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Trauma, Children, Families, Service
Systems
Chris Bray, Ph.D, M.A. LPPatty Ostberg- Speiker M.A.
The Institute for Translational Research in Children’s Mental Health
University of Minnesota
Introduction
The Institute for Translational Research in Children’s Mental Health UMN: To reduce the vast gap between research and practice
Ambit Network UMN: To improve access to quality care for traumatized children, families, communities
Agenda
Trauma-Informed PracticeAwareness Building
• Stress and the developing brain
• The impact of traumatic stress on behavior
Skill Building
• Screening, assessment, intervention
• Strategies to promote resilience and healing for caregivers and system providers
Disclaimers
This one hour presentationis an appetizer not a full course meal. We hope it makes you hungry for more
Central Questions
• What is a trauma lens?
• What does it mean to see a child through a trauma lens?
Trauma-Informed Practice
A philosophy
Moving from “What’s wrong with you?”to
“What’s happened to you?”
Not an intervention to address PTSD
Trauma-informed Practice Values
PHYSICAL & PSYCHOLOGY SAFETY TRUST
CHOICEEMPOWERMENT
COLLABORATION
Awareness/Knowledge Building
Know trauma h
istory
Understan
d
traumatic
stress
Understand trauma’simpact
Understand victimization
Help survivors heal
Skill Building
Has youth been screened?
Are caregivers knowledgeable?
Do your colleagues understand trauma?
Do you coordinate case plans?
Three Levels Of Stress
National Science Council on the Developing Child
Chowchilla California 1976
Terr, Lenore. 1985. Too Scared to Cry.
Adverse Childhood Experiences Study
Dr. Felitti – Kaiser Permanente Dr. Anda – Center for Disease Control and Prevention
Research On Psychological Trauma
Over 40 years of research• Lenore Terr. (1985). Too Scared to Cry
• Judith Lewis Herman. (1997). Trauma and Recovery
• ACE Study (1998)
Increasingly sophisticated• Are there underlying genetic mechanisms
that influence children’s responses totraumatic events (e.g. Caspi & Moffitt, Cicchetti)
• Epigenetics
The truth about childhood is stored up in our bodies and lives in the depths of our souls. Our intellect can be deceived, our feelings can be numbed and manipulated, our perceptions shamed and confused, our bodies tricked with medication, but our soul never forgets. And because we are one, one whole soul in one body, someday our body will present its bill. Alice Miller
Traumatic Stress
Child Traumatic Stress
• Physical & emotional responses to events threatening the “life or physical integrity” of a child or someone critically important to the child (e.g. parent/sibling)
• Traumatic events overwhelm an individual’s capacity to cope: create feelings of terror, powerlessness, & intense physiological arousal
NCTSN Child Welfare Trauma Training Toolkit
The 3 E’s= Child Traumatic Stress
The experience of an event by a child that is emotionally painful or distressful which often results in lasting mental and physical effects*
• Event
• Experience
• Effects
*National Institute of Mental Health
Traumatic Events (Exposures)
• Natural Disaster
• War/Terror
• Grief and Loss
• Accident/Illness
• Physical, Emotional, Sexual Abuse
• Witnessing Domestic Violence
• Neglect
• Removal from the home
• Historical Trauma
Traumatic Experiences
Traumatic Effects (Symptoms)
• Nightmares
• Flashbacks
• Intrusive thoughts
• Trauma triggers/reminders
• Feeling isolated
• Inability to recall key features of the trauma
• Hyperarousal
• Hypervigilance
The Brain: Why Do They Act Like They Do?
Five Core Concepts Of Brain Development
1. Experience shapes the architecture of the brain
2. Neural circuits are wired in a bottom up sequence
3. Neurodevelopment requires stimulation
4. Brains and skills are shaped by the “Serve and Return” nature of human interaction
5. Cognitive, emotional and social capacities are inextricably intertwined within the architecture of the brain
National Science Council on the Developing Child
Development’s Missing Stairs
When children endure multiple traumatic events over long
periods of time they are especially likely to have multiple gaps in their
development.
Experience Shapes the Brain
Synapses and Pruning
Experience Shapes the Brain
Limbic System
• Houses emotional life
• Supports hormonal system, emotion, behavior motivation, and formation of memories
• Collection of structures that includes the hypothalamus and hippocampus
We Learn By Experience
We Learn By Experience
How the Body Responds to Danger
Hypothalamus
Release of adrenaline and cortisol
Heart rate and blood pressure increase
Breathing rate increases
Hippocampus
Trauma Brain
31
– On constant alert for danger
– Quick to react to threats (fight, flight, freeze)
Exposure to trauma causes the brain to develop in a way that will help the person survive in a dangerous world:
Source: Teicher., M. H. (2002). Scars that won't heal: The neurobiology of child abuse. Scientific American, 286 (3),68-75.
Skill Building
Has youth been screened?
Are caregivers knowledgeable?
Do your colleagues understand trauma?
Do you coordinate case plans?
What You Can DoIndividual Level: Trauma Screening
What You Can Do: Referral
Make referrals to practitioners who use evidence-based interventions
Information In Presentation
• Dr. Abigail Gerwitz, Ph.D., L.P., Project Director for Center for Resilient Families, Institute for Translational Research in Children’s Mental Health
• Levine, P. A., & Kline, M. (2008). Trauma-proofing your kids: A parents guide for instilling confidence, joy and resilience. Berkeley, CA: North Atlantic Books.
• Siegel, D. J., & Bryson, T. P. (2012). The whole-brain child: 12 revolutionary strategies to nurture your child's developing mind. Brunswick, Vic.: Scribe Publications.
Why be Concerned with Trauma and Posttraumatic Stress in Parents, Caregivers, or Service Systems Professionals?
Associations between adult trauma and:– Child distress and child PTSD– Parenting/caregiving impairments
Ø How might caregivers respond differently to other adults (e.g. service providers) when they are dealing with traumatic stress?
Ø And most important, how might they deal differently with children?
Traumatized Caregivers May Be:
– Suffering from PTSD and related disorders (e.g., depression, anxiety)
– Using drugs to mask the pain
– Disempowered
– Parents of children who have become “parentified” (i.e. responsible beyond their years)
Traumatized Parents May Effect their Parenting and Caregiving:A history of traumatic experiences may:• Compromise parents’ ability to make appropriate safety
judgments• Make it challenging for parents to form and maintain secure
and trusting relationships, leading to: – Disruptions in relationships with infants, children, and
adolescents, and/or negative feelings about parenting; parents may personalize their children’s negative behavior, resulting in ineffective or inappropriate discipline.
– Challenges in relationships with caseworkers, foster parents, and service providers and difficulties supporting their child’s therapy.
A Trauma History Can:
• Impair parents’ capacity to regulate their emotions.
• Lead to poor self-esteem and the development of maladaptive coping strategies, such as substance abuse or abusive intimate relationships that parents maintain because of a real or perceived lack of alternatives.
• Result in trauma reminders—or “triggers”—when parents have extreme reactions to situations that seem benign to others
Pay Attention To Parents
Parenting is crucial – parents matter most to their children in very stressful contexts
– Effective parenting buffers children from the risks for depression and behavior problems (substance use, antisocial behavior, school dropout, etc)
– Parenting CAN be taught! There is a strong evidence base for parenting interventions
• Parent management training-Oregon model
• Effective directions (model)
• Triple P
• The Incredible Years
Helping Families Affected By Traumatic Stress
• Provide children and their parents with the effective prevention and treatment services they needo E.g. trauma-focused parent training o Trauma-focused cognitive behavior therapy
• Provide services that recognize what children have experiencedo Train the early childhood workforce to identify traumatic
stress (what happened to you? Vs. what did you do?)o Requires trauma-informed service systems ando Evidence-based intervention and prevention services
Role Of Adults In Building Children's Resilience
• Remain calm in crisis: strategies to responding to emotions
• Role model the capacity to withstand uncomfortable situations
• Be the “band-aid” for the child
• Calm presence through practice
• SIFT (Sensations, Images, Feelings, Thoughts)
Emotion Socialization (ES)
• ES is the process by which parents teach their children (explicitly or implicitly) about emotions
• Three ways by which children learn about emotions:o Observing their parents regulate emotions
o Parents’ responses to children’s ‘big’, usually negative emotions
o Explicit discussion about emotions
• Focusing on ES in parenting is particularly important in families affected by traumatic stress because traumatic events may overwhelm our capacity to effectively respond to emotions (i.e. cause emotion dysregulation)
Teaching About Emotions In Parent Training/Teachers, Caregivers
• Helping parents improve their own emotion regulation using mindfulness exercises, and strengthening intentionality (e.g. focusing on parenting values, and connecting them with parenting goals)
• Teaching parents emotion coaching – i.e. how to effectively teach, discuss, and respond to kids’ emotions
Let’s Practice!
Thank YouChris Bray: [email protected] Ostberg-Speiker: [email protected]
Institute for Translational Research in Children’s Mental Health (ITR) http://itr.umn.edu/
Ambit Network: http://www.ambitnetwork.org
ADAPT: www.adapt.umn.edu
Department of Veteran’s Affairs https://www.ptsd.va.gov
National Child Traumatic Stress Network (NCTSN): http://www.nctsnet.org/