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Trauma-Informed Practice

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Title: PowerPoint Presentation Author: Holly Aday Last modified by: Joanne Pritchard Created Date: 5/12/2015 4:55:16 PM Document presentation format – PowerPoint PPT presentation

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Title: Trauma-Informed Practice


1
Trauma-Informed Practice
2
Todays Agenda
  • Evaluation Pre-test
  • Review Learning Objectives
  • Trauma Basics
  • Adverse Childhood Experiences Study
  • Historical Trauma and Culture
  • Child Welfares Response to Trauma
  • Self-Care
  • Evaluation Post-Test

3
Curriculum Pre-Test
4
Goals for Today
  • Become familiar with the terms and definitions
    associated with trauma-informed practice.
  • Understand how trauma impacts children and adults
  • Develop strategies for how to help children and
    families heal from trauma
  • Understand how trauma impacts professionals

5
Activity Stress and Associated Feelings
  • Very Hot
  • Very uncomfortable
  • Extremely stressed out and anxious
  • Need to get out of here now
  • Hot
  • Moderately uncomfortable
  • Stressed and anxious
  • Distracted and edgy
  • Warm
  • Mildly uncomfortable
  • Slightly stressed and anxious
  • Losing my focus
  • Just Right
  • Comfortable
  • Not stressed or anxious
  • Focused and engaged
  • Cool
  • A little bored
  • Losing my focus
  • Ice cold
  • Totally bored
  • Not focused or engaged
  • Planning my escape

6
Child Trauma is
  • An event that overwhelms the childs ability to
    cope and causes fear, helplessness, or horror,
    expressed by sadness, withdrawal, or disorganized
    / agitated behavior.
  • Witnessing or experiencing an event that poses a
    real or perceived threat to the life or
    well-being of the child or someone close to the
    child.

7
Activity Matching Game
8
Types of Trauma Acute
  • Acute trauma is a single traumatic event that is
    limited in time
  • Serious accidents
  • Painful medical treatment
  • Natural disasters
  • Sudden or violent loss of a loved one
  • Physical or sexual assault
  • Terrorism
  • Separation from Parent/family

9
Types of Trauma - Chronic
  • Chronic Repeated, prolonged trauma (domestic
    violence, abuse, war)
  • Ongoing domestic violence
  • Repeated abuse
  • Long term bullying
  • Continued separation from family
  • War

10
Types of Trauma - Complex
  • Interpersonal trauma
  • May be varied and multiple in nature
  • Chronic
  • Often caused by trusted caregivers
  • It describes both childrens exposure to multiple
    traumatic events, and the wide-ranging, long-term
    impact of this exposure.

11
Child Traumatic Stress
  • When a child has had one or more traumatic
    events, and has reactions that continue and
    affect his or her daily life long after the
    events have ended, we call it Child Traumatic
    Stress.

12
How many children experience child traumatic
stress?
  • In 2010, according to the U.S. Department of
    Health and Human Services (2011), 695,000
    children were victims of substantiated child
    maltreatment. Of these
  • 78.3 experienced neglect
  • 17.6 were physically abused
  • 9.2 were sexually abused

National Child Traumatic Stress Network (2013)
13
Activity
  • Child Traumatic Stress in the child welfare
    system
  • Child Traumatic Stress in the home of origin /
    community

Photo Credit iStockphoto
14
Factors that influence how children experience
trauma
  • The number and severity of the traumatic episodes
  • Proximity to the event
  • The personal significance of the traumatic event
    for the child
  • The extent to which the childs support system is
    disrupted after the trauma

15
Other Factors
  • Childs age and developmental stage
  • Childs perception of the danger faced
  • Childs relationship to victim and/or perpetrator
  • Presence/availability of adults who can offer
    help and protection
  • Genetic predisposition
  • Previous history of trauma experiences

16
Trauma Impact on the Brain
  • The cerebral cortex is responsible for many
    complex functions. (memory, attention, thinking,
    language, etc).
  • Trauma can result in a smaller cortex, thus
    impeding the ability of the brain to perform
    these functions.
  • Trauma can disrupt attachment, bonding and Memory

17
Types of Memory
  • Implicit memory babies can perceive their
    environment and retain unconscious memories
    (e.g., recognizing mothers voice)
  • Explicit memory conscious memories are created
    around age two and tied to language development

18
Impact on Brain in Early Childhood
  • Reduced size of the cortex.
  • Affects cross-talk between the brains
    hemispheres which may affect
  • IQ
  • ability to regulate emotions, and
  • lead to increased fearfulness and
  • a reduced sense of safety and protection.

19
Impact on Brain in School Aged Children
  • Trauma undermines the development of brain
    regions that would normally help children
  • Manage fears, anxieties, and aggression
  • Sustain attention for learning and problem
    solving
  • Control impulses and manage physical responses to
    danger, enabling the child to consider and take
    protective actions

20
Impact to Adolescent Brain Development
  • Trauma can interfere with development of the
    prefrontal cortex, the region responsible for
    consideration of the consequences of behavior,
    realistic appraisal of danger and safety and
    ability to govern behavior and meet longer-term
    goals

21
Trauma and Development
  • Infants/Toddlers
  • Preschool-Age Children
  • School-Age Children
  • Adolescents

22
Child Traumatic Stress symptoms may include
  • Intrusive Memories
  • Nightmares or Flashbacks
  • Avoidance of Trauma Reminders
  • Heightened Arousal (being on edge, jumpy, or
    hyper-alert)
  • Intense and Overwhelming Feelings of fear, anger,
    shame, and helplessness

23
What are Trauma Reminders?
  • Anything that reminds children of past traumatic
    experiences (even years afterward)
  • Places
  • People
  • Sights
  • Sounds
  • Smells
  • Feelings

24
Video - Removed
25
How can Social Workers Reduce Trauma?
  • Investigation
  • Removal
  • Placement/placement changes
  • Transition home or to permanent plan
  • Case closure

26
How can a Social Worker Help?
  • Let child know they can talk about experiences or
    fears if they want to
  • Listen carefully when they do talk
  • Notice behaviors
  • Give the child choices and some sense of control
  • If you have any questions, ask for help from
    Supervisor
  • Know where to refer

27
What Can Social Workers Do?
  • Make referrals for services to
  • Mental Health services
  • Trauma focused Therapy
  • Public health nurse or physician
  • Special activities
  • Educational staff or programs

28
Adverse Childhood Experiences (ACE) Study
  • Landmark study done by the CDC and Kaiser
    Permanente regarding relationship of ACEs to many
    of the leading causes of death in adults.
  • The more traumatic experiences, the greater the
    risk of poor physical and behavioral health
    outcomes.
  • More than half of all children reported for
    maltreatment had experienced 4 or more ACEs at
    the time of contact with CWS.

Source National Survey of Child and
Adolescent Well-being (NSCAW), Research Brief
20, August 2013
29
ACE Study Video
30
Activity
  • At your tables, list different health concerns
    that might be related to ACEs. You will have 5
    minutes. Be prepared to report out.

31
How can Birth/Resource parents support Children
with ACEs?
  • DONTs
  • Dont be afraid to talk about the trauma if the
    child wants to, and listen if they do follow
    the childs cues
  • Dont Over-react
  • Dont underestimate how important it is for
    children to know their caretakers are in
    control
  • Dont be afraid to ask for help
  • DOs
  • Be nurturing/ comforting
  • Be Flexible
  • Be Honest Even if its Difficult
  • Be patient the effects of trauma can be
    long-lasting with a long process for recovery
  • Provide a consistent pattern for the childs day
  • Discuss behavioral expectations/discipline
  • Talk and share info with the SW and MH Clinician

32
Parents Trauma History
  • Many parents of children in foster care have
    histories of adult and/or childhood trauma
  • What this means
  • Parents past or present trauma can make it
    difficult for them to work effectively with case
    workers and resource parents towards
    reunification with their children

33
How Trauma can Affect Birth Parents
  • Compromise parents ability to make judgments
    about safety
  • Harder for parents to form and maintain secure
    and trusting relationships
  • Impair their capacity to regulate emotions
  • Low self-esteem and lack of coping strategies can
    impair a parents decision-making ability
  • Make the parent more vulnerable to other life
    stressors

34
Activity
  • Review Pages 2 3 of Birth Parents with Trauma
    Histories and the Child Welfare System A Guide
    for Resource Parents
  • Groups will take into consideration the Parents
    own Trauma history and chart ways to engage
    parents in the development of their case plan and
    assist parents in their Trauma recovery

35
How can Social Workers Help Parents Heal
  • Understand parents anger, fear, resentment, or
    avoidance as reactions to past trauma
  • Assess parents trauma history
  • Understand that Traumatized parents are not bad
    and do not judge or blame them
  • Build on parents desires to care for their child
  • Help parents understand impact of their own past
    trauma
  • Refer parents to trauma-informed services

36
Cultural Trauma
  • Social and cultural realities strongly influence
    childrens risk forand experience oftrauma.
  • Children and adolescents from minority
    backgrounds are at increased risk for trauma
    exposure and subsequent development of PTSD.
  • In addition, childrens, families and
    communities responses to trauma vary by group.

37
The Influence of Culture
  • Variance of trauma responses
  • Strong cultural identity and community/ family
    connections
  • Shame

38
Importance of Culture VideoGeorgetown University
Center for Human Development
39
Cultural Trauma Activity
  • Discuss and chart in your table groups what
    factors may contribute to Cultural Trauma and
    what types of trauma responses you may see.

40
Historical Trauma
  • Historical Unresolved Grief
  • Disenfranchised Grief
  • Internalized Oppression
  • Multigenerational Trauma
  • The population of Native Americans in North
    America decreased by 95 from the time Columbus
    came to America in 1492 and the establishment of
    the United States in 1776.

41
VIDEO - Case Study Historical Loss
The voice of a young woman and her anger.
42
Activity What can you do?
  • At your table group develop a role play between a
    Social Worker and a Family Member in which the
    Social Worker displays skills that exhibit
    sensitivity and awareness regarding cultural and
    historical trauma.

43
Pathways to Wellbeing(Formerly known as Katie A.)
  • WHAT IS IT?
  • Class-Action Lawsuit in CA that further spells
    out and holds accountable the roles of Child
    Welfare Workers and Mental Health personnel in
    supporting mental/behavioral health needs of
    children youth
  • WHO IS ELIGIBLE FOR SERVICES?
  • Children Youth in Foster Care (or at imminent
    risk of entering Foster Care)

44
Pathways to WellbeingImplications for Child
Welfare Practice
  • MUST SCREEN children and youth for mental health
    issues
  • REFER children/youth to trauma-informed and
    evidence-based practices
  • MONITOR children/youths health well-being
  • MUST COLLABORATE with Mental Health providers
    as part of Child Family TEAMS!
  • Check with your supervisor for more
    county-specific details!
  • Concerted Efforts

45
Essential Elements of Trauma-Informed Child
Welfare Practice
  1. Maximize the childs sense of safety.
  2. Assist children in reducing overwhelming emotion.
  3. Help children make new meaning of their trauma
    history and current experiences.
  4. Address the impact of trauma and subsequent
    changes in the childs behavior, development, and
    relationships.
  5. Coordinate services with other agencies.

45
46
Essential Elements of Trauma-Informed Child
Welfare Practice
6. Utilize comprehensive assessment of the
childstrauma experiences and their impact on the
childs development and behavior to guide
services. 7. Support and promote positive and
stable relationships in the life of the child. 8.
Provide support and guidance to childs family
and caregivers. 9. Manage professional and
personal stress.
47
Essential Elements Activity
  • Evenly distribute the 9 Essential Elements
    amongst the Table Groups
  • Have each table write a definition and provide
    one case example for each Essential Element to
    which they were assigned.

48
Quote
  • The expectation that we can be immersed in
    suffering and loss daily and not be touched by it
    is as unrealistic as expecting to be able to walk
    through water without getting wet.
  • Rachel Remen,
  • Kitchen Table Wisdom

49
Secondary Traumatic Stress
  • Distress that results when an individual hears
    about the firsthand trauma experiences of
    another. Symptoms mimic those of PTSD.
  • re-experiencing personal trauma or
  • changes in memory/perception
  • depletion of personal resources
  • disruption in perception of safety, trust,
    independence.

50
Sources of Secondary Traumatic Stress
  • Child or family member death on an active or
    recently closed case,
  • Investigating abuse and neglect
  • Working in violent communities
  • Working with families with extensive abuse
    histories
  • Removing a child under distressing circumstances
  • System frustrations
  • Verbal or physical assault by parents or
    community members.

51
Compassion Fatigue Self-Test An Assessment
  • Cynicism and anger
  • Anxiety, fearfulness
  • Emotional detachment
  • Hopelessness and Guilt
  • Sleep disturbance
  • Social withdrawal
  • Diminished self-care
  • Physical ailments

52
Coping
  • Understand and accept ones vulnerability
  • Learn to balance the needs of the client, the
    agency and oneself
  • Utilize supervision to recognize and address
  • Recognize when ones self care system is not
    working
  • Recognize negative and positive coping behaviors.
  • Consider offering and asking for peer support

53
Trauma Training Post-Test
54
Wrap up
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