1. The Children’s Hospital of Philadelphia
Our Kids are Not Broken: Recognizing and Building on the Strengths of Youth Who Have Endured Trauma
Ken Ginsburg, MD, MS Ed
The Children’s Hospital of Philadelphia
Covenant House PA

2. Objectives
To understand what adverse childhood experiences do to the brain, body, and behavior
To consider how a trauma-focused approach prepares us to better serve youth and maintain appropriate boundaries
To consider why a risk-based approach can engender shame

3. Resilience The Ability To Overcome Adversity
The Capacity to Bounce Back

4. Resilience is a Mindset

5. Resilience is
NOT
Invulnerability

6. The Bottom Line
Young People will be more resilient if the important adults in their lives believe in them unconditionally and hold them to high expectations
Young People live up or down to the expectations we set for them

7. Breathe

8. The Parable of the River
Once upon a time there was a town that was built just beyond the bend of a beautiful river. One day some of the children were playing beside the river when they noticed three bodies in the water. They ran for help and the townsfolk quickly pulled the bodies out of the river. One body was dead, so they buried her. One man was ill, so they took him to the hospital and nursed him back to health. The third was a healthy girl, who was then placed with a family who cared for her and took her to school. From that day on, every day bodies came floating down the river, and every day, the people of the town would tend to them – taking the sick to the hospitals, placing the healthy with families, and burying the dead. This went on for years, and the townsfolk not only came to expect a number of bodies each day but also worked at developing elaborate systems for picking them out of the river and tending to their needs. Some were generous in tending these bodies and a few extraordinary ones gave up their jobs so they could do this full time. And the town itself developed pride in its generosity and efficiency in body tending. However, during all these years and despite the generosity and effort, nobody thought to go up river, beyond the bend that hid from sight what was above them and find out why, daily, those bodies came floating down the river.
(Adapted from Rolbeiser, R. (1999). The holy longing. New York: Doubleday)
The Parable of the River

9. Trauma Informed Care

10. The model is borrowed from Camara Phyllis Jones, M.D., M.P.H., Ph.D.

11. Felitti VJ, Anda RF, Nordenberg DF, Williamson DF, Spitz AM, Edwards VJ, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine 1998;14(4):

12. The Adverse Childhood Experiences
Emotional Abuse
Physical Abuse
Sexual Abuse
Neglected
Exposure to Substance Abuse in Household
Exposure to Mental Illness in Household
Exposure to Domestic Violence in Household
Parent(s) Sent to Prison
Were Parents Divorced or Did You Experience Parental Abandonment?

13. UNLESS

14. UNLESS Until When???

15. The Effect of ACEs on the Brain

16. The Effect of ACEs on Behavior

17. How Do We React to Behavior

18. Being Trauma Informed is Healing (for Us and Youth)
But focusing on trauma or risk holds the potential to re-traumatize

19. To enable all young people, especially those who need us most, to reach their full potential as productive, caring, responsible citizens.
Youth who need us the most are often those who push us away
Youth who need us the most are often those who push our buttons
Youth who need us the most, raise uncomfortable feelings in us

20. Tying it Together: Addressing Risk, Acknowledging Trauma but Developing Strengths

21. (What they’re missing)
Behavioral Change 101
(What they’re missing)

22. The Five Steps of Behavioral Change
Awareness
Motivation
Skills
Trial and error
Maintenance

23. Confidence gets it started . . . . . . and shame paralyzes all efforts

24. Finding Competence . . . . . . Building ConfidenceX X X

25. “Love is seeing someone as they deserve to be seen, as they really are , not through the lens of the behaviors they have sometimes needed to display.”

26. We are loving for reasons beyond spirituality; we are loving to initiate positive change

27. Who are our kids who have been through so much?

28. Giving Kids Control Over Their Decisions

29. Learning Not to Undermine Competence
Talking in a way young people understand
Recognizing the cognitive development of adolescence
No more lectures!!!!!!

30. Maimed and left in a wheelchair
You fight, but she uses her knife first
Maimed and left in a wheelchair
Stabbed
in back
You fight, but she uses her knife first
Stabbed
in the
heart
You are
killed
You fight
and kill her
How long
are you
Happy?
Jail
20 years
Your mom
is ashamed
Die poor,
with no family No
job No
education
How long
are you
angry?
You don’t
fight
You finish school
Your mom
is proud
You have
kids

31. Life Running with Gangs
A Future as an Architect, Building
Your Community
Death and Destruction
Sense of
control returns
Life Running with Gangs

32. Resilience
Is about learning to cope, in a positive way with life’s inevitable stressors
We might do our greatest good by raising youth with a wide repertoire of positive coping strategies

33. Positive Coping Strategies Negative Coping Strategies
Relief
Relief
Positive Coping Strategies
You Feel Awful!!!
You Feel Awful!!!
You Feel Awful!!!
Stress
Discomfort
Discomfort
Discomfort
Negative Coping Strategies

34. Positive Coping Strategies Negative Coping Strategies
Relief
Relief
Positive Coping Strategies
You Feel Awful!!!
You Feel Awful!!!
You Feel Awful!!!
Stress
Discomfort
Discomfort
Discomfort
Negative Coping Strategies

35. Connection is the most important coping strategy

36. Distinguishing Paper Tigers from Real tigers Knowing When Bad Things are Temporary Knowing When Good Things are Permanent

37. A Stress Management Plan for Teens
(It Might Just Work for grownups)

38. Stress Management : Tackling The Problem
Making the problem manageable
Active Avoidance
Let Some things go

39. Serenity Prayer
Grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference

40. Stress Management : Taking Care of My Body
Exercise
Fear
Anger

41. Stress Management : Taking Care of My Body
Relaxation
Nutrition

42. Stress Management : Taking Care of My Body
7) Sleep
Stimulation
Cool Down
Exercise
Shower
Release emotion

43. Stress Management : Managing Emotions
Instant Vacations
Releasing Emotions

44. The Worst thing is not to be stressed . . . it is to be NUMB

45. Stress Management Plan : Making the World Better
Contributing to the world

46. Help youth to know how much they matter Recognize the credentials they bring to the world

47. Do The Work It Takes To Love The Second Sentence

48. Offer Radical Calmness Amidst a Chaotic Reality

49. There is no “other”
There is only US

53. Fosteringresilience.com