Becoming Trauma Informed Trauma and Its Impact Presenter

Becoming Trauma Informed: Trauma and Its Impact Presenter Names Presenter Contacts w w w. healthfederation. org

OBJECTIVES By the end of this workshop, participants will be able to: • Define traumatic stress/adverse experiences and their impact on brain development • Discuss the ACES study and its relationship to adult outcomes • Identify the signs and symptoms of trauma/adversity on behavior, functioning and health. • Identify the important pillars of trauma responsive practice w w w. healthfederation. org

Guidelines • VOLUNTARY Participation • Be Inclusive and Caring with each other • Preserve Confidentiality • Use SELF-REGULATING TOOLS to manage your physiology. CHOICE…CONTROL…EMOTIONAL MANAGEMENT w w w. healthfederation. org

Community Meeting • What’s your name? • How do you feel right now? • What’s one success you’ve had over the last 7 days? • What’s one goal you have for today? From the work of Dr. Sandra Bloom The Sanctuary Model http: //sanctuaryweb. com/ w w w. healthfederation. org

PAUSE and REFLECT: One Young Child • Bring to mind a young child you know or have worked with who struggled—either with behavior, learning, or relationships. • Recall one strength this child had. • Recall some of the challenges you faced when working with this child. • Keep this child in mind throughout the day. We will discuss in more detail later in the training day. w w w. healthfederation. org

As many as two out of every three children have been exposed to at least one traumatic event before the age of 16. http: //www. samhsa. gov/children/dropin_trauma_elementary. asp What is trauma? • Sudden • Unexpected • Perceived as dangerous • Threat of physical harm or actual physical harm • Intense fear, helplessness • Overwhelms our immediate ability to cope w w w. healthfederation. org

Trauma is… Traumatization occurs when both internal and external resources are inadequate to cope with an external threat. -Bessel Van der Kolk, The Body Keeps the Score Trauma is not an event itself; it is a RESPONSE to a stressful experience in which a person’s ability to cope is dramatically undermined. Massachusetts Advocates for Children, 2005 w w w. healthfederation. org

From: Center on Developing Child at Harvard https: //developingchild. harvard. edu/ w w w. healthfederation. org

It’s all about PERCEPTION… • And our biology • And our caregivers’ responses w w w. healthfederation. org

View Video and Discuss Through Our Eyes Series https: //ovc. gov/pubs/Through. Our. Eyes/ First Impressions Video-You Tube https: //www. youtube. com/watch? v=br. VOYt. NMm. Kk Child Development Core Story-University of Minnesota https: //www. youtube. com/watch? v=kivv 2 BJhzb. A Center on Developing Child Harvard: Toxic Stress https: //developingchild. harvard. edu/science/keyconcepts/toxic-stress/ w w w. healthfederation. org

• • • Trauma Impact is DIFFERENT How many traumatic experiences… Duration and intensity Does it involve primary attachment figures? Age when experiences begin A person’s natural temperament Cognitive capacity w w w. healthfederation. org

All of Our Experiences are Embedded in the Way our Bodies and Minds Function. It’s BIOLOGY, not PATHOLOGY…. The Body Keeps the Score Bessel Van Der Kolk w w w. healthfederation. org

http: //www. acestudy. org/ Kaiser Permanente Medical Group Centers for Disease Control and Prevention (CDC) ADVERSE CHILDHOOD EXPERIENCES (ACE) The largest scientific research project of its kind to date A decade long ongoing collaboration led by: Vincent J. Felitti, MD Robert F. Anda, MD, MS Analyzing the relationship between multiple categories of childhood trauma and health and behavioral outcomes later in life. 5 -Minute ACES Primer Video-KPJR Films/Resilience w w w. healthfederation. org

Study method 17, 421 members of the Kaiser Health Plan in San Diego County from 1995 -1997 Confidential survey asking questions about childhood trauma and current health status and behaviors combined with physical examination w w w. healthfederation. org Demographics: • primary care setting • educated • middle class • predominantly white

Adverse Childhood Experiences A C E • 17, 000 adults • 10 types of adverse experiences • Only 1/3 had NO ACES • 16% had 4 or more ACES • More ACES were STRONGLY correlated with significantly poor health outcomes and health risk behaviors w w w. healthfederation. org

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Higher ACE scores increases risk for… • • • 2. 5 X more likely to fail a grade Score lower on standardized tests More receptive/expressive language difficulties Suspension or expulsion-more frequent Referral to special education at higher rates Cumulative Impact of Trauma • ACES tend to come in groups or cluster For example, if you had a battered mother, – 95% of children exposed will have at least one other ACE – 52% will have up to 5 additional ACES – The tipping point for adaptive responses or little biological impact is 4… w w w. healthfederation. org

ACE STUDY, 1999 – Anda & Felitti w w w. healthfederation. org 18

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Maslow’s Hierarchy of Needs w w w. healthfederation. org 20

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The Autonomic Nervous System Sympathetic Parasympathetic • Fight or Flight Response • Body responds to a perceived threat • Increase heart rate • Muscles contract • Pupils dilate • Decrease stomach movement and secretion • Rest and Digest • Restores body to a state of calm • Decrease heart rate • Muscles relax • Pupils constrict • Increase stomach movement and secretion w w w. healthfederation. org

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SURVIVAL RESPONSES • FIGHT • FLIGHT • FREEZE w w w. healthfederation. org

Why is it important to consider survival responses when working with children and families? v Our survival responses and the survival responses of those we work with may be activated as a result of a perceived threat. A person can be activated by: Challenging family members v Challenging children and their families v Witnessing the continued suffering of others v Challenging life events v Witnessing continued injustices towards others v Reminders of times when threatened v w w w. healthfederation. org

Organizing Principle: Three Parts of The Brain Cortex: Thinking Integrates input from all 3 parts. Cognition, beliefs, language, thought, speech. Limbic Area: Emotional Assesses risk. Expression and mediation of emotions and feelings, including emotions linked to attachment. Survival Brain: Instinctual Carries out “fight, flight, & freeze. ” Unconscious. Digestion, reproduction, circulation, breathing - responds to sensation. w w w. healthfederation. org 27

The Limbic Area: Amygdala v The amygdala is the appraisal system of the brain. v Signals rest of nervous system when there is a threat v Amygdala It creates templates from highly charged emotional memories v Positive memories v Negative memories 28 w w w. healthfederation. org

Explicit Memory The process of conscious learning and storing of information like facts and events Accessed by our intention v Facts v Life history on a timeline v There is a sense of self & time v Develops between 18 -24 months of age w w w. healthfederation. org 29

Implicit Memory Includes body memories like sensations associated with traumatic memories Cues trigger implicit memories v Does not have a sense of self & time v Develops before birth v Can be triggered out of the blue COZOLINO (2002) THE NEUROSCIENCE OF PSYCHOTHERAPY w w w. healthfederation. org

Internal Trigger External Trigger Internal body sensation Muscle tension Smells Visuals (people, places & things) Sounds Headache Memory Capsule pain, numbness, dizziness, trembling, paralysis, nausea, palpitations, anxiety, terror, shame, anger, rage, flashbacks, nightmares or intrusive thoughts w w w. healthfederation. org Stomachache Scaer, R, (2007) The Body Bears the Burden

Behavior is a child’s language. Remember developmental versus chronological age w w w. healthfederation. org

Trauma Reminders Seeing, feeling, hearing, smelling something that reminds us of past trauma Activates the alarm system… The response is as if there is current danger. Thinking brain automatically shuts off in the face of triggers. Past and present danger become confused. w w w. healthfederation. org

The Problem with Trauma Reminders Are. . . • • Rarely clear Often unnoticed, even by the individual Can be invisible (sensory oriented) Can seem trivial/minor Are often uncontrolled factors Don’t always make sense Revert us to less functional versions of ourselves w w w. healthfederation. org

Trying to play chess in a hurricane… w w w. healthfederation. org

Trauma Reminders in schools • • Bells Whistles Physical conflicts with peers Verbal conflicts with peers or adults • Raised voices, yelling, angry faces • Unintentional physical contact (e. g. hallways, gyms, recess, school bus) • Witness an argument or fight w w w. healthfederation. org

Impact on Relationships • Relationships are developed through the emotional bond between the child & primary caregiver. It is through this relationship we learn to: – Regulate emotions/“self soothe” – Develop trust in others – Freely explore our environment – Understand ourselves & others – Understand that we can impact the world around us w w w. healthfederation. org

Impact on Learning • • Organizing narrative material Cause & effect Taking another's perspective Attentiveness Regulating emotions Executive functioning Engaging in curriculum w w w. healthfederation. org

Impact on Classroom Behavior • • • Reactivity & impulsivity Aggression Defiance Withdrawal Perfectionism w w w. healthfederation. org

Trauma-Informed and Responsive Care “Trauma Informed and Responsive Care is a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment. ” Hooper et al. The Open Health Services and Policy Journal, 2010, 3, 80 -100. w w w. healthfederation. org

SAFETY is the FIRST Step…. Children and adults who have survived childhood and ongoing trauma tend to exemplify the following traits related to safety: – Hypervigilance (Always on alert, waiting for the next disaster) – Inability to trust the word and presence of other adults (Relational challenges and isolation) – Need to exert control in every situation – Challenges in deferring to authority or overly compliant – Difficulty managing own physiology and emotional activation (Flooded or Disconnected) w w w. healthfederation. org

It Starts With US…CHANGING OUR PERCEPTION… “What’s wrong with you? ” TO “What’s happened to you? ” (Foderaro 1991, Bloom 2007) OUR RESPONSES…VERBAL , PHYSICAL AND NON -VERBAL MATTER… w w w. healthfederation. org

Perspective Shift Trauma-Informed Resiliency-Informed Students are bad. Students are suffering. Students are resilient. Students need to be punished. Students need an effective intervention. Students need our compassion as they learn new skills. Traditional Caregivers just don’t care. Caregivers care, but lack understanding and skills. We need to stop making excuses for students. What is wrong with you? We need to learn how trauma impacts a child’s and adult’s development. What happened to you? Adapted by Elaine Miller-Karas TRI© https: //www. traumaresourceinstitute. com/ w w w. healthfederation. org Caregivers can learn selfregulation skills based on science. We need to learn how skills of well-being can reduce suffering. What is right with you?

Share one thing you’ve learned today that you can take back to your organization. w w w. healthfederation. org

Resources For Schools Making SPACE for Learning: Trauma Informed Practice in Schools, Australia, www. childhood. org. au The Heart of Teaching and Learning: Compassion, Resiliency, and Academic Success, Washington, http: //www. k 12. wa. us/compassionateschools Calmer Classrooms, Australia, http: //education. qld. gov. au/schools/healthy/pdfs/calmer-classrooms-guide. pdf Helping Traumatized Children Learn, MA Advocates for Children, https: //traumasensitiveschools. org Trauma Smart, Missouri, www. traumasmart. org Zones of Regulation Model ™, Leah Kuypers, http: //www. zonesofregulation. com Toolbox for Learning ™, Dovetail Learning, https: //www. dovetaillearning. org/ w w w. healthfederation. org