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Warning Signs
and Seeking
Help
TRAUMA IN CHILDREN &
ADOLESCENTS
Gregory Hickey, Saul Garcia, & Sammy Sablan
MHMR Services for the Concho Valley
Greg & Saul - Mobile Crisis Outreach Team Coordinators
Screen children and adults in crisis and refer to resources in the community, including
inpatient psychiatric care
Sammy – Director of Children & Adolescent Services and Criminal
Offender Programs
WHO ARE WE AND WHAT DO WE DO?
Recognizing signs associated with trauma, depression, and
suicide in children and adolescents
How do we treat trauma and depression?
How to access treatment and community resources
TODAY’S AGENDA
COMMON SOURCES,
SIGNS, AND SYMPTOMS
OF TRAUMA
T w o t y p e s o f t r a u m a :
Event Trauma
Sudden, acute, and unexpected
Threat to l i fe or abil i ty to adapt
Examples: Natural disasters, car accidents, f ire, etc.
Process Trauma
Ongoing, continuous exposure to the stressor
Threat to l i fe or abil i ty to adapt
Examples: long-term sexual or physical abuse, war, community or domestic violence, etc.
N o t n e c e s s a r i l y t h e e v e n t t h a t c a u s e s t r a u m a , b u t t h e b e l i e f s , t h o u g h t p r o c e s s e s , a n d s u b j e c t i v e
e x p e r i e n c e o f t h e e v e n t
S o u r c e s o f T r a u m a :
Community Violence (range between 39 to 85% of chi ldren experience)
Sexual Abuse (estimated 25 to 43% experience)
Domestic Violence
Physical Abuse
Acts of Terrorism
Natural and Man-Made Disasters
Motor Vehicle Accidents
Suicide
Accidents (dog bites, fal ls, near -drownings, etc.)
COMMON SOURCES OF TRAUMA
Signi f icant ly more boys than g i r ls are exposed to community v io lence
Youths l i v ing in pover ty and Nat ive Amer ican youths are at a h igher r i sk
7.9 mi l l ion chi ldren received emergency medical care for unintent ional in jur ies in 2006
400,000 chi ldren were t reated for in jur ies susta ined due to v io lence in 2006
In 2011 , Chi ld Protect ive Ser v ices received 3 .4 mi l l ion refer ra ls for 6 .2 mi l l ion chi ldren
78.5% neglect
17.6% physical abuse
9.1% sexual abuse
Nat ional Sur vey of Chi ldren’s Exposure to V io lence (2011)
Representative sample of 4,549 children age 0 -17.2 years of age 46.3% - Physical assault
10.2% - Child maltreatment
6.1% - Sexual victimization
25.3% - Domestic or community violence
PREVALENCE OF TRAUMA
Children exposed to a traumatic event or a sequence of
traumatic events may exhibit dif ficulty managing their
emotions and behaviors
Children age 0 to 2 years of age:
Poor/delayed verbal skills
Problems with memory
Excessive temper and/or aggression
Withdrawal
Fear and avoidance of adults who remind them of the traumatic event
Irritability
Regression – Potty training, sleeping through the night, bottle/thumb
sucking
Physiological Issues – Poor sleep, appetite, weight, digestion
SYMPTOMS AND BEHAVIORS COMMON IN
TRAUMATIZED CHILDREN
Children age 3 to 6 years of age:
Difficulty functioning and focusing in school
Development of learning disabilities
Poor skill development
Verbally abusive
Acting-out in social situations
Self-blaming
Sensitive startle reflex
Unable to trust others
Problems with self-confidence
Fear of abandonment
Physiological issues – stomachaches, nightmares, bedwetting, sleep
disturbances
SYMPTOMS AND BEHAVIORS COMMON IN
TRAUMATIZED CHILDREN
As a ch i ld ages , many of the symptoms and behav ior s associated with t rauma begin to mirror those exper ienced by adul t s
These inc lude : Intense depression and sadness
Suicidal Thoughts
Intense anxiety and social withdrawal
Declining performance in school
Addictive behaviors – food, alcohol, drug use
Sexual acting-out and promiscuity
Disruptive neurological changes CNS, brain structures, neuroendocr ine system
Development of PTSD Common after near -death/injury exper ience
Re-exper iencing the event/flashbacks
Hypervigi lance
Avoidance of l ike events
Symptoms must persist for more than 30 days and cause signif icant distress and impairment
SYMPTOMS AND BEHAVIORS COMMON IN
OLDER CHILDREN AND ADOLESCENTS
TREATMENT FOR
TRAUMA AND PTSD
Advice from the American Psychological Association
About half of all children in the U.S. experience some kind of traumatic event, often more than once
Many live with ongoing trauma, with little -to-no break
Almost all children experience acute distress following a traumatic event
Most return to prior levels of functioning with the support of family, friends, and other care givers/educators
However, a minority will require further clinical intervention and ongoing professional help
Stage of development and culture play a critical role in a child’s perception of events and the role of family and professional help
TARGETED TREATMENT FOR CHILDREN &
ADOLESCENTS
Advice from the American Psychological Association, Cont…
Mental Health Professionals Should:
Identify children affected by trauma and consider the role of culture in treatment
Help the child and their family make connections for follow -up and ongoing care
Locate training for community disaster/emergency response
Obtain training in developmentally/culturally appropriate evidence -based therapies designed to treat traumatized children effectively
Good Post -Trauma Care Wil l :
Convey the expectation the child will make a full recovery
Normalize, generally speaking, traumatic reactions to stressful events
Identify the child’s individual coping skills and build heavily on their strengths
Attend to immediate needs – safety, shelter, and family support
Engage parents in treatment and provide assistance as needed
Assess for at-risk signs
Consider child, family, and cultural perspectives
TARGETED TREATMENT FOR CHILDREN &
ADOLESCENTS
Trauma-Focused Cognit ive Behav ioral Therapy (TF -CBT) Relatively short -term (12-16 sessions)
Involves parents and children and engages them in trauma -sensit ive interventions, mixed with cognit ive -behavioral , family focused, and humanistic techniques
Skil ls learned for: Managing stressful thoughts, emotions, and result ing behaviors (cognit ive model)
Safety planning
Social growth
Parenting ski l ls
Posit ive family interact ions
Applicable to a variety of sett ings: Family Homes
Foster Care
Group Homes
Kinship Care
Residential Programs
Psychiatr ic Inpatient
Has been proven the most efficacious therapy for chi ldren and adolescents affected by trauma Labeled a Model Program and Best Pract ice
Effective in treating PTSD, depression, anxiety, feel ings of shame, mistrust, sexual acting -out, and others
TARGETED TREATMENT FOR CHILDREN &
ADOLESCENTS
Dialectical Behavior Therapy
Originally used to treat adults who were chronically suicidal and self -injurious
Now adapted for children and teenagers to treat: Suicidal thoughts or actions
Self-injurious behavior (cutting, burning, head-banging, scratching)
Risk-taking behavior
Intense conflict with authority figures and peers
Combines CBT techniques with Zen mindfulness practices Classroom style, with homework and experiential activities
Core mindfulness – full awareness of thoughts, feelings, impulses, and behaviors
Learning to tolerate distress and regulate emotions
Social skills and interpersonal effectiveness
Walking the Middle Path – learning balance in life, eliminating extremes
TARGETED TREATMENT FOR CHILDREN &
ADOLESCENTS
Reality Therapy William Glasser’s Choice Theory
Behaviors are based on choice
Five basic needs:
Survival
Love and Belonging
Power
Freedom
Fun
Goals: Examine what the child wants, needs, evaluate behaviors, and plan accordingly
WDEP Method (Robert E. Wubbolding) Ask what the child Wants
Ask what the child is Doing
Focus on current behavior, not past occurrences
The child must take personable responsibility for their actions
Ask the child to Evaluate themselves
Is what you are doing right now getting you what you want or need?
Work with the child to make Plans to fulfill needs
Write-up a contract
TARGETED TREATMENT FOR CHILDREN &
ADOLESCENTS
Crisis Intervention Goals for Children and their families:
Relieve the acute symptoms of stress
Restore functioning
Identify and understand events that precipitated the crisis
Establish connections between current events and those in the past
Identify pertinent community resources
Identify new coping mechanisms, new ways of thinking/feeling
Nine-Step Model (U.S. Department of Health & Human Services)
Rapidly establish a constructive relationship
Elicit and encourage expression of painful feelings and emotions
Discuss the precipitating event
Assess strengths and needs
Formulate a dynamic explanation
Restore cognitive functioning
Plan and implement treatment
Terminate
Follow-Up
TARGETED TREATMENT FOR CHILDREN &
ADOLESCENTS
Crisis Intervention
A note on suicidal thoughts
When dealing with a depressed child, do not hesitate to ASK
Take any expression of suicidal thinking seriously, not merely as attention -
seeking behavior
Assess lethality
Seek immediate help
Psychiatric inpatient care
Use of local mental health crisis system
Emergency Rooms, local psychiatric care facilities
TARGETED TREATMENT FOR CHILDREN &
ADOLESCENTS
Counseling Services
Ministers, Priests, Rabbis for those religiously inclined
May not have proper training for TF -CBT
Licensed Professional Counselors, Licensed Clinical Social Workers
Employed by schools, service agencies, hospitals
West Texas Counseling & Guidance, locally
Able to employ techniques discussed today, depending on training
Local Mental Health Crisis System
Local Crisis Hotline
(325) 653-5933
Mental Health Deputies
Mobile Crisis Outreach Team (MHMR Services for the Concho Valley)
ACCESSING TREATMENT
IN CONCLUSION…
Thank you for your interest in our session today!
We can be reached at MHMR Services for the Concho Valley
Greg Hickey – (325) 234-0155; [email protected]
Saul Garcia – (325) 234-6954; [email protected]
Sammy Sablan – (325) 658-7750 ext. 539; [email protected]
Any questions?
CONCLUSION
The National Child Traumatic Stress Network
MUSC National Crime Victims Research and Treatment Center
U.S. Department of Veterans Affairs, National Center for PTSD
University of Florida EDIS – “Trauma & Adolescents,” A. Eckes
and H.L. Radunovich
American Psychological Association
NYU Langone; The Child Study Center
SOURCES
