1. Trauma 101 An Overview of Trauma-Informed Care

2. Goals  Connect colleagues  Enhance and enrich awareness and knowledge of trauma  Develop a shared language  Increase awareness of Adverse Childhood Experiences Study  Learn basics of brain growth and impact of toxic stress  Understand four components of Trauma- Informed Care  Embrace reasons for hope

3. Predictions, Acknowledgments and Disclaimers  Most of the information and research on trauma- informed care is new.  Information may be a review or it may be a new experience.  Learning about trauma may be painful. We encourage each participant to mentally create a Safety Plan.  There is more to know about trauma than we can present.

4. Safety Plan  Safety Plan is a list of simple external and internal activities that a person can choose to use when feeling triggered or overwhelmed.  Mentally consider what promotes your safety:externally (i.e. sit near door, doodle, walk out)internally (i.e. self-awareness, self-talk, reassure yourself that you are competent and capable of maintaining your safety)

5. Ground Rules Because we will be interactive, we ask that everyone be mindful about maintaining a safe environment for discussion.  Respect all opinions.  Share air space.  Be question sensitive.  Preserve confidentiality.  Be self-protective.  Limit side conversations (including technology).

6. ACEs Research  How many of you know about the ACEs Research?  Dr. Nadine Burke-Harris TedTalk: Dr. Burke-Harris received a medical degree at UC Davis and a Masters in Public Health from Harvard. In 2015 she worked at California Pacific Medical Center where she developed programs to address health disparities in the San Francisco Bay Area.  http://www.ted.com/talks/nadine_burke_harris_how_c hildhood_trauma_affects_health_across_a_lifetime http://www.ted.com/talks/nadine_burke_harris_how_c hildhood_trauma_affects_health_across_a_lifetime

8. According to Dr. Roy Wade, a local pediatrician, researcher and member of the Philadelphia Task Force: “When we looked at how common ACEs were across Philadelphia, we found the highest prevalence in the 22 nd police district with almost 60% of the respondents from this area stating they had experience four or more ACEs growing up. We know that there are higher rates of health and social problems clustering in the 22 nd district. Our research suggests that early childhood stress could explain the high occurrence of these conditions in the 22 nd district neighborhoods.” October 2015 Presentation for the New Eyes Video ACEs in Philadelphia

9.  Appreciating the impact of ACEs is one key piece of understanding trauma  In addition to ACEs, we can consider the impact of a variety of other traumas and chronic toxic stress The Value of Knowing About ACEs

10.  An overriding emotional event involving deep distress, alarm, fear or terror  “Neuro-electrical jolt”  The event is perceived as inescapable  And/or sustained, toxic stress, also inescapable  Neurological landscape changes – Powerful sensory memories are created which lead to: Fight Flight Freeze Capitulation What is Trauma?

11. Principles of Trauma  Everyone has different responses, depending on their history of trauma, support, degrees of resilience and temperament  Some trauma resolves on its own  Some trauma remains dormant until triggered  Post Traumatic Stress (PTS) – high degree of stress for several days or weeks after a significant trauma  Post-Traumatic Stress Disorder (PTSD) – stress symptoms are present three months after event

12.  “The experience of trauma is complex. Trauma varies in type, source, chronicity, and impact; it is experienced at different developmental stages, within different context – family, community, and culture – and in the presence or absence of different internal and external resources and challenges. It is not surprising, then, that disparity exists in our understanding of trauma in its manifestations, and in its proper treatment.” Source: Treating Traumatic Stress in Children and Adolescents by Blaustein and Kenniburgh Complexity

13. Early Brain Development  Nurturing, responsive and individualized interactions from birth build healthy brain structure  Healthy brain architecture is the necessary foundation required for optimal future learning, behavior and health Regional Child Abuse Prevention Councils 2011

14. Key Brain Basics  Human brain consists of about 84 billion neurons.  Each neuron forms about 1,000 connections.  One billion synapses in 1 cubic inch of brain tissue.  403 billion glia cells in each brain.  420 trillion synaptic boutons.  8.4 quadrillion synaptic proteins  2.5 quadrillion neuronal/brain cell interactions (electrical conversations) per minute. Source: Dr. Bruce Perry April 20, 2015

15. Stress and the Brain  Excessive and repeated stress: Neglect, violence Chaos, unpredictability Hostility, rejection  Causes disruption of brain architecture: Impairs cell growth Interferes with healthy neural circuits Regional Child Abuse Prevention Councils 2011

16. The Theory of Everything  “Scientists are calling the correlation between childhood trauma, brain architecture, and adult well- being the new psychological ‘theory of everything.’”  “Adverse Childhood Experience research shows that both physical and emotional suffering are rooted in the complex workings of the human immune system… What happens to the brain in childhood sets up the lifelong programming for this master operating system, governing all: body, brain, and mind.”  “The unifying principle of this new ‘theory of everything’ is this: your emotional biography becomes your phsycial biology... Your early stories script your biology and your biology scripts the way your life will play out.” Source: Childhood Distrupted: How Your Biography Becomes Your Biology and How You Can Heal by Donna Jackson Nakazawa, 2015.

17. Amygdala  Small almond-sized structure  One on either side  Part of limbic system  Acts as sentry or router  Processes incoming data, especially as it relates to danger, fear or pain  Decides where in the brain to send information

18. Amygdala  Amazing ability to store sensory memories, especially as related to danger, fear and pain  Can be activated (triggered) in as little as 1/12 th of a second, ordering the brain to release powerful neuro-chemicals (brain hormones) so body is ready to fight, flee or freeze  “Hijacks” the brain

19. Amygdala  Overwhelming moments of deep fear or terror, ACEs or chronic, toxic stress transform healthy amygdala (sentries) into ones that are hyper-sensitive, easily agitated and prone to signaling the brain to release toxic levels of neuro-chemicals.  The child or adult with overly-reactive amygdala can lead to a host of problems: Hyper-arousal Hyper-aggression Dissociation Inabilities to concentrate Health problems

20. Amygdala  The brain actually becomes inflamed from all of the excess stress hormones/neuro-chemicals surging through it.  This over-sized, reactive amygdala can lead to all the physical, mental, emotional and social problems described in the ACEs research.

21. Kinds of Trauma Situational OR Relational Acute/Single Event Chronic Trauma Complex Trauma Chronic Toxic Stress Allostatic Load Developmental Trauma Attachment-Related Trauma Transgenerational Trauma Cultural/Political Trauma Community Traumas Medical Trauma War Trauma Vicarious Trauma Unprocessed Memories Adverse Childhood Experiences (ACEs) Occurred in the past vs currently being experienced

23. PART  Prevention: ensuring to whatever degree is possible that traumatizing events are prevented from occurring in the first place  Avoid triggering or otherwise exacerbating existing trauma-related issues and needs  Respond appropriately and in trauma-informed ways if  Therapeutic processes that can promote recovery and healing of trauma-related issues and needs.

24. Why there is Hope  Research is providing clearer information, provides scientific evidence of the impact of trauma, violence, ACEs.  There are trauma-sensitive responses that can change outcomes for the better.  The brain is capable of being changed.

25. Trauma-Sensitive Therapies and Programs  Somatosensory Activities  Yoga / Mindfulness  Art & Music Therapy  EMDR (Eye-Movement Desensitization Reprocessing)  TFCBT (Trauma-Focused Cognitive Behavioral Therapy)  Dr. Sandra Bloom’s Sanctuary Model  Dr. Bruce Perry’s Neurosequential model  IFP’s Trauma Courses and Trauma- Competent Certification Process

26. Hope  Schools and other systems that impact children and families can become brain-based with staff that is trauma-informed  Schools and other systems can incorporate the principles and practices that:  P revent ACEs, trauma and toxic stress  A void triggering and exacerbating trauma  R espond to students and others in effective ways when they are triggered  provide T herapeutic interventions that promote healing

27. Post-Traumatic Growth  A positive change experienced as a result of the struggle with a major life crisis or a traumatic event.  Human beings can be changed by their encounters with life challenges, sometimes in radically positive ways. Source: https://ptgi.uncc.edu/what-is-ptghttps://ptgi.uncc.edu/what-is-ptg

28. Post-Traumatic Growth  300 studies since 1990  70% report positive psychological growth 1.New Opportunities 2.Closer Relationships 3.Stronger 4.Greater Appreciation for Life 5.Spiritual / Religious Source: The Huffington Post: The Surprising Benefit of Going Through Hard Times 01/02/2016

29. The Single Most Significant Component of Healing  …is experiencing healthy relationships.  According to Neurons to Neighborhoods: “Human relationships, and the effects of relationships on relationships, are the building blocks of healthy development.”  “Healing takes place in the context of healthy relationships over time.”

30. Reframe  Instead of asking, “Whats wrong with you?”  Trauma-informed people ask, “What happened to you?” Joseph Foderaro Psychoeducation Training Specialist Drexel University College of Medicine

31. Continuum of Sophistication with Regard to Trauma Education Provides a panoramic view of nature of trauma education Serves as a construct to enhance overall awareness and understanding Not everyone needs to advance along continuum Each area represents knowledge levels in multiple trauma-related domains As people move along continuum they become increasingly better equipped to meet trauma-related needs Non-clinical model to bring levels of trauma education to large numbers of people who impact children and families

32. Continuum of Sophistication Trauma- Aware Trauma- Informed Trauma- Sensitive Trauma- Competent Training Time Needed (approximate) 2-4 hours12-15 hours (Six 2.5 hour sessions with outside reading) 40-50 hours (Additional twelve 2.5 hour sessions with outside reading) 120+ hours (Additional twelve 2.5 hour sessions with outside reading and practicum work) General overall trauma knowledge Basic awareness Gained more sophisticated information Becoming more sensitive Ever-growing knowledge and skill base Degrees of appreciation for current models Introduction to the concept that there are several models Enhanced awareness and understanding of specific approaches Increased awareness and understanding of somatosensory approaches Greater awareness and understanding of somatosensory approaches and related skills

33. Resources  Institute for Family Professionals www.ifpros.net www.ifpros.net  United Way of Greater Philadelphia and Southern New Jersey Suzanne O’Connor soconnor@uwgpsnj.org or 215-665-2453 soconnor@uwgpsnj.org