1. Trauma Informed Care and Practice
Jodi Nilsson - Clinical Psychologist

2. What is Complex Trauma? Complex trauma is:
physical, emotional, sexual abuse
Community or family violence
Natural disaster
Chronic illness
Grief
Exposure to war
All are overwhelming emotional experiences. These can not be easily integrated (think processed) and lead to dysregulated survival response.

3. Key concepts Integration Regulation and dysregulation
The flow of information through the senses into through the body into the mind, it’s processing and then subsequent flow of information out of the body
Regulation and dysregulation
Regulation is the way in which we moderate and manage our emotional input and output
Dysregualtion is when this system is overwhelmed and is not able to adequately integrate our experience.
FEAR

4. Survival response Fight or flight Sympathetic nervous system
Automatic, whole body response geared for surviving in different environmental conditions
This is a response to fear

5. Trauma and the Brain When exposed to an overwhelming emotional event:
The amygdala acts to protect – short term
Stops message being sent to frontal cortex
Stops message to hippocampus (stops memories)
Amps up message to the hypothalamus to go into fight/flight/freeze/flop
This is an automatic process that stops ‘rational thought’, overrides the ability to communicate and stops the brain from remembering

6. Effects of Trauma Interrupts normal development
Social - unable to form and maintain relationships
Emotional – problems with regulation
Cognitive – slower processing, attentional problems, memory disrupted
Physical – ACE study

7. Normal adolescent development
Normal adolescents have not developed their pre frontal cortex, they rely on their limbic system – emotional and reactive leading to impulsivity and ‘poor decision making’ Cultural expectations on behaviour

8. Consider your own ‘training’
To say please and thank you When are tantrums considered okay? Emotional training form birth

9. Attachment
Nurturing adult attachments provide children with protective, safe havens and secure bases from which to explore and engage with others and their environment (Bowlby 1988) Early care-giving has a long-lasting impact on development, the ability to learn, capacity to regulate emotions and form satisfying relationships (Siegel 2012) Teachers, youth workers and significant adults in a child’s life can provide important attachments for children (Bergin and Bergin 2009, Riley 2010) “The biological function of attachment is survival; the psychological function is to gain security” (Schaffer 2004)

10. Considering attachment, trauma and development
To punish a traumatised young person for their automatic survival behaviour is like punishing an epileptic for a seizure

11. Plan Regulation, Integration and Connection…
Feeling safe and secure physically and emotionally is necessary to regulate
2. Relationships and secure attachments lead to safety an encourage regulation
3. Being able to express what has happened – creating a narrative after events where non-verbal at the time

12. Plan Safe Places…physically, emotionally and culturally
1. Consistent and stable care giving
2. Boundaries and agreed rules
3.Individual plan to reduce triggers
4. Psycho- education
Attunement: when our emotional experience is matched and reflected by a care giver

13. Plan Regulation…
Encourage development of emotional regulation skills
Gradual over time, start with noticing emotional states
Communication will take time, encourage development of communication skills
SHAME: powerful human emotion that results when punished after dysregulating event and breaks relationships

14. Plan Connection… Unconditional positive regard where possible
Reduce punishment and shame
Encourage attunement
Group sport – role of peers

15. Know thyself
Whose expectations? (is this fair?) Who am I comparing you to? How am I reacting to this?

16. Meet Dysregulation with Regulation
It is normal for staff to feel hurt, abused, angry, frustrated, intolerant, anxious, de-skilled and even frightened.
Intense and painful feelings are somehow pushed [or projected] into the staff
It is normal to question your own competence and professional worth
Self care and self regulation is the key to developing compassion necessary to respond to variety of needs

17. Whole school approach Feelings of inadequacy and shame fuel behaviour
Need for in class regulation, empathy and understanding

18. Summary
Complex trauma results in less extensive neural brain development (impacts on learning)
: less ability to consciously control sub-cortical responses (reactivity)
:less time in more complex ‘relaxed’ or ‘connected’ states (feeling uncomfortable)
Overall less ability to self regulate emotionally and less ability to form relationships
Relationships are key to learn to regulate.
SAFETY is central.

19. Resources… https://www.bathspa.ac.uk