RECOGNIZING CHILDHOOD TRAUMA, AND PROVIDING TRAUMA INFORMED CARE - PowerPoint PPT Presentation

Loading...

PPT – RECOGNIZING CHILDHOOD TRAUMA, AND PROVIDING TRAUMA INFORMED CARE PowerPoint presentation | free to download - id: 69106a-NGVkN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

RECOGNIZING CHILDHOOD TRAUMA, AND PROVIDING TRAUMA INFORMED CARE

Description:

RECOGNIZING CHILDHOOD TRAUMA, AND PROVIDING TRAUMA INFORMED CARE FDR Middle School Bristol, Bucks County GORDON R. HODAS M.D. August 23, 2007 – PowerPoint PPT presentation

Number of Views:385
Avg rating:3.0/5.0
Slides: 114
Provided by: pleutze
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: RECOGNIZING CHILDHOOD TRAUMA, AND PROVIDING TRAUMA INFORMED CARE


1
RECOGNIZING CHILDHOOD TRAUMA, AND PROVIDING
TRAUMA INFORMED CARE
FDR Middle School Bristol, Bucks
County GORDON R. HODAS M.D. August 23, 2007
2
INTRODUCTION
  • IMPORTANT STARTING POINTS
  • Schools repeatedly identified as a core
    protective factor for children and adolescents
  • If child attends regularly, feels safe, is
    engaged.
  • If educational program is individualized,
    flexible, and committed to wellbeing of students.
  • Most effective way to achieve above trauma
    informed care.

3
INTRODUCTION
  • TRAUMA INFORMED CARE
  • Ultimately, TIC is an attitude set of beliefs
  • The youths development choices have been
    limited by traumatic life experiences.
  • Youths negative behaviors largely an outcome of
    trauma not intentional.
  • Given the opportunity support, the youth can
    and will do better.
  • TIC not stand alone value added to effective
    treatment, care, and education.

4
INTRODUCTION
  • THE CHALLENGE OF EFFECTIVE TEACHING
  • Being a teacher, thats an awful hard thing to
    learn....A good teacher has got to be able to
    know what a person can be taughta teacher is
    most interested in teaching the normal way, the
    way the average person learns. And theres some
    people, theyre lacking in knowing how to do
    things the average way. It dont make no sense
    to them....what counts (is) having a way that is
    your ownall the way to you from inside your own
    self.

5
INTRODUCTION
  • THE BEST TEACHER, THE BEST METHOD
  • The best teacher will be he who has at his
    tongues end the explanation of what it is that
    is bothering the pupil. These explanations give
    the teacher the knowledge of the greatest
    possible number of methods, the ability of
    inventing new methods, and, above allthe
    conviction that the best method would be the one
    which would answer best all of the possible
    difficulties incurred by a pupil that is, not a
    method but an art and talent.
  • Leo Tolstoy

6
INTRODUCTION
  • REFLECTING ON TEACHING IMPORTANCE OF BEING A
    REFLECTIVE PRACTITIONER
  • Reflection-in-action involves thinking about
    what one is doing, in order to cope
    withtroublesome divergent situations of
    practice, and come up with new ways to address
    the problem.
  • When someone reflects-in-action, heconstructs
    a new theory of the unique case.
  • Don Schon, The Reflective Practitioner

7
INTRODUCTION
  • OUR FOCUS CHILDHOOD TRAUMA AND ITS IMPACT ON
    STUDENT LEARNING BEHAVIOR
  • PART I Trauma basic considerations role of
    culture
  • PART II Impact and neurobiology
  • PART III Direct effects of trauma on student
    learning and behavior
  • PART IV Maintaining trauma informed care, and
    trauma informed educational settings

8
PART I TRAUMA BASIC CONSIDERATIONS
  • Prevalence
  • Definition
  • Types
  • Determinants of childs response
  • Cultural considerations

9
PART I TRAUMA BASIC CONSIDERATIONS
  • CHILDHOOD TRAUMA AS A HIDDEN EPIDEMIC
  • Actual prevalence high.
  • Disclosure of maltreatment to professionals
    uncommon.
  • Screening by professionals inconsistent.
  • Poorly understood by many.
  • Responses by professionals can be
    counter-productive and re-traumatizing.
  • Distinction trauma informed care vs.
    trauma-specific treatment.

10
PART I TRAUMA BASIC CONSIDERATIONS
  • CHILDHOOD TRAUMA PREVALENCE
  • Adolescent Inpatients 93 with history of
    trauma, 32 met PTSD criteria.
  • Up to 67 males and females seeking substance
    abuse Rx have PTSD complete or partial.
  • Youth in JJ 93 of males, and 84 of females,
    with one or more traumatic events.
  • Youth in JJ witnessing violence or death
  • 59 males.
  • 47 females.

11
PART I TRAUMA BASIC CONSIDERATIONS
  • TRAUMA AS PRECURSOR TO ARREST VIOLENCE
  • Arrest, as consequence of childhood abuse or
    neglect
  • As juvenile, 53 more likely.
  • As young adult, 38 more likely.
  • Violent crime leading to arrest 38 more likely.

12
PART I TRAUMA BASIC CONSIDERATIONS
  • CHARACTERISTICS OF TRAUMA
  • Traumatic event (per DSM IV) involves
    experiencing, witnessing, or being confronted by
    event or events that involved actual or
    threatened death or serious injury, or a threat
    to the integrity of self or others.
  • The individuals response involved intense fear,
    helplessness, or horror (with children, may have
    disorganized or agitated behavior).
  • Only 2 trauma-related diagnoses Acute Stress
    Disorder, and Posttraumatic Stress Disorder
    (re-experiencing, avoidance/numbering,
    hyperarousal).

13
PART I TRAUMA BASIC CONSIDERATIONS
  • TYPES OF TRAUMA INCLUDE
  • Neglect, and abuse physical, sexual, emotional.
  • Witnessing domestic abuse or community violence.
  • Bullying.
  • Traumatic loss.
  • Medical trauma.
  • Natural disasters.
  • War and terrorism.
  • Refugee trauma.

14
PART I TRAUMA BASIC CONSIDERATIONS
  • DETERMINANTS OF CHILDS RESPONSE TO TRAUMA
    RESULT OF 3 SETS OF VARIABLES
  • Characteristics of the traumatic event(s)
  • Characteristics of the environment
  • Characteristics of the individual child

15
PART I TRAUMA BASIC CONSIDERATIONS
  • CHARACTERISTICS OF THE TRAUMATIC EVENT(S)
  • Frequency, severity, duration of event(s)
  • Degree of physical violence and bodily violation
  • Level of terror and humiliation experienced
  • Persistence of threat
  • Physical and psychological proximity to event and
    perpetrator

16
PART I TRAUMA BASIC CONSIDERATIONS
  • CHARACTERISTICS OF THE ENVIRONMENT
  • Immediate reaction of caregivers or those close
    to child
  • Type, quality of, and access to, constructive
    supports
  • Attitudes and behaviors of first responders and
    caregivers
  • Degree of safety for victim following the event
  • Prevailing community attitudes and values
  • Cultural and political considerations

17
PART I TRAUMA BASIC CONSIDERATIONS
  • CHARACTERISTICS OF THE INDIVIDUAL CHILD
  • Age and stage of development
  • Prior trauma history
  • Intelligence
  • Strengths, coping, and resiliency skills
  • Vulnerabilities
  • Childs culturally based understanding of the
    trauma

18
PART I TRAUMA CULTURAL CONSIDERATIONS
  • SIGNIFICANCE OF CULTURE IN UNDERSTANDING IMPACT
    OF TRAUMA ON CHILDREN
  • Traumatic event influenced by cultural beliefs
    and parenting practices.
  • Environment may or may not recognize event as
    traumatic, such that trauma not acknowledged and
    support not offered.
  • Child may or may not cognitively experience
    event as traumatic, but body responds anyway.

19
PART I TRAUMA CULTURAL CONSIDERATIONS
  • THE REFUGEE EXPERIENCE 3 PHASES (NCTSN)
  • Preflight Time prior to escape from country of
    origin disruption, violence, danger.
  • Flight Time of transitional placement (refugee
    camps) following displacement from ones home
    uncertainty basic needs unmet possible
    separation of family and/or physical/sexual
    trauma to children.
  • Resettlement Family settlement in new, host
    country clash between traditional and new
    cultures, social disruption, and task of
    acculturation.

20
PART I TRAUMA CULTURAL CONSIDERATIONS
  • TYPES OF PREFLIGHT STRESS FOR CHILDREN
  • Witnessing atrocities.
  • Possible direct victimization.
  • Insufficient food other necessities.
  • Forced labor.
  • Forced combat.
  • Separation from family.
  • Segregated camps.

21
PART I TRAUMA CULTURAL CONSIDERATIONS
  • TYPES OF FLIGHT STRESS FOR CHILDREN
  • Uncertainty and instability.
  • Basic needs unmet malnutrition and medical
    care.
  • Separation from family and familiar cues.
  • Refugee camps.
  • Depersonalization.
  • Witnessing violence or suicide.
  • Victimization in camp.

22
PART I TRAUMA CULTURAL CONSIDERATIONS
  • TYPES OF RESETTLEMENT STRESS FOR CHILDREN
  • Loss of culture and social network of homeland
    (cultural bereavement).
  • Reconciling traditional beliefs and practices
    with those of prevailing culture.
  • Language barriers.
  • Stigma based on nationality, race, religion.

23
PART I TRAUMA CULTURAL CONSIDERATIONS
  • TYPES OF RESETTLEMENT STRESS FOR CHILDREN (2)
  • Victimization through bullying.
  • Lack of familiarity with laws social service
    systems
  • Differential rates of acculturation between
    parents and child.
  • Possible inversion of family hierarchy.
  • Possible secrecy/denial re past family trauma.

24
PART I TRAUMA CULTURAL CONSIDERATIONS
  • SYMPTOMS RESULTING FROM REFUGEE STRESS
  • Each phase of refugee process associated with
    Sxs.
  • Younger children more vulnerable.
  • Stress exposures cumulative.
  • Internalizing behaviors common anxiety, PTSD,
    depression, withdrawal, somatic complaints.
  • Externalizing behaviors impulsivity,
    inattention/ hyperactivity, aggression,
    delinquency.

25
PART I TRAUMA CULTURAL CONSIDERATIONS
  • SOURCES OF POTENTIAL COPING RESILIENCE
  • Parental wellbeing, parental support to child.
  • Esprit de corps among war-exposed children.
  • Devotion to a cause.
  • Abilify to recognize and avoid danger.
  • Abilify to appeal to adults for caretaking.
  • Abilify to manage anxiety and calm self.

26
PART I TRAUMA CULTURAL CONSIDERATIONS
  • SOURCES OF COPING AND RESILIENCE (2)
  • Use of play.
  • Use of imagination wishing things were
    different.
  • Sense of humor.
  • Acculturation to new country.
  • Use of social support network in community.
  • Maintaining connection to culture of origin.

27
PART I TRAUMA CULTURAL CONSIDERATIONS
  • BACKGROUND ON LIBERIA
  • Located on Africas western coastline.
  • Founded as a republic in 1847 by freed American
    slaves. English spoken in much of Liberia.
  • Civil war began in 1989 and continued
    intermittently, disrupting prior prosperity and
    creating strife among indigenous groups.
  • Resettlement of Liberians in America began in
    1992, under the U.S Refugee Program (USRP).

28
PART I TRAUMA CULTURAL CONSIDERATIONS
  • BACKGROUND ON LIBERIA (2)
  • Resettlement increased in 1998 due to continued
    instability.
  • Between 2003-2005, more than 8,000 refugees
    emigrated to US. Bucks County as one site.
  • Most wealthy Liberians in US came earlier.
  • Recent current immigrants more rural, greater
    exposure to war, flight, and refugee camp life.
  • Some on the run for a decade or more.

29
PART I TRAUMA CULTURAL CONSIDERATIONS
  • BACKGROUND ON LIBERIA (3)
  • Dual flight for some forced to flee 2x or
    more.
  • Many adults with limited exposure to formal
    education. Children with refugee camp education.
  • One parent families common, due to flight, death.
  • Recent settlement of extended families in US,
    some with limited previous time living together.
  • Informal guardianships common. Not all children
    biological.

30
PART I TRAUMA CULTURAL CONSIDERATIONS
  • CONSEQUENCES OF PRIOR REFUGEE STATUS
  • Poor primary health care concept not embedded.
  • High blood levels possible.
  • Lack of trust toward outsiders.
  • Education limited, disrupted in past, low skill
    levels.
  • Education may not be a parental priority for
    child.
  • Lack of understanding of expected school
    behavior, and limited readiness.

31
PART I TRAUMA CULTURAL CONSIDERATIONS
  • PARENTAL RESPONSE TO PRIOR TRAUMA
  • Shame and humiliation.
  • Secrecy.
  • Denial.
  • Unwillingness to discuss.
  • Impact often greater on 2nd generation, the
    children of parents subject to trauma in homeland.

32
PART I TRAUMA CULTURAL CONSIDERATIONS
  • PARENTING PRACTICES
  • Extended family, not nuclear family, the typical
    family structure in earlier village life and in
    US.
  • Large, multi-generational families, many in
    house.
  • Membership in family fluid and informal.
  • Communal network of support helps raise children.
  • Any adult in network seen as empowered to monitor
    child and intervene.

33
PART I TRAUMA CULTURAL CONSIDERATIONS
  • PARENTING PRACTICES (2)
  • Traditional values adults primary, children
    respect elders. Older children help with younger
    siblings.
  • Children allowed considerable independence in
    play.
  • Corporal punishment seen as necessary to prepare
    child to be good citizen, and sign of good
    parent.
  • Harsh tone and verbal reprimands also common.
  • Ancient custom punishing child with ground hot
    peppers.

34
PART I TRAUMA CULTURAL CONSIDERATIONS
  • PARENTING POTENTIAL CULTURAL CONFLICTS
  • Unapproved family member picks up child at
    school.
  • Examples of possible neglect
  • Ten year old child left alone to care for infant.
  • Child running around without apparent
    supervision.
  • Examples of possible abuse
  • Giving child a beating.
  • Use of switch or belt, leaving a mark.
  • Verbal abuse.
  • Use of ground hot peppers.

35
PART II TRAUMA IMPACT AND NEUROBIOLOGY
  • Impact global, encompassing development, physical
    health, behavior, beliefs, and values
  • Neurobiological processes influence, and are
    influenced by, above elements

36
PART II TRAUMA IMPACT
  • CHILDHOOD TRAUMA OVERVIEW
  • Multiple variables determine impact, as
    discussed.
  • Single events disrupt the life of child and
    family, but often resolve without serious
    long-term damage.
  • Severe, chronic, and/or recurring trauma can have
    serious, long-term consequences.
  • These consequences can affect every aspect of a
    childs functioning, including mental physical
    health, values beliefs, learning, and behavior.

37
PART II TRAUMA IMPACT
  • CHILDHOOD TRAUMA OVERVIEW (2)
  • Childhood maltreatment neglect, physical abuse,
    emotional abuse, and sexual abuse can have
    severe consequences. Secretive, stigmatizing,
    family betrayal, threats to prevent disclosure.
  • Refugees may have prior exposure to war,
    displacement loss, trauma in refugee camp,
    family separation, and stress of immigration
    resettlement.

38
PART II TRAUMA IMPACT
  • CHILDHOOD TRAUMA OVERVIEW (3)
  • Immigrant children may be subjected to other
    forms of trauma in US
  • Witnessing community violence or domestic abuse
  • Bullying.
  • Victimization by other community violence (drugs,
    guns, etc.).
  • Possible traumatic loss.

39
PART II TRAUMA IMPACT
  • CONSEQUENCES OF SEVERE, CHRONIC TRAUMA
  • Neurobiological abnormalities.
  • Effect on brain size and activity.
  • Disruption of normal developmental process.
  • Likelihood of additional victimization.
  • Likelihood of aggression violence.

40
PART II TRAUMA IMPACT
  • SEVERE, CHRONIC TRAUMA CONSEQUENCES (2)
  • Likelihood of negative lifestyle unhealthy
    habits.
  • Physical health problems, during childhood and
    throughout the life cycle, and shorter life
    expectancy.
  • Increased risk of psychiatric disorders.
  • Increased risk of substance abuse.

41
PART II TRAUMA IMPACT
  • SEVERE, CHRONIC TRAUMA CONSEQUENCES (3)
  • Effect on behavior What do we see?
  • Effect on relationships What do we see?
  • Effect on beliefs What are typical beliefs re
    others?
  • Effect on values What are typical values?
  • Effect on learning and school-related behavior.

42
PART II TRAUMA IMPACT
  • VICTIMS AND VICTIMIZERS SAD REALITY
  • Many juvenile offenders were victimized earlier.
  • Childhood and youth victims are, as result of
    their victimization, at higher risk of becoming
    victimizers.
  • Dramatic example, per Philadelphia police 90 of
    citys murderers, and also 90 of citys homicide
    victims, have prison records.
  • Trauma increases likelihood of arrest 53 more
    for juveniles, and 38 more for young adults.

43
PART II TRAUMA IMPACT
  • TRAUMA AS PRECURSOR TO VIOLENCE
  • Violent crime leading to arrest 38 more likely.
  • Adjudicated females (2 separate studies)
  • Over 75 of adjudicated females had been sexually
    abused.
  • Over 90 of incarcerated females reported some
    form of childhood maltreatment (2 separate
    studies).

44
PART II TRAUMA NEUROBIOLOGY
  • THE BOTTOM LINE LONG-TERM EFFECTS OF TRAUMA ON
    THE BRAIN
  • Severe, prolonged childhood abuse damages the
    developing brain via hormonal and structural
    changes.
  • Potentially irreversible, although the brain is
    dynamic and continues to grow into mid-20s.
  • Childhood violence a significant causal factor in
    10-25 of all developmental disabilities.

45
PART II TRAUMA NEUROBIOLOGY
  • BASIC SURVIVAL RESPONSES TO DANGER AND THREAT
    (NORMAL PROCESSES)
  • Hyperarousal responses fight or flight, in
    support of active mastery and/or
  • Dissociation responses passive, surrender
    response, to escape/avoid situation.
  • Both responses are normal and of adaptive
    benefit, increasing the likelihood of survival.

46
PART II TRAUMA NEUROBIOLOGY
  • THE HYPERAROUSAL RESPONSE
  • Either fight or flight, enabling individual
    to take emergency action in response to fear,
    terror, and danger.
  • Fight self-defense.
  • Flight removing self from danger.
  • Mediating neurobiology Catecholamines
    adrenaline and noradrenalin and hypothalamic
    pituitary axis.

47
PART II TRAUMA NEUROBIOLOGY
  • THE HYPERAROUSAL RESPONSE (2)
  • Physiological responses associated with
    hyperarousal
  • Increased heart rate.
  • Increased blood pressure.
  • Increased energy availability in skeletal
    muscles.
  • Observable manifestations of hyperarousal
  • Highly focused attention
  • Sweating
  • Erect posture

48
PART II TRAUMA NEUROBIOLOGY
  • THE DISSOCIATION RESPONSE
  • Dissociation disengaging from stimuli in the
    external world and attending to an internal
    world (Perry et al, 1995), in order to
    camouflage oneself and child and buy time.
  • Dissociation involves emotional numbing and
    withdrawal.
  • A dissociation continuum, depending on trauma
    severity and circumstances.
  • Mediating neurobiology Increase in vagal tone.

49
PART II TRAUMA NEUROBIOLOGY
  • THE DISSOCIATION RESPONSE (2)
  • Physiological responses associated with
    dissociation
  • Decrease in heart rate.
  • Decrease in blood pressure.
  • Observable manifestations of dissociation
  • Decreased movement
  • Compliance
  • Avoidance
  • Restrictive affect

50
PART II TRAUMA NEUROBIOLOGY
  • TRAUMA DISRUPTS AROUSAL SYSTEM
  • Hyperarousal the primary problem.
  • Catecholamine release, and over-activation of
    hypothalamic-pituitary axis.
  • A previously adaptive, emergency response becomes
    maladaptive.
  • Adaptive emergency state becomes maladaptive
    trait.

51
PART II TRAUMA NEUROBIOLOGY
  • SPECIFIC COMPONENTS OF HYPERAROUSAL
  • High baseline.
  • Low threshold for activation.
  • High amplitude of response.
  • Slow turnoff.
  • Higher baseline.
  • Future reactivation.
  • Result Impaired capacity for self-regulation.

52
PART II TRAUMA NEUROBIOLOGY
  • SPECIFIC STRUCTURAL BRAIN CHANGES, WITH SEVERE
    TRAUMA AND PTSD (DeBellis)
  • Smaller brain volumes (decreased function)
  • Total intracranial volume.
  • Corpus callosum.
  • Larger volumes of ventricles left ventricle
    total lateral ventricles.

53
PART II TRAUMA NEUROBIOLOGY
  • BRUCE PERRYS CONCEPT OF NEURO-BIOLOGICAL
    REGRESSION
  • Cortex essential for self-regulation direct
    effect plus management of lower brain responses.
  • With severe trauma, the brain relies on primitive
    responses to danger, bypassing the cortex.
  • Neurobiological regression retreat from the
    cortex to increasingly less mature levels of
    brain functioning (cortex to limbic system, to
    midbrain, to brainstem) the trauma response.

54
PART II TRAUMA NEUROBIOLOGY
  • DIRECT IMPACT OF THE TRAUMA RESPONSE ON THE
    INDIVIDUAL
  • When cortex is bypassed, the individual cannot
    listen, reason, or problem-solve effectively.
  • When flooded by hyperarousal and catecholamines,
    same limitations apply.
  • Impact is global internal discomfort fear,
    impaired learning, problem solving, daily
    functioning, ability to form relationships,
    develop display empathy.

55
PART II TRAUMA NEUROBIOLOGY
  • POSSIBLE IMPACT OF STUDENTS TRAUMA RESPONSE ON
    SCHOOL STAFF
  • Students trauma response misperceived by adult
    as a personal challenge, or as intentional
    defiance.
  • With above mindset, adult less likely to respond
    sympathetically to the student.
  • Staff anger, feeling challenged or devalued.
  • Counter-aggression may occur.

56
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • Effects on academic performance
  • Effects on student behavior

57
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • HELPING TRAUMATIZED CHILDREN LEARN SUPPORTIVE
    SCHOOL ENVIRONMENTS FOR CHILDREN TRAUMATIZED BY
    FAMILY VIOLENCE (2005)
  • A collaborative study involving Massachusetts
    Advocates for Children, Hale and Dorr Legal
    Services Center of Harvard Law School,
    Taskforce on Children Affected by Domestic
    Violence.
  • Discusses impact of trauma on learning, behavior,
    relationships, and how to help traumatized
    children in school.

58
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • FEAR AND SURVIVAL AS THE ORGANIZING FORCES FOR
    TRAUMATIZED STUDENTS
  • Student may anticipate that the school
    environment will be threatening, and constantly
    scrutinizes it for signs of danger.
  • Such a response often sabotages the (students)
    ability to hear and understand a teachers
    positive messages, to perform well academically,
    and to behave appropriately.
  • Students are often unaware of the above process.

59
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON ACADEMIC
    PERFORMANCE
  • Language and communication skills
  • Learning retrieving new verbal information
    hyperarousal interferes with learning readiness
    and ability to connect words to experience.
  • Social and emotional communication language
    used to regulate behavior, not for social and
    emotional exchange.
  • Problem solving requires adequate receptive/
    expressive language, ability to extract key
    ideas from what is said.

60
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON ACADEMIC
    PERFORMANCE (2)
  • Organizing narrative material difficulty
    establishing sequential ordering and remembering.
  • Cause-and-effect relationships due to lack of
    predictability of environment. Lack of
    cause-and-effect helps explain students
    resistance to behavior management techniques
    that assume understanding of cause and effect.

61
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON ACADEMIC
    PERFORMANCE (3)
  • Taking anothers perspective sense of self too
    fragile, so unable to develop or offer empathy.
  • Attentiveness to classroom tasks child is
    attentive, but often paying attention to the
    wrong things. Mediated by anxiety and fear,
    misinterpretation, and/or dissociation. As
    result, child falls behind, may give up.

62
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON ACADEMIC
    PERFORMANCE (4)
  • Regulating emotions the core deficit and the
    most striking feature ofchronically traumatized
    children
  • Impairs adaptive functioning in global manner.
  • Due to hyperarousal and hyper-vigilance.
  • May result in impulsivity and aggression.
  • May result in withdrawal and disconnection.
  • May result in somatic symptoms, or combinations
    of above.

63
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON ACADEMIC
    PERFORMANCE (5)
  • Executive functioning planning, goal setting,
    implementing plans, anticipating consequences
    all involve cortical functions (prefrontal
    cortex) that are adversely affected by trauma.
  • Engaging in the curriculum fear and scanning
    for danger pre-empt academic engagement and
    motivation.

64
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON CLASSROOM BEHAVIOR
  • Overall theme
  • traumatized childrens behavior in the
    classroom can be highly confusing, and children
    suffering from the behavioral symptoms of trauma
    are frequently profoundly misunderstood.

65
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON CLASSROOM BEHAVIOR
    (2)
  • Reactivity and impulsivity especially in
    response to shaming/humiliation or other
    provocation.
  • Aggression a default response, due to absence
    of more mature coping skills, and a response to
    intense fear (...traumatized childrens most
    challenging behavior often originates in immense
    feelings of vulnerability).

66
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON CLASSROOM BEHAVIOR
    (3)
  • Understanding the traumatized students
    aggressive behavior
  • aggressive behavior is less akin to the
    willful defiance of an obstinate student than the
    response of a frightened child to his or her
    experience of traumatic violence.
  • E.B. Carlson

67
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON CLASSROOM BEHAVIOR
    (4)
  • Defiance due to fear, anxiety and anger.
    Threats from adults to impel compliance make the
    child feel more anxious, threatened, and out of
    control.
  • Withdrawal a conscious response due to anxiety,
    fear or depression, or a dissociative response.
  • Perfectionism childs response to inability to
    meet expectations at home and avoid trauma. May
    lead child to be easily frustrated and then give
    up.

68
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON RELATIONSHIPS
  • Relationships with school personnel
  • Essential for students to experience meaningful
    relationships with caring adults.
  • Adults must overcome students distrust and the
    tendency to overreact and challenge authority.
  • These behaviors can frustrate educators and
    evoke exasperated reprisals.

69
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • IMPACT OF CHILDHOOD TRAUMA ON RELATIONSHIPS (2)
  • Relationships with peers
  • Absence of social skills creates awkwardness.
  • Low threshold for feeling dissed
    over-stimulated.
  • May strike preemptively.
  • May use, rather than truly engage, peers.
  • Need assistance in initiating and maintaining
    friendships.

70
PART III DIRECT EFFECTS ON STUDENT LEARNING AND
BEHAVIOR
  • FURTHER COMPLEXITY WITH REFUGEE CHILDREN
  • Academic problems, problematic behaviors, and
    psychiatric symptoms can result from past trauma,
    current trauma, or combination.
  • Trauma may be due to one or more types of
    exposure, not necessarily maltreatment.
  • Depression due to loss possible.
  • Current maltreatment may be culturally based.
  • Need to be able to make important distinctions.

71
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • Definition of trauma informed care.
  • Core elements and models.
  • First steps.
  • Avoidance of restraint and coercive
    interventions.
  • Nature of trauma informed education, instruction,
    and relationships.

72
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • TRAUMA INFORMED CARE DEFINITION
  • Trauma informed care involves the provision of
    interventions informed by an understanding of the
    pervasiveness of trauma and its consequences. TIC
    addresses the symptoms and core deficits related
    to the traumatic experience, and promotes the
    persons self-awareness, self-regulation, and
    healthy functioning.

73
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • ELABORATION OF TRAUMA INFORMED SERVICES (Ann
    Jennings, 2004)
  • Trauma informed services are not specifically
    designed to treat symptoms or syndromes related
    to sexual or physical abuse or other trauma, but
    they are informed about, and sensitive to,
    trauma-related issues present in survivors.all
    components of a given service system have been
    reconsidered and evaluated in light of a basic
    understanding of the role that violence plays in
    the lives of people

74
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • TRAUMA INFORMED CARE
  • Ultimately, TIC is an attitude
  • The youths development choices have been
    limited by traumatic life experiences, and
    negative behaviors are, to considerable extent,
    an outcome of this.
  • The youth, given the opportunity, can and will do
    better.

75
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • TRAUMA INFORMED INTERVENTIONS OPERATE AT TWO
    LEVELS
  • The level of individual physiology, with
    particular attention to issues of arousal and
    self-regulation.
  • The larger social-environmental level, to
    mitigate conditions that produce or sustain
    maladaptive traumatic reactions.

76
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • ARC MODEL, NATIONAL CHILD TRAUMATIC STRESS
    NETWORK, FOR COMPLEX TRAUMA
  • A Attachments
  • R Regulatory capacity
  • C Competencies across multiple domains
  • Schools are a potential protective factor for
    children, can actively promote all three
    components of the ARC model.

77
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • THE 9 CORE ELEMENTS OF TRAUMA INFORMED
    INTERVENTIONS AND RELATIONSHIPS 9 Cs
  • Coercion (to be avoided).
  • Collaboration.
  • Control.
  • Choice.
  • Cultural competence.

78
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • THE 9 Cs (2)
  • Connection/interdependence.
  • Comprehension/self-awareness.
  • Competence/skills.
  • Contentment/personal meaning.

79
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • TRAUMA INFORMED STRATEGIES FIRST STEPS
  • Recognize childs negative behaviors as
    adaptive and default responses, not intentional.
  • Determine if externally based trauma or danger
    continues, and address. Dont change defenses
    when still needed for safety.
  • Discard use of certain terms and connotations,
    particularly manipulative and
    attention-seeking.
  • Understand culture of child and family.
  • Avoid coercion, shaming, and humiliation.

80
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • TIC INVOLVES EFFORTS TO AVOID USE OF SECLUSION
    AND RESTRAINT
  • S/R only an emergency intervention of last
    resort.
  • S/R are re-traumatizing and non-therapeutic.
  • Use of S/R can also traumatize staff and
    observers.
  • S/R reduction elimination are part of broader
    commitment to avoid interpersonal coercion.
  • Coercion traumatizes, and models violent
    responses to anxiety and stress.

81
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • NATIONAL EXECUTIVE TRAINING INSTITUTE(NETI) 6
    CORE STRATEGIES FOR RESTRAINT REDUCTION
  • Leadership toward Organizational Change.
  • Use of Data.
  • Workforce Development.
  • Use of Restraint Reduction Tools.
  • Child and Family Involvement.
  • Debriefing Activities.

82
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • RESTRAINT REDUCTION TOOLS
  • Trauma history.
  • Risk assessment for violence and suicide.
  • Risk assessment for contraindications to use of
    restraint.
  • Safety/De-escalation Plan.
  • Consider use of comfort rooms.

83
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • BEYOND SPECIFIC TOOLS FACTS, ALSO NEED FOR
  • Understanding of child and family story.
  • Hypothesis or formulation whats going on.
  • Dissemination of information, staff familiarity.
  • Use of information in actual interventions.
  • Modification of interventions, based on outcomes.

84
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • ELEMENTS OF A SAFETY PLAN INCLUDE
  • Childs way of calming self, chilling.
  • Likely triggers and precipitants of vapor lock.
  • Signs and symptoms of vapor lock.
  • What child wants staff to do and not do.
  • What child wants to be encouraged to do.
  • Identification of others who can provide support.

85
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • COMPONENTS OF FLEXIBLE FRAMEWORK,
  • MA. CHILDRENS COLLABORATIVE (TRAUMA INFORMED
    EDUCATION)
  • School-wide Infrastructure and Culture
  • Staff Training
  • Linking with Mental Health
  • Tailored Academic Instruction
  • Nonacademic Strategies (relationships with
    adults)
  • School Policies, Procedures, Protocols

86
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • SPECIFIC COMPONENTS OF TRAUMA INFORMED EDUCATION
    (KEY ASPECTS)
  • Review policies and procedures with awareness of
    trauma informed practice.
  • Help students feel safe, physically
    emotionally.
  • Balance accountability with understanding of
    traumatic behavior.
  • Use positive behavioral supports for
    accountability, based on affirmation and support.

87
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • SPECIFIC COMPONENTS OF TRAUMA INFORMED EDUCATION
    (2)
  • Build on student strengths.
  • Create meaningful, structured opportunities for
    student decision-making (sense of agency).
  • Promote student involvement school
    community.
  • Teach self-regulation skills to students.
  • Reduce bullying and harassment.

88
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • SPECIFIC COMPONENTS OF TRAUMA INFORMED EDUCATION
    (3)
  • Model respectful, nonviolent relationships.
  • Offer staff training to reinforce core concepts
  • Training should help staff understand that a
    traumatized childs disruptive behavior often is
    not a matter of willful defiance, but originates
    in feelings of vulnerability.
  • Use trauma informed approaches to academic
    instruction.

89
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • SPECIFIC TRAUMA INFORMED APPROACHES TO ACADEMIC
    INSTRUCTION
  • Offer predictability safety in routines and in
    expectation of positive responses no surprises.
  • Break academic tasks down into smaller parts.
  • Use frequent support and encouragement.
  • Identify common triggers, with goal of prevention
    or mitigation of incidents.

90
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • TRAUMA INFORMED APPROACHES TO ACADEMIC
    INSTRUCTION (2)
  • Use language-based teaching approaches
  • Present information and directions in multiple
    (auditory and written) ways. Have child repeat
    and practice.
  • Process specific information by repeating
    sequences of events and highlighting
    cause-and-effect relationships.
  • Review preview material, placing in familiar
    context.
  • Identify process feelings identifying,
    verbalizing, and understanding feelings promote
    self-regulation.
  • Ensure appropriate evaluations and Rx.

91
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • USING RELATIONSHIPS TO PROMOTE TRAUMA INFORMED
    CULTURE IN EDUCATION
  • Understand that trauma is a central,
    life-organizing experience, which impairs
    neurobiological function normal development.
  • Assume all students have experienced trauma
    (universal precautions).
  • Be aware of your attitudes and reactions.
  • Discover the person behind the behavior.

92
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • USING RELATIONSHIPS TO PROMOTE TRAUMA INFORMED
    CULTURE IN EDUCATION (2)
  • Work hard to develop a trusting relationship, and
    let youth know you want to work together.
  • Model qualities that the youth needs to learn.
  • Manage your emotions, and remain professional.
  • Support skill acquisition promote competence,
    to help youth improve self-control and coping.

93
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • USING RELATIONSHIPS TO PROMOTE TRAUMA INFORMED
    CULTURE IN EDUCATION (3)
  • Help student see you as an ally a carrier of
    hope.
  • Avoid intimidation, humiliation, shaming, and
    angry, punitive responses.
  • Help student identify potential triggers and how
    to manage them.
  • Address issues of safety, and ensure that the
    student is committed to own safety.

94
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • USING RELATIONSHIPS TO PROMOTE TRAUMA INFORMED
    CULTURE IN EDUCATION (4)
  • Work with the students family.
  • Work with students school team and MH team, with
    school counselor as point person.
  • Help the student make positive changes in life
    e.g. less risk-taking, resisting peer pressure,
    and associating with positive people.
  • Encourage the student to identify meaningful
    goals, accept responsibility, put forth the
    effort.

95
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • ADDITIONAL APPROACHES WITH LIBERIAN REFUGEE
    STUDENTS AND FAMILIES
  • Obtain complete history of child and family
    experience prior to, and following, resettlement.
  • Get to know students family.
  • Become familiar with extended family, community
    leaders, and social networks.
  • Help parents and student learn expectations for
    public education.

96
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • HELPING LIBERIAN STUDENTS AND FAMILIES (2)
  • Help family learn other societal rules
    expectations, including those of child welfare
    system.
  • Dont assume the basis of childs problems find
    out
  • Address trauma via group approach in classroom
    Cognitive Behavioral Intervention for Trauma in
    Schools (CBITS).
  • Help family connect with social service agencies.
  • Form alliances with religious community
    leaders.

97
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • INVOLVING IMMIGRANT AND REFUGEE FAMILIES IN
    THEIR CHILDRENS SCHOOLS (2003, ILLINOIS STATE
    BOARD OF EDUCATION PARENT OUTREACH FOCUS GROUP)
  • Orientation sessions for parents, start of year,
    at community sites.
  • Welcome videos, part of above or separate.
  • Parent handbooks, bilingual as needed.
  • Family-to-family mentoring programs.

98
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • ILLINOIS PARENT OUTREACH FOCUS GROUP (2)
  • Home visits by teams of two, scheduled in
    advance.
  • Social events, with all school staff their
    families encouraged to attend.
  • Varying day and time of parent events.
  • Periodic in-service trainings for school staff.
  • Partnering with other community programs
    agencies.

99
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • CBITS (COGNITIVE BEHAVIORAL INTERVENTION FOR
    TRAUMA IN SCHOOLS)
  • An evidence-based, time-limited, school-based,
    group intervention for students ages 11-15, who
    have experienced significant traumatic events,
    with moderate level of symptoms.
  • Target symptoms include PTSD and depression.
  • Structure 10 group sessions for children led by
    school counselor, 1-3 individual child sessions,
    2 parent sessions, plus 1 teacher education
    session.

100
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • CBITS (2) A MULTI-MODAL APPROACH, INCORPORATING
    6 TECHNIQUES
  • Education.
  • Relaxation training.
  • Cognitive therapy.
  • Real life exposure.
  • Graded exposure to stress/trauma.
  • Social problem-solving, including relapse
    prevention.

101
PART IV MAINTAINING TRAUMA INFORMED EDUCATIONAL
SETTINGS
  • PROVISION OF MENTAL HEALTH SERVICES
  • Concept of mental health services may be alien.
  • Stigma associated with psychiatric disorders
    Rx.
  • Develop services in collaboration with elders,
    religious leaders, or other community leaders.
  • Trauma specific treatment for most severe cases,
    including those involving sexual violence.
  • Where indicated, referral of family for treatment
    of trauma, substance abuse, or domestic violence.

102
CONCLUSION
  • Transformation, through use of trauma informed
    care
  • Taking care of ourselves, so we can help others

103
CONCLUSION
  • Outcomes of Trauma Informed Care (Hodas)
  • From To
  • Danger Safety
  • Fear Security
  • Uncertainty Predictability
  • Confusion Understanding
  • Disrespected Respected

104
CONCLUSION
  • Outcomes of Trauma Informed Care (2)
  • From To
  • Coerced Able to choose
  • Threatened Reassured
  • Rejected Accepted
  • Unequal Partner

105
CONCLUSION
  • Outcomes of Trauma Informed Care (3)
  • From To
  • Hyperaroused Calm
  • Reactive Reflective
  • Fragmented Coherent
  • Mistrusting Trusting

106
CONCLUSION
  • Outcomes of Trauma Informed Care (4)
  • From To
  • Fragile Resilient
  • Victim Survivor
  • Isolated Connected
  • Overpowered Empowered

107
CONCLUSION
  • TAKING CARE OF OURSELVES AS HELPERS
  • Dealing with traumatized students and their
    behavior is itself traumatizing.
  • Range of possible internal reactions
  • Sadness and anxiety.
  • Anger rage.
  • Rescue fantasy.
  • Emotional depletion. Compassion fatigue.
  • In addition, many helpers themselves experienced
    trauma in their lives, and this can be
    reactivated.

108
CONCLUSION
  • HELPER COPING STRATEGIES INCLUDE
  • Make calm and therapeutic responses a priority.
  • Dont take it personally.
  • View self as agent of prevention and empowerment.
  • Remember, child doing best he/she can, right now.
  • Keep goals realistic.
  • Dont try to make it all better you cant.
  • Maintain personal boundaries with clients.

109
CONCLUSION
  • HELPER COPING STRATEGIES (2)
  • Seek assistance and support from coworkers.
  • Seek supervision as needed from supervisor.
  • Know when to remove yourself from a situation.
  • If past trauma interferes with your life or work,
    obtain therapy from a trauma informed therapist.
  • Celebrate small successes.
  • Remember why you chose to do what you do.

110
CONCLUSION
  • SUGGESTED REFERENCE TRAUMA AND TIC
  • Hodas, G (2006) Responding to childhood trauma
    The promise and practice of trauma informed care.
    National Association of State Mental Health
    Program Directors (NASMHPD).
  • Easy access via web search Hodas with
    NASMHPD
  • -Multiple additional references are identified
    at the end of the above paper.

111
CONCLUSION
  • SUGGESTED REFERENCES REFUGEE TRAUMA
  • Lustig, S. et al (2003) Review of Child
    Adolescent Refugee Mental Health. White Paper
    from NCTSN Refugee Trauma Task Force.
    www.nctsn.org
  • Illinois School Board of Education (ISBE) Parent
    Outreach Focus Group (2003) Involving Immigrant
    Refugee Families in Their Childrens Schools
    Barriers, Challenges, Successful Strategies.

112
CONCLUSION
  • SUGGESTED REFERENCES LIBERIAN CULTURE AND
    IMMIGRANTS
  • Schmidt, S. (2005) Liberian refugees Cultural
    Considerations for Social Service Providers.
    Bridging Refugee Youth Childrens Services
    (BRYCS), www.brycs.org/brycs resources.htm
  • Association of Liberian Ministers in US
    (AliMUSA) www.alimusa.org.

113
CONCLUSION
  • SUGGESTED REFERENCE CBITS
  • Jaycox, L (2004) Cognitive Behavioral
    Intervention for Trauma in Schools (CBITS).
    Longmont, CO Sopris West Educational Service.
    303-561-2829.. www.sopriswest.com.
About PowerShow.com