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The Impact of Trauma on Children and Families

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Presentation on theme: "The Impact of Trauma on Children and Families"— Presentation transcript:

1 The Impact of Trauma on Children and Families
Implications for Child Welfare and the Court System Presented by C. Lynne Edwards, LCSW CASA State Conference, 2012

2 Presented by C. Lynne Edwards, LCSW
Myths #1: The effects of abuse/neglect, removal and other traumas to young children will “vanish” as long as they are in a loving home. #2: If a child has no cognitive memory of a loss, then they don’t grieve and have no long lasting effects. Presented by C. Lynne Edwards, LCSW

3 Presented by C. Lynne Edwards, LCSW
Myths and Realities #3: There is nothing that parents or anyone can do to change the impact of their child’s early traumatic experiences. #4: Behavior can best be managed by rules and consequences. Presented by C. Lynne Edwards, LCSW

4 Presented by C. Lynne Edwards, LCSW
What We Now Know Feeling safe positively affects the nervous system and provides stimulation for healthy development. Development of trust Attachment/Bonding Conscience development Emotional Regulation Self-esteem Cause and effect thinking Behavioral performance Positive/hopeful belief system Independence Resilience Presented by C. Lynne Edwards, LCSW

5 Child Traumatic Stress
The physical and emotional responses of a child to events that threaten the life or physical integrity of the child or someone important to the child. Traumatic events overwhelm a child’s capacity to cope and elicit feelings of terror, powerlessness, and out of control physiological arousal. Presented by C. Lynne Edwards, LCSW

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Types of Trauma ACUTE CHRONIC COMPLEX Presented by C. Lynne Edwards, LCSW

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Complex Trauma Multiple, chronic and prolonged, developmentally adverse events Often of an interpersonal nature with early life onset Effects are cumulative Presented by C. Lynne Edwards, LCSW

8 Response to Trauma Affected by…
Presented by C. Lynne Edwards, LCSW Response to Trauma Affected by… Child’s chronological age and developmental stage Child’s perception of the danger Whether the child was a victim or witness Child’s past experience with trauma Child’s relationship to the perpetrator Presence/availability of adults to help Under most conditions, parents are able to help their distressed children restore a sense of safety and control but when children are moved from one caretaker to another, the security of the attachment process is disrupted and mitigates against trauma-induced terror. Children are likely to become intolerably distressed and unlikely to experience a sense that their external environment is able to provide safety and relief. Presented by C. Lynne Edwards, LCSW

9 Presented by C. Lynne Edwards, LCSW
Experience of Trauma Trauma is experienced through the body, mind and spirit and has a long term impact. An overwhelming sense of terror, helplessness and horror Physical sensations such a rapid heart rate, trembling, dizziness or loss of bladder or bowel control When trauma is associated with the failure of those who should be protecting and nurturing a child, it has profound, multifaceted, and far-reaching effects on nearly every aspect of the child’s development and functioning, including their ability to achieve the national goals for children of safety, permanency and well-being. Presented by C. Lynne Edwards, LCSW

10 Impact on Children and Parents
Adverse Childhood Experiences Study Adverse childhood experiences: are a major health issue result in social, emotional and cognitive impairment linked to higher risks for medical conditions (heart disease, severe obesity, COPD) linked to higher risk for substance abuse, depression and suicide attempts Presented by C. Lynne Edwards, LCSW

11 Presented by C. Lynne Edwards, LCSW
Impact on “Our” Kids Studies with antisocial youth have found self-reported trauma exposure ranging from 70% to 92% (Greenwald, 2002) Antisocial youth have a high rates of Post Traumatic Stress Disorder (Greenwald, 2002) Research suggests that anger and violent acting out often are symptoms of PTSD (Chemtob, Novaco, Hamada, Gross, & Smith, 1997) Study of Foster Care Alumni revealed higher levels of PTSD in the alumni than in war veterans. Their ability to think before they act, their academic performance, ability to regulate their emotions, the integration of their senses, their self defeating aggression, additive behaviors, hyperarousal and their capacity for logical thinking are all impacted. Presented by C. Lynne Edwards, LCSW

12 Biology Movement and sensation Hypersensitivity/insensitivity
Coordination, balance and body tone Unexplained physical symptom Increased medical problems

13 Brain Development Children are born with “instincts” that are the result of pre-programming in the brain Other parts of the brain are not pre-programmed Neurological pathways or patterns that begin to form are based on what infants SEE, HEAR, SMELL and FEEL Children are born with “instincts” that are the result of pre-programming in the brain

14 Mood Regulation Difficulty knowing and describing their feelings
Brain can shift from feeling to thinking State dependent responses to experiences Caregiver’s brain helps child’s brain to organize regulation Caregiver’s brain teaches child self-soothing Child experience of safety allows for exploration

15 Cognition and Learning
Focusing on and completing tasks Anticipating and planning for future events Absence of cause and effect thinking Range of learning difficulties Adaptive development impaired

16 Behavioral Control Poor impulse control
Self-destructive behavior/aggression Sleep disturbances/eating disorders Fear driven responses A behavior problem is a relationship problem Interventions require the use of relational rather than confrontational approaches to behavioral change

17 Memory Lack cognitive memory of events
Memory of trauma stored in the senses, the body State dependent memory Explicit Memory Semantic: Factual information Autobiographical: Sense of self in time Implicit Memory Somatic: Sense of body at time Perception: Senses Behavioral: What we did with our body

18 Self-Concept and World View
Lack of a continuous, predictable sense of self World is not a safe place to be I’m a bad child; everything bad is my fault People who love you, hurt you and/or abandon you My feelings don’t matter

19 Presented by C. Lynne Edwards, LCSW
Attachment rooted in biology mutual psychological process learned after birth Presented by C. Lynne Edwards, LCSW

20 Presented by C. Lynne Edwards, LCSW
Trauma and Attachment Both research and psychoanalytic theory have both demonstrated a clear connection between physical, emotional, sexual abuse, neglect, multiple losses and other traumatic events during childhood and negative changes in a child’s neurological, biological, and emotional development and on the ability to form healthy attachments. Presented by C. Lynne Edwards, LCSW

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The Attachment Cycles Initiating Positive Interactions Parent Initiates Positive Interaction Gratification Child Responds Gratification Parent Responds Child’s arousal escalated to anger or rage Child attempts to soothe himself Attachment response of the child include Clingy, anxious when separated from mom Get close, go away I don’t need you at all Presented by C. Lynne Edwards, LCSW

22 Positive Interactions
Nurturing E Engagement C Challenge S Structure Presented by C. Lynne Edwards, LCSW

23 Presented by C. Lynne Edwards, LCSW

24 Symptoms of Traumatic Stress
Reexperiencing the trauma Avoiding trigger situations or people Reduced range of emotions Trouble concentrating and impulsive Feelings of powerlessness and helplessness Attachment challenges Increased range of emotions (fear, anxiety, depression, self-harm, addictions, oppositional behaviors)

25 What this looks like in children…
Pervasive feelings-Fear and anxiety Core issues-grief, loss, rejection, attachment, control, guilt, identity Internalized beliefs-I’m a bad kid, I can’t trust adults, people who say they love you, hurt and/or leave you, the world is not a safe place to be, etc. Control issues-children feel so out of control they try to control everything in whatever way they can Presented by C. Lynne Edwards, LCSW

26 What this looks like in children…
Sensory issues-sensitive to touch, loud noises, Delayed adaptive development Regulation of emotions-their brains can not shift from their emotions to their thought processes Pull/Push-come close, now go away; afraid of getting close High risk behaviors Presented by C. Lynne Edwards, LCSW

27 What this looks like in parents…
Presented by C. Lynne Edwards, LCSW What this looks like in parents… All of the above PLUS: Parents’ ability to appraise danger is compromised Trauma reminders presented in children’s behaviors trigger extreme reactions. Tendency for parents to personalize their children’s negative behavior which challenge attachment and can lead to ineffective or inappropriate discipline. Danger: difficulty making appropriate judgments about their own and their child’s safety, overprotection and/or failing to notice situations that could be dangerous for the child Sights, sounds, situation or feelings that remind parents of their own traumatic experiences can trigger unhelpful behaviors toward their children. Also, parents may disengage, making relating to their children more difficult. Presented by C. Lynne Edwards, LCSW

28 What this looks like in parents…
Presented by C. Lynne Edwards, LCSW What this looks like in parents… Parents’ capacity to regulate their emotions is impaired. Parent’s executive functioning is impaired which results in poor decision-making, problem solving or planning. Parent is more vulnerable to other life stressors. Parents have a negative view of themselves as parents and unhealthy interpersonal relationships. Regulation: leads to ineffective coping strategies, addictions, etc. Presented by C. Lynne Edwards, LCSW

29 Presented by C. Lynne Edwards, LCSW
The brains of children who experience trauma are wired differently. Mismanagement of trauma…. Reduces likelihood of reunification (1) Increases placement instability (2) Increase in restrictive placements (3) Increases likelihood of using stronger psychotropic medications (4) Increases child perpetuating intergenerational cycle of abuse and neglect when they become a parent Women who have experienced trauma are more likely to self- medicate with a substance (55-99%) (1) Intergenerational transmission of trauma (Depression, PTSD) (2) Unresolved childhood trauma can lead to reenactments with partners in adult relationships and/or with their children (3) Unresolved childhood trauma can lead to difficulty forming secure attachments with their children (4) Childhood trauma can result in parenting styles that include threats & violence (2) Childhood sexual abuse survivors can miss “red flags” of sexual abuse with their own children due to avoidance of trauma memories themselves (2) Presented by C. Lynne Edwards, LCSW

30 Trauma Informed Care (TIC)
“Trauma-Informed Care is a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment.” (Hopper, Bassuk, and Olivet 2009, p. 133)

31 Trauma Informed Child Welfare System
“A trauma informed child welfare system is one in which all parties involved recognize and respond to the varying impact of traumatic stress on children, caregivers, and those who have contact with the system. Programs and organizations within the system infuse this knowledge awareness and skills into their organizational cultures, policies and practices. They act in collaboration, using the best available science to facilitate and support resiliency and recovery.” (Hendricks, Conradi, & Wilson, 2011, p.189)

32 Presented by C. Lynne Edwards, LCSW
Implications CASA volunteers, attorneys, GALs and judges can help youth and create a trauma-informed system by… Presented by C. Lynne Edwards, LCSW

33 Presented by C. Lynne Edwards, LCSW
Implications …learning about trauma …helping parents and children receive appropriate services and treatment; …using what we now know to make better informed decisions; and, …advocating for trauma training across systems and with providers Trauma informed evidence based clinical treatment is a crucial part of healing for children and parents Safety, permanency and well-being In order to reduce the impact of the trauma, must first understand the physical, neurological, sensory, emotional, developmental impact. Both case management and clinical services need to reflect the short and long term impact of trauma Presented by C. Lynne Edwards, LCSW

34 Presented by C. Lynne Edwards, LCSW
Implications First do no harm Prevent → Protect → Repair → Restore The earlier the intervention occurs, the greater the opportunity for the brain to be repaired Many studies indicate that caregiver functioning is a major predictor of child functioning after child experiences a trauma (Linares et al. 2001, Lieberman, Van Horn, & Ozer 2005) Birth parent involvement can improve children's depression and lower their externalizing behavior problems (McWey, Acock, & Porter 2010) See NCTSN Guide for Attorneys and Judges on Birth Parents and “What Children in Foster Care Want You to Know” Presented by C. Lynne Edwards, LCSW

35 Presented by C. Lynne Edwards, LCSW
Implications Interventions require the use of relational rather than confrontational approaches to behavior change Many studies indicate that caregiver functioning is a major predictor of child functioning after child experiences a trauma (Linares et al. 2001, Lieberman, Van Horn, & Ozer 2005) Birth parent involvement can improve children's depression and lower their externalizing behavior problems (McWey, Acock, & Porter 2010) See NCTSN Guide for Attorneys and Judges on Birth Parents and “What Children in Foster Care Want You to Know” Presented by C. Lynne Edwards, LCSW

36 Presented by C. Lynne Edwards, LCSW
Implications Trauma related factors are often at the heart of placement disruptions. Each time a child moves his opportunities to form healthy attachments are jeopardized Understand and respond to the impact of trauma on parents Secondary trauma Presented by C. Lynne Edwards, LCSW

37 Presented by C. Lynne Edwards, LCSW
Implications Birth/Foster/Adoptive parents need to learn strategies for developing healthy attachments and healthy brains and reducing traumatic stress Focus on strengths and resilience increases positive outcomes for children and families The child that goes home is not the same child. If we’ve done are work right, parents aren’t the same either. Interventions require the use of relational rather than confrontational approaches to behavior change Parent education Presented by C. Lynne Edwards, LCSW

38 Presented by C. Lynne Edwards, LCSW
Implications Use Protective Factors as the framework for services Parental Resilience Knowledge of child development/parenting Concrete supports Social connections Parent-child relationship/nurturing Social and emotional competence of children Presented by C. Lynne Edwards, LCSW

39 Presented by C. Lynne Edwards, LCSW
Implications All systems of care for children who have experienced trauma and their families need to reflect trauma informed practice and address the five protective factors through… Trauma screening Gathering thorough trauma history Referring families for comprehensive, trauma informed clinical assessment Presented by C. Lynne Edwards, LCSW

40 Internal Working Model
Physiology Sensory integration Neurology Development Biology Relationships Experience Genetic Predispositions Special Needs Trauma/Loss Nurturing, Structure, Engagement Adaptive behaviors Attachment Figures Number of Caregivers Inner Working Model Presented by C. Lynne Edwards, LCSW

41 Presented by C. Lynne Edwards, LCSW
What you can do CASA volunteers, attorneys, GALs and judges can help youth and create a trauma-informed system by… Presented by C. Lynne Edwards, LCSW

42 Presented by C. Lynne Edwards, LCSW
What you can do …learning about trauma …helping parents and children receive appropriate services and treatment; …using what we now know to make better informed decisions; and, …advocating for trauma training across systems and with providers Trauma informed evidence based clinical treatment is a crucial part of healing for children and parents Safety, permanency and well-being In order to reduce the impact of the trauma, must first understand the physical, neurological, sensory, emotional, developmental impact. Both case management and clinical services need to reflect the short and long term impact of trauma Join or form a work group to bring training on trauma and TIC to legal, judicial, behavioral mental health and social service profersionals in your area. Presented by C. Lynne Edwards, LCSW

43 Presented by C. Lynne Edwards, LCSW
What you can do Raise the question “Will this action add to traumatic stress?” If the answer is yes, What services and support are in place to reduce the stress for parents and children? Request that parents and caregivers receive trauma informed services. Support children maintaining safe connections with family and caregivers. Presented by C. Lynne Edwards, LCSW

44 Presented by C. Lynne Edwards, LCSW
What you can do Raise the question “How will this action add promote a child’s emotional and psychological safety as well as his physical safety?” Review the results of any trauma screening and assessments and use them to guide recommendations. If there has not been a trauma informed assessment, request one. Presented by C. Lynne Edwards, LCSW

45 Presented by C. Lynne Edwards, LCSW
What you can do Learn about the resources available and how they address trauma and build protective factors. Whenever possible, allow children to live with parents and other adults with whom they are connected rather than in a foster or group home or detention facility. Parent education Presented by C. Lynne Edwards, LCSW

46 Presented by C. Lynne Edwards, LCSW
Resources Child Welfare Information Gateway: Supporting Brain Development in Traumatized Children and Youth National Child Traumatic Stress Network-newsletter and developed the Child Welfare Trauma Training Toolkit. nctsn.org/products/child-welfare-trauma-training-toolkit-2008 Creating Trauma-Informed Child Welfare Systems: A Guide for Administrators Presented by C. Lynne Edwards, LCSW

47 Resources Adverse Childhood Experiences cds.gov/ace/pyramid.htm
Child Welfare Trauma Referral Tool Trauma Symptom Checklist for Children

48 Resources SAFESTART Center www.SAFESTARTCenter.org
Center for the Study of Social Policy Child Welfare Information Gateway: Supporting Brain Development in Traumatized Children and Youth devtraums.cfm National Child Traumatic Stress Center for the Study of Social Policy (cssp.org) Using data, extensive community experience and a focus on results, CSSP promotes public policies that strengthen families and protect and lift children from poverty, helps child welfare and other public human services systems improve their work and achieve race equity for children and families in their care and provides tools and resources. Child Welfare Information Gateway: Supporting Brain Development in Traumatized Children and Youth National Child Traumatic Stress Network-focused on raising the standard of care and improving access to services for traumatized children, their families and communities throughout the United States. Also developed the Child Welfare Trauma Training Toolkit.

49 Presented by C. Lynne Edwards, LCSW
Contact Information C. Lynne Edwards, LSCW Trauma and Attachment Therapist Prevention Consultant What we do today can help improve others’ tomorrow. Presented by C. Lynne Edwards, LCSW


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