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Helen Bader Schoolof Social WelfareImproving lives and strengthening communities through research, education and community partnerships

• Criminal Justice

• Social Work

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Effects of Child Maltreatment

& Effective Approaches to Treatment

Dimitri Topitzes, PhD, LCSW

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Agenda

• Define maltreatment trauma

• Discuss primary and second symptoms of trauma

• Explore variations of trauma informed care (trauma-sensitive, trauma-informed, trauma-focused)

• Examine phases of trauma-focused interventions

• Review promising approaches

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Potential Traumatic Event

• Trauma is a two-fold phenomenon: exposure and symptoms

• Potential traumatic event (as defined by DSM V): • Death/threatened death, actual/threatened serious physical injury,

actual/threatened sexual violence• Direct experience, witnessing, or learning about love one (if death, then

sudden), secondary exposure (VT)• Examples…childhood physical abuse, witnessing IPV, invasive medical

procedures, war, violent crime, car accident, etc.

• Is this an exhaustive definition?• Chronic childhood neglect?• Chronic emotional abuse in childhood or adulthood?

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Child Maltreatment• Official measures• Acts of commission or commission• Actor/s• Immediate consequences

– Physical/emotional harm, sexual abuse or exploitation– Danger of or imminent risk of harm

• Generally a strict definitional standard

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Yearly Incidence• 2006: 905,000 children substantiated for CAN (1 in 80) National

Child Abuse and Neglect Data System

• 2006: National Incidence Study-4: 2.9 million children victims CAN (1 in 25).

• 2012: 686,000 maltreated children in the United States, a rate of 9.2 per thousand

• Since 2012, abuse and neglect on decline. Abuse on declining faster, neglect declining more slowly

• Why the decline?

• Yet, when broaden definition many more children affected

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Complex Trauma

• Multiple Incident: Type II– Often prolonged or enduring – Relational field– Context of social exploitation– Leads to complex symptom presentation– Often in childhood (due to vulnerable nature of children): CDT– Can be adulthood: DV, POWs, Victims of Sex Trade, etc.

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Primary Symptoms of Trauma

• Intrusion (re-experiencing, intrusive memories, nightmares, dissociative flashbacks)

• Avoidance (effortful, thoughts and feelings, external reminders)

• Cognition &/or mood alterations (memory disturbance, self and world schemas, negative mood)

• Hyperarousal (hypervigilance, sleep disturbance, aggression and irritability, concentration problems)

• With children, more behaviorally based, regressive play, etc…

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Secondary Symptoms of Trauma (II)

• Secondary Symptoms or Trauma Consequences – Extensive– Short and long-term

• Cascade Effects: within

• Multifinality: across

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Short Term Secondary Symptoms

• Internal representations of self and others• Attention regulation• Affect regulation• Behavior regulation• Cognitive development• Social adjustment• Academic performance• Motivational development• Self-concept

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Long-Term Effects of Complex Trauma

• Mental health impairments

• Behavioral health impairments

• Physical health impairments

• Educational attainment

• Human capital

• Criminality

Exercise

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Levels of Trauma-Informed Services

• Trauma-Sensitive

• Trauma-Informed

• Trauma-Focused

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Principles of Trauma-Informed and Trauma-Focused Interventions

• Assess both acute and chronic forms of trauma

– Trauma history affect course of treatment

– Complex childhood trauma increases risk for acute adult trauma

– Trauma can underlie multiple presentations

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Principles (cont’d)

• Address primary sx’s, secondary sx’s & causes:

– Primary symptoms:• Address safety & safety appraisal

– Secondary Symptoms, short and long-term:• Emotion regulation• AODA treatment

– Causes or Trauma Memories• Trauma memory resolution

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Principles of T.I.C.• Relationship –

– Therapeutic alliance

• The Lower Brain Interventions– – Calm, non-reactive interventionist always– Somatosensory strategies

• Motivation– – Individualized interventions that intrinsically motivates (e.g., client choices)– Therapeutic window

• Coordinated systems of care

• Interventionist self care to prevent vicarious trauma– Personal support network– Personal hobbies– Spirituality– Supervision and consultation

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Phase-Based or Multi-Stage Treatment Models (Indv.)

1. Safety (ID areas of danger or perceived danger)

2. Enhance networks of care

3. Attention/Emotion/Behavior Regulation

4. Building Other Self-Capacities, e.g., problem solving

5. Cognitive Restructuring or Reprocessing

6. Trauma Resolution through Play/Memory/Narrative Work

7. Meaning Making or Future Self

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Models

• TF-CBT (cognitive processing demonstration #3)

• Trauma Systems Therapy

• Integrative Treatment of Complex Trauma

• Expressive Therapies

• Trauma Narrative Therapy

• Parent Child Interaction Therapy

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Thank you

Dimitri Topitzes, PhD, LCSW

Associate Professor

Helen Bader School of Social Welfare

University of Wisconsin-Milwaukee

topitzes@uwm.edu

414-229-3004