1. Understanding Complex Trauma: Strengthening Supporting Learning Environments through a Trauma Sensitive Lens Washington PBIS Conference May 21st, 2011

2. “Exposure to extremely stressful conditions that one can’t change or escape from can have profound effects on anyone, regardless of age. It can alter how we see the world, how we see others, and how we perceive our own worth.” (Mark Katz. (1997). On Playing a Poor Hand Well, p. 5) Copyright 2007 WSU Area Health Education Center

3. Complex trauma defined Both the process of exposure and the process of adjustment to terrible stress As a common defining concern, complex trauma originates in the child’s family But, community violence, racism, and the profound stressors of poverty also contribute to the complexity of trauma Often occurs early in the child’s life ◦ Occurs at most rapid period of development ◦ Occurs when thought and action by the child aren’t options ◦ Trauma effects the basic biology of responding to stress The experience of traumatic events often involves chronic exposure to trauma Exposure to multiple trauma types is common. Exposure to one trauma type is a marker for risk of exposure to others Copyright 2010 WSU Area Health Education Center

4. Trauma is an existential threat to children, families, and communities. Family factors are among principal dropout risks ◦ Maltreated children have 3 times the drop out rate of the general population ◦ At least half of all child maltreatment victims will experience serious school problems, especially conduct issues. But… ◦ Community risks- violence and racism ◦ School culture and school actions are equally predictive Nationally, children with emotional and behavioral disorders who are also in special education classes have the highest school drop out rate (50%). Trauma is the defining common denominator in students entering the juvenile justice and treatment systems. Only one in 10 children with severe behavior and emotional distress ever engage in formal treatment.

5. “Complex Trauma Outcomes are most likely to develop and persist if an infant or child is exposed to danger that is unpredictable and uncontrollable because the child’s body must allocate resources that are normally dedicated to growth and development instead to survival.” (Focal Point, 2007, p.4) Copyright 2007 WSU Area Health Education Center

6. Attachment Biology Self Regulation ◦ Emotional & Behavioral Regulation Cognition Self-Concept Copyright 2007 WSU Area Health Education Center What Does Trauma Look Like?: The Identified Primary Domains Of Impairment

7. Problems with boundaries Hesitant to look towards adults for attention or support—suspiciousness and distrust Sense of security and safety can be compromised or destroyed Uncertainty about the reliability and predictability of the world Difficulty forming trusting relationships with others—hesitant to enlist others as allies Trouble interpreting emotional signals Copyright 2007 WSU Area Health Education Center How Complex Trauma May/Can Disrupt Attachment:

8. The Still Face Experiment C:\Documents and Settings\naturner\My Documents\Still Face Experiment_ Dr. Edward Tronick.flv C:\Documents and Settings\naturner\My Documents\Still Face Experiment_ Dr. Edward Tronick.flv

9. Copyright 2007 WSU Area Health Education Center “Children are like wet cement. Whatever falls on them makes an impression." – Hiam Ginott

10. Trauma’s risk to development has a biological foundation The most developed areas of the brain are the areas most frequently used Ongoing development of the brain throughout childhood and adolescence ◦ Critical periods for definition of structure, function, and coordination of the brain Copyright 2007 WSU Area Health Education Center Brain Development And Trauma

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12. Brain and hormonal systems are a single unified system Central nervous system appraisal of threat and triggering of threat response Direct neural and hormonal responses to prepare fight/flight survival responses Activation of cognition for planning and problem- solving Copyright 2007 WSU Area Health Education Center Trauma And Biological Response To Trauma

13. Elevated stress hormone levels (Particularly Adrenaline and Cortisol) Sustained stress hormones correlated with ◦ trauma-related reductions in brain function of limbic system, hypothalamus, hippocampus (involved in threat appraisal, stress regulation, memory, cognition, and learning) ◦ Impaired regulation in the overall system Cerebral cortex (prefrontal and frontal lobes) function reduced with resulting problems of verbal skills, memory, and problem solving Underdeveloped Corpus Callosum – structure that allows for communication between the Left and Right hemispheres Copyright 2007 WSU Area Health Education Center Trauma’s Potential Effects On Biological Threat Management

14. Three interacting ways trauma can lead to ineffective behaviors and risk of high and persistent emotional distress in response to threat ◦ Learned responses of fear that are not matched to objective risk (hyper-vigilance and anxiety/terror) ◦ Heightened arousal as a trait (hyper-arousal) ◦ Risk of incomplete development of integrated brain function for mastery of new situations and response to threat Threat-arousal response in traumatized individuals

15. Copyright 2007 WSU Area Health Education Center Threat Appraisal and Detection in Traumatized Children

16. If we are responding to trauma-related reactions recognizing the biological basis of behavior in a child or adult means blame has no place. Understanding the biological risks points to some of the actions we can take as caring adults Copyright 2007 WSU Area Health Education Center Implications Of Trauma On Biological Threat Response System

17. Constantly scanning the world for warning signs Focus on non-verbals of others (facial expressions, voice tone, body language) constantly looking for signs of anger or other potential behaviors indicative that abuse will happen In a constant state of “survival mode” Difficulty describing feelings and internal experiences Difficulty communicating wishes and desires Poor impulse control Lack of mentoring for appropriate behavior and communication with others Utilize aggressive behaviors to regain control over environment or to send message regarding lack of control Self soothing behaviors Sleep and eating disturbances Difficulty complying with rules Traumatic play Copyright 2007 WSU Area Health Education Center How Complex Trauma Can/May Disrupt Self-regulation:

18. Difficulty in their ability to learn and process verbal information Harder to use language as a vehicle for communication Difficulty in organizing and remembering new information Difficulty understanding cause and effect Difficulty focusing on tasks at hand Difficulty planning and anticipating Problems with orientation in time and space Difficulty focusing on and completing tasks Tend to have poor problem solving skills Copyright 2007 WSU Area Health Education Center How Complex Trauma Can/May Disrupt Cognition:

19. Feel incapable of having a positive impact on the outside world ◦ Hopelessness Difficulty in initiating play or having safety with imagination and exploration Low self-esteem--diminished sense of self worth Disturbances of body image Shame and guilt; self blame Unsure of own needs and often lack capacity to get needs met Copyright 2007 WSU Area Health Education Center How Complex Trauma Can/May Disrupt Self-concept:

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21. In children not identified in Special Education Compared to no known adverse events, ◦ Academic failure was X2 for students with two adverse events and X3 for students with three or more adverse events. ◦ Attendance problems increase X2 with one adverse event, X3 with two adverse events, and X6.6 with three or more adverse events. ◦ School behavior problems were X2, X3.6, and X4.4 with increasing adverse event exposure. ◦ With any adverse event, students have chronic health problems X2.

22. ARC Model Components ARC Model Components Attachment Self- RegulationCompetency Caregiver Affect Management Affect Identification Developmental Tasks Attunement Affect ModulationExecutive Functions Consistent Response Affect Expression Self Development Routines and Rituals Copyright 2007 WSU Area Health Education Center

23. Trauma and Us Each of us is a trauma survivor or will be We engage traumatized children through the lens of our own trauma histories The foundation for change starts with awareness of ourselves and understanding the power of relationship

25. “The world breaks everyone and afterwards many are strong at the broken places.” ~ Ernest Hemingway Copyright 2007 WSU Area Health Education Center

26. C:\Documents and Settings\naturner\My Documents\Jessica's _Daily Affirmation_.flv C:\Documents and Settings\naturner\My Documents\Jessica's _Daily Affirmation_.flv Copyright 2007 WSU Area Health Education Center