrom, LMSW.

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Presentation on theme: "Trauma Informed Care Carol Warmbier, LISW Brenda Gerdes, LISW Penny Nordstrom, LMSW."— Presentation transcript:

1 Trauma Informed Care Carol Warmbier, LISW Brenda Gerdes, LISW Penny Nordstrom, LMSW

2 Definition of Trauma  “The word “trauma” is used to describe experiences or situations that are emotionally painful and distressing, and that overwhelm peoples’ ability to cope, leaving them powerless.” (Center for Nonviolence and Social Justice, 2008)  “The person’s response to the event must involve intense fear, helplessness or horror (or in children, the response must involve disorganized or agitated behavior)”. (American Psychiatric Assoc. (APA) 2000, pg. 463)

3  “Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being”. (Substance Abuse and Mental Health Administration)

4 Facts about Trauma “Through Our Eyes” 

5 Traumatic Events  Trauma can take many forms:  Emotional, sexual or physical abuse  Someone in household who is chronically depressed, mentally ill, institutionalized or suicidal  An alcohol or drug abuser in the household  Incarcerated household member  Extremely painful and frightening medical procedures  Catastrophic injuries and illnesses  Rape or assault  Muggings  Burglary

6 Traumatic events (cont.)  Witnessing murder  Automobile accidents  Immigration  Natural disasters (hurricanes, earthquakes, tornadoes, fires, floods, volcanoes)  Abandonment (especially for small children)  Acts of terrorism (such as September 11, 2001) or family involvement in a war  Witnessing violence such as a parent harming another parent  Personal Betrayals

7 12 Core Concepts * see handout: UCLA-Duke University National Center for Child Traumatic Stress, 2010, 2012  Understanding Traumatic stress responses in childhood Moment-to-moment reaction is strongly influenced by prior experience and developmental level.

8 1 st Core Concept: Traumatic experiences are inherently complex  Piaget’s Developmental Model can be a framework to think about how trauma impacts at various developmental levels  Degree of complexity often increases in cases of multiple or recurrent trauma exposure and in situations where a primary caregiver is a perpetrator of trauma

9 Process of Trauma Traumatic Event Overwhelms the Physical & Psychological Systems Current Stress Reminders of Trauma Life Events, Lifestyle Painful Emotional State Self-Destructive Action Substance Abuse; Eating Disorders; Deliberate Self- Harm; Suicidal Actions Destructive actions Aggression; Violence; Rages Retreat Isolation; Dissociation’ Depression’ Anxiety Sensitized Nervous System Response to Trauma Flight or Fight, Freeze, Altered State of Consciousness, Body Sensations, Numbing, Hyper-vigilance, Hyper-arousal

10 Trauma Effects: Preschool Children  Separation anxiety  Regression of previously mastered stages of development  Lack of developmental progress  Re-creating the traumatic event  Difficulty at naptime or bedtime  Increase somatic complaints  Changes in behavior  Over or under reaction to physical contact, bright lighting, sudden movement  Increased distress  Anxiety/fear/worry about safety of self and others  Worry about recurrence of the traumatic event  New fears, statements and questions about death and dying  Attachment issues (National Child Traumatic Stress Network Schools Committee, October 2008)

11 Trauma effects: Elementary School Children  Anxiety/worry/fear about safety of self and others  Worry about recurrence of violence  Increased distress  Changes in behavior  Distract of others  A changing inability to interpret and respond appropriately to social cues  Increase somatic complaints  Changes in school performance  Recreating the event  Over or under reacting to bells, physical contact, doors slamming, siren, lighting, and/or sudden movements  Statements and questions about death and dying  Difficult with authority, redirection or criticism  Re-experiencing the trauma  Hyper arousal  Avoidance behaviors  Emotional numbing ( National Child Traumatic Stress Network Schools Committee, October 2008)

12 Trauma Effects: Middle School Children  Anxiety/worry/fear about safety of self and others  Worry about recurrence of violence  Increased distress  Changes in behavior  Increase somatic complaints  Changes in school performance  Discomfort with feelings  Repeated discussion of event and focus on specific details of what happened over or under reacting to bells, physical contact, doors slamming, sirens, lighting, and/or sudden movements  Difficult with authority  Re-experiencing the trauma  Hyper arousal  Avoidance behaviors  Emotional numbing (National Child Traumatic Stress Network Schools Committee, October 2008)

13 Trauma Effects: High School Students  Anxiety/fear/worry about safety of self and others  Worry about recurrence or consequences of violence  Changes in behavior  Withdrawal from others or activities  Irritability with friends, teachers, events  Angry outbursts  Change in academic performance  Decreased attention  Increase in activity level  Absenteeism  Increase in impulsivity, risk- taking behavior  Discomfort with feelings  Increase risk for substance abuse  Discussion of events and reviewing of details  Negative impact on issues of trust and perception of others  Over or under reacting to bells, physical contact, slamming doors, sirens, lighting, and/or sudden movements  Repetitive thoughts and comments about death or dying  Heightened difficult with authority, redirection or criticism  Re-experiencing the trauma  Hyper arousal  Avoidance behaviors  Emotional numbing (National Child Traumatic stress Network Schools Committee, October 2008)

14 2 nd Core Concept : Trauma occurs within a broad context that includes children’s personal characteristics, life experiences, and current circumstances  Internal—intrinsic factors such as temperament, previous experience with trauma, and mental health  External—external factors such as surrounding physical, family, community and cultural environments  These factors may influence the student’s expectations regarding danger, protection and safety as well as the course of their adjustment

15 3 rd Core Concept: Traumatic events often generate secondary adversities, life changes, and distressing reminders in children’s daily lives  Family may move  Parents may divorce  Financial difficulties  Legal issues Cascade of changes in child’s life compound the problem

16 4 th Core Concept: Children can exhibit a wide range of reactions to trauma and loss  Post traumatic stress can develop over time into psychiatric disorders including PTSD, separation anxiety, and depression  PTSD and grief reactions may affect several areas of a child’s life: attachment, peer relationships and emotional regulation…this may reduce the child’s level of functioning at home, school and/or in the community

17 5 th Core Concept: Danger and safety are core concerns in the lives of traumatized children  Critical to provide safety for children who have experienced trauma in their history  Even when they are physically safe, they may continue to fear and, many times, have a hard time distinguishing between safe and unsafe situations. Trauma impacts their ability to assess risks accurately…perception of others’ behaviors may be inaccurate—people look at them wrong, teachers “yell” at them, they can’t do anything right

18 6 th Core Concept : Traumatic experiences affect the family and broader caregiving systems  Caregivers’ stress level can negatively affect their ability to provide on-going care for their children.  Families will also need to be engaged in treatment and support

19 7 th Core Concept: Protective and pro-motive factors can reduce the adverse impact of trauma  Positive attachment with primary caregiver or other caring adult  Strong social support network  Reliable and consistently available adults in their lives  Supportive school and community environment

20 8 th Core Concept: Trauma and post-trauma adversities can strongly influence development  These disruptions may inhibit development and present as regressive behavior, reluctance to participate in age- appropriate activities as well as inappropriate responses in social and academic settings  These responses may then lead to other at-risk behaviors such as sexual acting-out/abuse, reckless driving, substance abuse, self-injury, etc.  Engagement in the academic environment may be compromised by the effects of trauma

21 9 th Core Concept: Developmental neurobiology underlies children’s reactions to traumatic experiences  Survival Circuits- traumatic stress is about survival in the moment. The brain is divided into higher and lower order systems.  The higher order system in the brain is responsible for thought and decision-making. This is what we use the majority of the time.  Lower order systems regulate the involuntary survival systems in the body: heartbeat, breathing, reflexes, etc. The amygdala is located in the lower order system of the brain. This is the location of the fight or flight response and will sometimes shut down the thinking part of the brain in order to focus on survival.  Long term memory involves the laying down of moments in a clear organized manner.  The amygdala lays down memory in a very fragmented, choppy, disoriented manner. We don't have any memory in our lower part of the brain except for traumatic events. The only emotions that we can access when triggered are those that are associated with the original trauma.

22 9 th Core Cont.  Triggers can include sights, smells, sounds and physical issues and can quickly engage the amygdala.  The problem is that the traumatized brain becomes hypersensitive and may kick in more rapidly than it needs to or is more easily accessed, even when there is no real threat or crisis. The brain will respond in the way that it did during the traumatic event.  As helping professionals, we must know what the triggers are and be familiar with the environments that impact the student. Trauma will look different from child to child.

23 Awareness (Attention)  In the moment before a traumatic response we may see shifts in AWARENESS  When triggered a child tends to focus on the specific elements in their environment necessary to survival  We want to be aware of shifts in focus, awareness, and attention  Hyper-sensitive  Hyper-vigilant  Dissociated  Inattentive

24 Affect (Emotions)  An emotional process  Similar emotions experienced when triggered as were experienced at the time of the trauma  Similar level of intensity

25 Actions (Behaviors)  A child will experience a significant shift in behavior when triggered  This is almost always an attempt to diminish the painful emotions that have just been elicited  Kicking, screaming, biting, cutting, running away, isolations (all motivated by survival)  Soothing behaviors (rocking, sucking, masturbating) We must understand a child’s internal catalog to truly understand their behaviors

26 10 th Core Concept: Culture is closely interwoven with traumatic experiences, response, and recovery  Culture influences ways that children/families respond to traumatic events, including how they disclose personal information and seek help.  Experiences with historical/multigenerational trauma can affect world view and thus their responses to loss/grief and expectations of self/others.

27 11 th Core Concept: Challenges to the social contract, including legal and ethical issues, affect trauma response and recovery  How the adults/systems respond to the child’s distress contribute to their perceptions of themselves and others.  The success/failure of institutional responses (educational, legal and welfare systems) will influence the child’s adjustment as well as his/her evolving beliefs, attitudes and expectations.

28 12 th Core Concept : Working with trauma-exposed children can evoke distress in providers that makes it more difficult for them to provide good care.  Helping professionals may also experience trauma from working with children/families with trauma histories. It’s important to recognize the impact of these cases on you personally/professionally and to have professional consultation available to consider a plan of action.  We have legal and ethical responsibilities to make decisions regarding mandatory reporting and/or referral for treatment.

29 Treatment Options  Trauma focused Cognitive Behavioral Therapy (CBT)  Parent-Child Interaction Therapy  Alternatives for Families CBT  Trauma Systems Therapy (TST)

30 Resources  Saxe,G.N., Ellis, H.B., Kaplow, J.B. (2007) Collaborative Treatment of Traumatized Children and Teens- The Trauma Systems Therapy Approach.  UCLA-Duke University National Center for Child Traumatic Stress, “NCTSN Core Curriculum on Childhood Trauma— The Twelve Core Concepts”, 2012  (Through Our Eyes)

31 Resources  International Society for Traumatic Stress Studies  https://www.istss.org/Home.htm  National Child Traumatic Stress Network   Child Trauma Academy   The Trauma Center at Justice Resource Institute   Sidran Institute: Traumatic stress Education an Advocacy   The Adverse Childhood Experiences Study 

32 Resources  Trauma Information Pages   National Center for Children Exposed to Violence   National Center for Trauma Informed Care   National Trauma Consortium   SAMHSA   Center For Early Childhood Mental Health Consultation 

33 Resources  Books and Children’s Resources  A Terrible Thing Happened – A story for children who have witnessed violence or trauma by Margaret M. Holmes  When I Miss You (The Way I feel Books) by Cornelia Maude Spelman  When I Feel Scared (The Way I Feel Books) by Cornelia Maude Spelman  Maybe Days: A Book for Children in Foster Care by Jennifer Wilgocki  What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety by Dawn Huebner  Help Me Say Goodbye: Activities for Helping Kids Cope When a Special Person Dies by Janis L. Silverman

34 Resources  Arnie and His School Tools: Simple Sensory Solutions That Build Success by Jennifer Veendendall  Squirmy Wormy: How I Learned to Help Myself by Lynda Farrington Wilson  Grief is Like a Snowflake by Julia Cook (Julia Cook has many other books pertaining to all different behaviors)  My Time Book from Scholastic


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