TRAUMA-INFORMED PRACTICE: ASSESSING & TREATING CHILDREN FOLLOWING A DISASTERKaren Rice, PhD, LSW, ACSWMarc Felizzi, PhD, LCSW

Assistant ProfessorsDepartment of Social WorkMillersville University

TRAUMA • A Psychophysical reaction to an event which is experienced as

overwhelming

• An event that arouses a strong

emotional reaction in those

exposed to it

(Rothschild, 2000)

SYMPTOMS OF TRAUMA

• Hyper-arousal: state of alertness, expecting the danger to recur, feels as if danger is still present

• Intrusion: Trauma interrupts daily life (e.g. flashbacks, re-enacting the traumatic event)

• Emotional constriction: Feeling numb, dissociating, feeling a disconnect between events and their meanings. Feelings of “unreality”

• Avoidance behavior: A means of preventing a confrontation with danger

• (Briere & Scott, 2006)

TRAUMA TYPES• According to the National Child Traumatic Stress Network (NCTSN) there

are 12 types of trauma children might experience

• Community and school violence• Complex trauma• Domestic violence• Early childhood trauma• Medical trauma• Natural disasters• Neglect• Physical abuse• Refugee and war zone trauma• Sexual abuse• Terrorism• Traumatic grief

TRAUMA AND THE BRAIN

• The brain responds to external influences

• Brain controls the nervous system & is linked to other parts of body

• During a traumatic event or flashback, amygdala becomes activated, and hippocampus shuts down, which interferes with the ability to “make sense” of event

(Rothschild, 2000)

TRAUMA AND THE BRAIN

• Systems of the brain process experiences by receiving & responding to perception of stress (flight/ fight/ freeze)

-Amygdala: stores emotions & reactions to traumatic events; present at birth (implicit memory; experienced in body or senses)

-Hippocampus: processes data as a narrative, makes sense out of experiences, matures about age 3 (Explicit memory; linguistic)

(Rothschild, 2000)

TRAUMA AND THE BRAIN

• Limbic system produces cortisol, which is used to return body to equilibrium after stress/ trauma

• Increased cortisol levels seen in trauma victims

(Rothschild, 2000)

TRAUMA AND CHILDREN

• Developmental Trauma• Attachment• Biology• Mood regulation• Dissociation• Behavioral control• Cognition• Self-concept

(Child Welfare Committee, 2008; NCTSN; van der Kolk, 1996)

CHILDREN’S COGNITIVE REACTIONS

• Confusion, disorientation

• Fear of separation from family/ pets

• Recurring dreams or nightmares

• Preoccupation with disaster

• Trouble concentrating or remembering things (schoolwork)

• Difficulty making decisions

• Questioning spiritual beliefs

(Rothschild, 2000)

CHILDREN’S BEHAVIORAL REACTIONS TO TRAUMA

• Sleep problems

• Crying easily

• Avoiding reminders of disaster

• Excessive activity level

• Increased conflicts with family

• Hyper-vigilance, startle reactions

• Isolation or social withdrawal

• Focus on disaster/ worry another will occur

• Lack of interest in usual activities, even playing with friends

• Returning to earlier behaviors, such as baby talk, bedwetting, or tantrums

• Increase in teens' risky behaviors, such as drinking alcohol, using substances, harming themselves, or engaging in dangerous activities

(Rothschild, 2000)

CHILDREN’S PHYSICAL REACTIONS TO TRAUMA

• Fatigue, exhaustion

• Gastrointestinal distress

• Appetite change

• Tightening in throat, chest, or

stomach

• Worsening of existing medical

conditions

• Somatic complaints

(Rothschild, 2000)

APPROACHES TO TREATMENT OF TRAUMATIZED CHILDREN

• Counseling• Psychodynamic-Trauma-Focused Therapy• Cognitive Behavioral Trauma-Focused Therapy (CB-TFT)• Trauma Focused Therapy

• Psychotropic Medication

• Exposure Therapy

• Relaxation Therapy

• Creative Arts Therapy

GOAL WHEN WORKING WITH CHILDREN WHO EXPERIENCED TRAUMA

• Establish sense of safety

• Regulate affect

• Reestablish attachment

• Enhance brain’s executive function

• Reframe and integrate traumatic experience

(Malchiodi, 2008)

ESTABLISH SENSE OF SAFETY

• Where do you feel safe?• Sense of safety essential to resolving trauma experience

• Ask questions to assess:• “Where do you fee the safest?”• “Who do you feel the safest with?”• “What do you do to feel safe?”

(Malchiodi, 2008)

REGULATE AFFECT

• Important to address body’s response to trauma

• Trauma prevents normal expression of cognitive processes

• Goal is to empower individuals to regulate reactions to stressful events

• Questions to ask:• “How big or small is your hurt?”• “If your hurt could talk, what do you think it would say?”• “If your hurt could listen, what would you say to it?”

(Malchiodi, 2008)

REESTABLISH ATTACHMENT

• Identifying institutions to foster supportive relationships is essential

• Foster and build supportive networks

• Strengthen friendships and peer support

(Malchiodi, 2008)

ENHANCE BRAIN’S FUNCTIONING

• Provide youth with opportunity to discuss disaster-related events

• Promote positive coping and problem-solving skills

• Emphasize strengthening resiliency to • Take decisive actions; do not avoid• Avoid blowing event out of proportion

(Malchiodi, 2008)

REFRAME AND INTEGRATE TRAUMATIC EXPERIENCE

• Telling one’s story gives trauma survivors a voice

• Stories link past, present, and future

• Reparative nature to “restory” one’s life

(Malchiodi, 2008)

ISSUES ASSOCIATED WITH SPECIFIC DISASTER: FIRES

• Emotional and physical exhaustion

• Survivor guilt

• Fear and anxiety

• Lingering distress

(Malchiodi, Steele, & Kuban, 2008)

FOCUS OF TREATMENT-SPECIFIC TO FIRES

• Provide perceptions of safety and security

• Provide opportunity to discuss feelings and concerns to correct misperceptions and to offer reassurance

• Provide predictable activities and normal routines

• Provide and maintain interpersonal connections

• Encourage healthy behaviors

• Educate and encourage parents/caregivers to model positive coping skills

• Reduce exposure to events that increase stress

• Encourage participation in less stressful events

• Develop response plan that addresses psychological impact

(Malchiodi, Steele, & Kuban, 2008)

QUESTIONS

“Trauma stays with us even though the trigger may appear to be out of sight”

(Rothschild, 2000)