1. Who we help
Community of people with Developmental Disabilities and co-occurring mental health diagnoses
People deemed “too challenging” for typical agencies
Most common factor is a trauma history

2. Where we’re going Effective, therapeutic crisis response!
(But before that, we have to get there)
Trauma and its effect on the brain
Behavioral reenactments
Strategic Self Regulation Therapy (SSRT) Stage Model
MANAGE system for crisis Response
Acute crisis interventions

3. Symptoms of the people we serve
Violence
Aggression
Manipulation
Emotional outbursts
Lack of motivation
BAD BEHAVIOR

4. A more thoughtful look at “bad behavior”
Developmental Trauma
Van Der Kolk (2005) “Developmental Trauma Disorder: Towards a Rational Diagnosis for Chronically Traumatized Children

5. A. Exposure
1. Multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma (abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence and death). 2. Subjective Experience (rage, betrayal, fear, resignation, defeat, shame).

6. B. Triggered pattern of repeated dysregulation in response to trauma cues
Dysregulation (high or low) in presence of cues. Changes persist and do not return to baseline; not reduced in intensity by conscious awareness.
Affective
Somatic (physiological, motoric, medical)
Behavioral (e.g. re-enactment, cutting)
Cognitive (thinking that it is happening again, confusion, dissociation, depersonalization).
Relational (clinging, oppositional, distrustful, compliant).
Self-attribution (self-hate and blame).

7. C. Persistently Altered Attributions and Expectancies
Negative self-attribution
Distrust protective caretaker
Loss of expectancy of protection by others
Loss of trust in social agencies to protect
Lack of recourse to social justice/retribution
Inevitability of future victimization

8. D. Functional Impairment
Educational
Familial
Peer
Legal
Vocational
Sound like anyone you’ve met?

9. What trauma does to the brain

10. The Bipartisan Brain
Feeling
Limbic System
Thinking
Frontal Lobes

11. Functions of the Brain Systems
ACTION!
Limbic System
Thinking
Frontal Lobes

12. Stop, Think, Solve Problems
Behaviors of the Systems
Behaviors
Freeze, Flight, Fight
Behaviors
Stop, Think, Solve Problems
Behaviors of the systems

13. Turned off by Limbic System
Triggering Events
Limbic System
Freeze, Flight, Fight
Frontal Lobes
Turned off by Limbic System

14. Turned off by Limbic System
When something in the world
is perceived as dangerous…
Frontal Lobes
Turned off by Limbic System
Limbic System
Freeze, Flight, Fight

15. Internal Triggers
Frontal Lobes
Stop and Think…
Limbic System
ACTION!

16. Something happens in the World
OR in the Body…
Frontal Lobes
A Problem to Solve…
Limbic System
DANGER!

17. The Social Brain
Engagement
Approach…
Disengagement
AVOID!

18. Turned off by Limbic System
Language Effects
Limbic System
Freeze, Flight, Fight
Frontal Lobes
Turned off by Limbic System
Broca’s Region
Language Production
and Comprehension

19. Turned off by Limbic System
Confabulation
Frontal Lobes
Turned off by Limbic System
Limbic System
Freeze, Flight, Fight
Broca’s Region
Language Production
and Comprehension

20. The Brain is…
The brain is an anticipation machine. It mostly anticipates what it has experienced.
It gathers information from the perceived (and “remembered”) social and external world as well as conscious and unconscious memory and process.
It then decides on, and prepares for, what it believes is coming next.

21. Treatment implications
A traumatized brain sees the world and everything in it as a potential threat
Luckily, neuroplasticity allows for “rewiring”
Basis for treatment is reestablishing fundamental attachments
The SSRT state/stage model allows for conceptualizing the path of treatment

22. The State Or Stage Model
Stage 1
“Wrap The World Around Them”
Stage 2
“Lay The Groundwork For Understanding Themselves & The World”
Stage 3
“Wrap Them Around The World”
Goals
Stop blowing up
Learn skills
Understanding
Targets
The body
The skills
The mind
Predominant
State
Anger
Pain
Hope
Treatments
Parasympathetic tools
The Map
Traditional psychotherapy
Outcomes
Stops blowing up
Can map events
Understand what makes them tick
Common
Misperceptions
We Are Reinforcing Bad Behavior
We Are Being Manipulated
We have Extinguished the Behavior

23. M A N A G E anage yourself and the environment while
modeling reasonable behavior A
gree, acknowledge, and listen N
avigate thoughts and perceptions A
id in generating solutions and problem solving G
enerate reasonable consequences and
take personal responsibility E
nd by repairing relationships