Attachment, Self-Regulation, and Competency: A … Self-Regulation, and Competency: A Framework for Working with Youth Exposed to Complex Trauma Natalie Turner, MS LMHC Associate Director,

Attachment, Self-Regulation, and

Competency: A Framework for

Working with Youth Exposed to

Complex Trauma

Natalie Turner, MS LMHC

Associate Director, Area Health Education Center

Washington State University

How we feel defines how we learn.

Neurodevelopment has to guide how we teach and how

we support children.

◦ Practical actions balance increasing sophisticated

interventions.

Recalibrating our expectations of children based on

knowledge of neurodevelopment.

Social emotional development and learning is the

smooth integration of feelings and thought.

Trauma challenges this smooth integration by disrupting

what has been learned and compromising new learning.

Copyright 2012 WSU Area Health

Education Center

Effective social emotional learning aligns with

effective classroom management

Clear and effective rules and procedures

Effective discipline and accountability practices support learning

Role appropriate high quality teacher-student relationships

Teachers‟ „Mindfulness‟ in assessing, anticipating, and acting to

support learning and behavior

Instruction and management practices that support student

responsibility for learning

Parent engagement and inclusion in learning supports

Intentional use of physical and social environment to support

learning.


Education Center

Iceberg Activity

Draw an iceberg on a piece of scratch paper

Think of a student

Fill in the top of the iceberg

Now think about what might

be influencing the student‟s

behavior: What is the NEED?

Fill in the bottom of the

iceberg


Education Center

The ARC Model

Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

Attachment

Self-

Regulation

Competency

Caregiver

Affect

Mgmt.

Attunement Consistent

Response

Routines

and

Rituals

Affect

Identification Modulation Affect

Expression

Developmental Tasks

Executive

Functions Self Dev’t

& Identity

Trauma

Experience

Integration

The 3-part model

What a child has come to understand is

dangerous

Will lead to a physical and/or

behavioral response that

tries to fill a need and find safety

Thus forcing the child to put energy into survival

rather than healthy development, leaving

them with developmental deficits

Copyright WSU 2012 Information may be

used with attribution

Just Stop It……

Attachment

Caregiver affect management- Keep Calm

and Carry On

Attunement- Accurately read another‟s cues

and respond appropriately

Consistent Response- If you do A, I will do B

Routines and rituals- Provide a predictable

sequence of events

Self-Regulation

Affect Identification- The ability to

identify an emotion and tell it apart from

other emotions

Modulation- The ability to maintain a

comfortable, appropriate level of arousal

Affect Expression- The ability to share

emotional experience with others and

with self in a safe and healthy way

Competency

Executive functions- Learning to act with thoughtfulness as opposed to reacting based solely on emotion and arousal

Self Development/Identity- Coming to know the intricacies of oneself in an accepting way, especially as it pertains toward personal growth

Trauma Integration- Finding ways the self is fragmented, identifying how to make a conscious choice, and processing specific events

Caregiver Affect Management

The main idea: Support staff in

understanding, managing, and coping with

their own emotional responses, so that

they are better able to support the

children in their class

Before a caregiver can help a child manage

emotional experiences, the caregiver must

manage their own emotional experiences

Foundational skill of the ARC model

Caregiver affect management directly

impacts a child‟s experience of

environment

Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in

Children and Adolescents

Triggers

Following Rules

Getting along with peers

Acting respectfully

Sitting quietly

Sharing

The ongoing issues

The core issue

Commitment

Competence

Recognition

Acceptance

Power

Respect

Love

Caring

Integrity

Trust

Control

The

Event

What just happened that you feel you must respond to

Stanley, S. et al (2008)


Education Center

Signs of Triggers

Avoiding talking about a topic or experience

Feeling like you‟re fine one minute then really upset the next

Having a reaction that is bigger than the event or the reaction of others

Feeling like no matter how much you talk about something it doesn‟t feel better

Keeping score of each time something happens

Body cues: ◦ Increased heart rate

◦ Knotted stomach

◦ Sweaty palms


Education Center


learning to accurately and empathically

understand and respond to children‟s

actions, communications, needs, and

feelings

Attunement is the capacity to accurately

read the emotional, cognitive, behavioral,

and physiological cues of another that

are both verbal and non-verbal and

respond appropriately

Children who have experienced

complex trauma often lack the skills to

easily identify and communicate what

they are feeling and cope with difficult

emotions

How do we interpret the meaning

behind behavior? Look past the top of

the iceberg and respond to what is

underneath

Identifying student‟s triggers and danger

response

Reflective listening skills

Attunement



“THEY’RE JUST TRYING TO

GET ATTENTION.”


Education Center

Some myths about attuning

It takes a long time

You need to know someone‟s history to be able to

attune

It‟s just „touchy feely‟

You can‟t attune to a stranger

If you attune, you haven‟t addressed anything

Attuning to behavior means condoning the behavior

Attuning to one person means not being available

to meet the needs of others


Education Center

“Nothing other people do is because of you. It

is because of themselves… When we take

something personally, we make the assumption

that they know what is in our world, and we try

to impose our world on their world.”

-Don Miguel Ruiz


Education Center

How Can Trauma Impact

Attunement?

Children who have experienced trauma or extreme

stress may:

Develop an expectation that bad things will happen to

them

Have a hard time forming relationships with other

people

Have difficulty managing or regulating feelings and

behavior

Have difficulty developing a positive sense of

themselves


Education Center Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in


How to attune

Accept what the other person is saying and feeling

Demonstrate that you‟re listening

Paraphrase (restate in your own words what you

hear the other person saying)

Identify out loud what you hear the other person

feels

Wait to offer suggestions, criticisms, reassurances,

etc. until you‟ve validated what the other person is

experiencing




Sesame Street Video

Consistent Caregiver Response

The main idea: Support staff in building

predictable, safe, and appropriate responses to

children‟s behavior in a manner that acknowledges

and is sensitive to the role of past experiences in

current behavior

Predictability builds sense of safety in environment

Limit setting as potential trigger for feeling

powerless

Predictability over time allows children to relax

vigilance and control and put their energy into

normal development Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in


Consistent response in the

classroom There is a struggle in classrooms between „consistent‟

and „consistent for this child‟

How to balance the demands of teaching and tracking

individual student behavior in order to respond

appropriately?

Some kids don‟t have the skill set to handle a consistent

adult

Help kids build these skill sets by giving feedback on

both positive and negative behavior- be specific and kind

Praise EFFORT not CHARACTER

Difference between “He won‟t” and “He can‟t”




Routines and Rituals


building routine and rhythm into

the daily lives of children and

families

Again! Predictability builds sense

of safety

Routine vs. ritual

Target building routine

particularly around areas of

vulnerability

Transitions can be especially

difficult



Transition Exercise

Affect Identification

The main idea: Work with

children to build an awareness of

internal experience, the ability to

discriminate and name emotional

states, and an understanding of

why these states originate

Children who have experienced

poor caretaking and poor

emotional support may have

never developed healthy ways to

identify what they are feeling

Limited skill set may be easily

overwhelmed by state of arousal

Children may miscue others as a

way of protecting themselves

from emotions that feel unsafe



The main idea: Work with

children to develop safe and

effective strategies to manage

and regulate physiological and

emotional experience, in

service of maintaining a

comfortable state of arousal

“Children who experience

unresponsive, inconsistent, or

abusive caretaking may fail to

develop healthy age-

appropriate skills and instead

must rely on primitive

regulation strategies.”

Young children rely on their

caregivers to modulate for

them, thus helping develop

these skills

These strategies may include:

◦ Failure to regulate

◦ Over-regulating/constricting

Children who can‟t modulate

may compensate by

◦ Over-controlling or shutting off

emotional experience

◦ Manage emotional experience

with physical stimulation

◦ Turning to external methods to

alter or control physiological

experience.

Modulation

Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic

Stress in Children and Adolescents

+10

+9

+8

+7

+6

+5

+4

+3

+2

+1

0

-1

Individual

Differences:

The Comfort

Zone

The POWER zone –

living in hyperarousal

The KEEP-IT-

COOL zone – any

arousal is scary

THE

ROLLER-

COASTER –

Comfort

zone? What

comfort

zone?

Not every child fits neatly into one of these three

categories

Think about the students you work with- which

strategy of organizing inner experience do they use?

Notice the numbers:

◦ Do you have most students in one strategy? Are

classrooms evenly split?

◦ This can inform you as to how to structure your

routines and rituals, consistent responses, where to

attune, etc.

At your tables

Affect Expression

The main idea: Help children build

the skills and tolerance for effectively

sharing emotional experience with

others.

The ability to effectively communicate

feeling is directly related to the ability

to build relationship and master

important developmental tasks.

When children‟s emotional

environment is rejecting, angry, or

indifferent, they often learn their

emotions are shameful and should be

kept hidden.

Hiding emotions may help

children who have experienced

complex trauma feel more in

control and able to navigate

feeling unsafe.

Trauma may impact affect

expression in children by:

◦ Failure to share emotions

◦ Emotions emerging in

unhealthy ways

◦ Communicating emotions

ineffectively

◦ Over-communication

Strengthen Executive Functions The main idea: Work with children

to act, instead of react, by using higher-

order cognitive processes to solve

problems and make active choices in

the service of reaching identified goals

Include impulse control, purposeful

decisions, considering consequences,

understanding outcomes, problem-

solving, etc.

Executive functions are sacrificed in

developing individuals who are trauma

affected. Instead, the danger response

is activated

The development of executive

functions can:

◦ Serve as a way to modulate intense

arousal

◦ Provide a sense of control and ability to

impact the world

◦ Bring conscious thought to actions

◦ Increase likelihood of developing high

resilience

Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress

in Children and Adolescents

Self-Development and Identity

The main idea: Support children in

exploring and building an

understanding of self and personal

identity, including identification of

unique and positive qualities,

development of a sense of coherence

across time, and support in the

capacity to imagine and work toward

a range of future possibilities

“Children who are routinely rejected,

harmed, or ignored internalize an

understanding of self as unlovable,

unworthy, helpless, or damaged.”

Self development includes:

◦ understanding self as separate from

others

◦ understanding of preferences and values

◦ identifying personal traits

◦ is an on-going process throughout life

State-dependent self-concepts may

develop, where children feel their

identity changes with their experience

in the moment

Focusing on the immediate moment

limits a child‟s perception of self to

what is rather than what could be



Trauma Experience Integration

The main idea: Work with children to actively explore, process,

and integrate historical experiences into a coherent and

comprehensive understanding of self in order to enhance their

capacity to effectively engage in present life

The ultimate goal for trauma affected individuals is to “build

[capacity] to harness internal and external resources in service of

effective and fulfilling navigation of their life, across domains of

functioning, as they define and meet self-identified personal goals.”

2 ways:

◦ Integration of themes of fragments of self and the associated early

experience

◦ Process specific events



Implementation Science and

adoption of new practice Implementation Stages

Exploration & Sustainability

Determining „what‟

Installation

Initial implementation

Full implementation

Critical role of improvement cycles

Implementation Drivers

Leadership

◦ Adaptive and Technical

Competency

◦ Staff selection, training, and coaching

Organization

◦ Systems development

◦ Facilitative administration

◦ Data systems and decision supports

Copyright WSU AHEC 2012 Reproduction

with attribution permitted 33

Stages of Change

Common Reactions to Change:

How can schools adapt ARC?

Lessons learned from pilot work:

◦ Collaboration time

◦ Classroom Observation

◦ CST

◦ Supervision

◦ Reflective practice practice change

◦ Role of leadership in supporting staff and

system change

Staff Expectations (and how we

addressed them) “Tools”

Time: small group discussion,

collaboration, problem solving, sharing

information

Case studies

Multiple methods of content delivery:

Handouts, lecture, videos, activities

Copyright WSU 2012 Information may be used with attribution

Why There is Reason for Hope-

Trauma Informed Practice in Education

Social support and resources build resiliency at any age. Resiliency buffers the effects of trauma.

Creating safety and predictability creates opportunity for new learning.

Understanding trauma creates opportunities for new behaviors.

Teachers can create powerful relationships.

Managing trauma‟s effects may result in increasing success for systems.

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Remember:

Trauma Does not Define Us…..

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For more information

Natalie Turner, Associate Director

Area Health Education Center of Eastern WA

WSU Extension

509.358.7563

[email protected]

http://extension.wsu.edu/ahec/trauma/Pages/ComplexTrauma

.aspx

Copyright WSU 2012 Information may be used with

attribution 40

mailto:[email protected]

http://extension.wsu.edu/ahec/trauma/Pages/ComplexTrauma.aspx

http://extension.wsu.edu/ahec/trauma/Pages/ComplexTrauma.aspx