Title: Creating a Trauma Informed Learning Environment
1Creating a Trauma Informed Learning Environment
- Presented by
- Kym Asam, LICSW, QMHP
2Objectives
- Differentiate between PTSD and developmental
trauma - Understand the impact of trauma on the brain
utilizing the Neuro-Sequential Model of
Therapeutics (NMT) - Impact on students capacity to learn
- Brain regions and a tiered (PBiS) approach to
intervention - Understand the students states of arousal and
how it impacts their functioning in school - Key skills in working with children who have
experienced developmental trauma - ARC and its intersect with a tiered approach
- Adults
- Students
-
3Polling Question 1
- How many audience participants have had some
training on developmental or complex trauma?
4Grounding Principles
- Trauma-Sensitive Schools benefit all children
those whose trauma history is known, those whose
trauma will never be clearly identified and those
who may be impacted by their traumatized
classmates. - Schools are the Central Community for most
children.
5Definitions
- What is trauma?
-
- Trauma is not an event itself, but rather a
response to a stressful experience in which a
persons ability to cope is dramatically
undermined.
6What is Developmental Trauma?
- A psychological and neurobiological injury that
results from protracted exposure to stressful
events - Derails typical development across all domains
(neurological, psychological, cognitive, social,
self/identity) - Experiences often occur in the caregiving system.
- Impact is immediate and long term
- Effects will require all tiers of intervention
7Sources of Trauma
- Sexual abuse
- Physical abuse
- Emotional abuse
- Neglect
- Domestic Violence
- Neighborhood violence
- Torture
- Bullying
- Prolonged exposure to traumatic stress
- Intrauterine stress
- Epigenetics
8Toxic Stress Pyramid
9Pervasiveness in children
- Overall substantiated child maltreatment in 2011
approximately 681,000 (705 in Vermont) - 9.1 experienced sexual abuse (67 in Vermont)
- 17.6 experienced physical abuse (37.1 in
Vermont) - 78.5 experienced neglect (2.6 in Vermont)
- 48.6 were males
- 51.1 were females
- Source National Childrens Alliance and US
Department of Health and Human Services, 2011
report - Child Welfare League of America
10The brain develops from the bottom up
Cortex
Limbic
Diencephalon
Brainstem
Prefrontal Cortex
Cerebral Cortex
Limbic
and the inside out
Diencephalon
Brain Stem
11Early childhood synaptic growth
12Brain Function
Abstract Thought Concrete Thought Affiliation/Rewa
rd Attachment Sexual Behavior Emotional
Reactivity Motor Regulation Arousal Appetite
/Satiety Sleep Blood Pressure Heart Rate Body
Temperature
Cortex
Encourage Abstract Thought Facilitate
Socio-emotional Growth Introduce Somato-Sensory
Integration Establish State Regulation
Limbic
Diencephalon
Brainstem
Perry, B. 2006
13The still face experiment
- http//www.youtube.com/watch?vapzXGEbZht0
14Neuronal Connections
- http//www.youtube.com/watch?v8NA_o1jOjsQ
15Impact of Neglect on the Brain
16Stages of Sleep
17Polling question 2
- How many of you have students who frequently go
to the nurse?
18Negative Interactions
- Social experiences with caregivers become
biologically embedded - .
19Effects of Trauma on Brain Functioning
Thalamus Visual, auditory, olfactory,
kinesthetic, gustatory
Prefrontal Cortex (Integration and Planning)
Amygdala (Intensity/significance)
Hippocampus (cognitive map)
20Normative Danger ResponsesAutonomic Nervous
Response System
- Fight
- Flight
- Freeze
- Flock
21Emotional Identification
22Facial Expression Recognition
23Arousal Continuum
State Calm Arousal, Attention Alarm Fear Terror
Adaptive Response Rest Vigilance Freeze Fight Flight
Regulation Brain Region Neocortex Cortex Cortex Limbic Limbic Midbrain Midbrain Brainstem Brainstem Autonomic
Deesecalating Adult Responses Talking, adult presence, rocking Eye contact, simple directives, quiet voice Quiet words, invited physical touch Disengagement, quiet adult presence Wait, leave group, allow child to calm, no words
Escalating Adult Responses Noise, confrontation Complex directives, anger, ultimatums Raised voice, shaking finger Chaos, frustration, yelling grabbing, shaking screaming
Cognition Abstract Concrete Emotional Reactive Reflexive.
Perry, B. (2006). Applying principles of
neurodevelopment to clinical work with maltreated
and traumatized children. New York, NY Guilford
Press
24Typical path to reactions
25Express Route to Reactions!
26Arousal and Cognitions
As arousal increases cognitive ability decreases.
Hyper-aroused children may be defiant, resistant
and/or aggressive. They are stuck in survival
mode and may freeze, fight, or flee.
Cognitive Ability
Arousal Level
A child in a hyper-aroused state can not be
reasoned with, she needs you to help her reduce
her arousal level.
27How to Intervene
- Somatosensory interventions
- Targeting the part of the brain that was impacted
by developmental insults - EVERY DAY
- EVERY GRADE
- EVERY BODY
28Targeting the Tiers, PBiS approaches
Brain stem/diencephalon
Intensive
limbic
targeted
universal
cortex
29Building up from the base
Establish State Regulation -- Intensive
- School staff can be thinking about short,
predictable, repetitive, patterned interactions
throughout the day which would include - Touch
- Rhythmic activities (rocking)
- Eye contact
- drumming
- Respond to physiological cues. A childs heart
rate is a great indicator of levels of arousal
(low end 80, high end 120). When interacting
become an affective co-regulator for the child.
Brainstem
Bruce Perry (2006)
30Building up from the base
Introduce Somato-Sensory Integration targeted,
intensive
Diencephalon
- Large motor and fine motor
- Music and movement
- Sensory stimulation
- Predictable routines (eating, transitions,
sleeping) - Consider beginning the day with predictable,
structured, patterned, rhythmic music and
movement activities. Studies have indicated that
children have increased self-regulation
throughout the day when sensory integration
occurs early. - Remember that the brain fatigues after 7 minutes.
Bruce Perry (2006)
31Polling Question 3
- How many of you work with students who receive
targeted or intensive level of supports who
struggle with playing games or taking turns?
32Building up from the base
Facilitate Socio-emotional Growth targeted
Limbic
- Turn-taking
- Team play
- Win lose
- Sharing
- Consider that social development is a progression
and the ability to form satisfying reciprocal
interactions may depend on backing up and
purposefully creating opportunities for parallel
play or learning opportunities in a dyad with an
adult and then a dyad with a peer before group
play or group learning will be successful.
Bruce Perry (2006)
33Building up from the base
Encourage Abstract Thought Universal
Cortex
- Humor
- Language
- Art
- Games
- Conflict resolution, problem solving
- Self-development and identity
- Self-esteem
- Children who have foundational skills will be
able to utilize their prefrontal cortex
successfully. However, for children with
disrupted or traumatic early experiences, adults
will need to emphasize the earlier skills.
Remember, stage not age.
Bruce Perry (2006)
34Polling Question 4
- Who in webinar land is familiar with the ARC
model?
35ARC Model - 10 Building Blocks
36attachment
intensive
Caregiver Affect Mgmt
Routines and Rituals
Attunement
Consistent Response
Affect Identification
Affect Expression
Modulation
targeted
Self-regulation
Devtal Tasks
Executive Functioning
Self Devt Identity
universal
competency
Trauma Experience Integration
Blaustein Kinniburgh, 2010 Kinniburgh
Blaustein, 2005
374 Key Principles of Attachment
- Build school staff capacity to manage affect
- Build school staff-child attunement
- Build consistency in school staff response to
child behavior - Build routines and rituals into classroom and
school
38Healthy Attachment Sequence
- Physical or psychological need
Security, trust, attachment, self-regulation,
object constancy
State of high arousal
Relaxation (parasympathetic ANS)
Attunement/satisfaction of need
Beverly James
39Unhealthy Attachment Sequence
- Physical or psychological need
Shame, mistrust, disregulation, disturbed mental
blueprint
Anxiety, rage, numbing
State of high arousal
Needs are disregarded/attunement disrupted
Beverly James
40Affect Management
- When caregivers modulate their own affect and
emotional responses, they can create an
emotionally safe environment in which children a
can learn
41Attunement
- Caregivers accurately read cues to respond to
underlying emotion rather than overt behavior.
Behavior is usually a front for feeling that a
child has difficulty expressing in a more
effective way.
42Attunement
- Communicating unmet needs
- What is the function of the behavior?
- Being a feelings detective!
43Consistent Response
- Caregivers respond in a consistent way to both
positive (desired) and negative/unsafe behaviors.
Predictability reduces the childs need for
control.
44Routines and Rituals
- Routines increases predictability and the childs
ability to anticipate next steps. Establishing
classroom and school-wide routines helps reduce
trouble spots (transitions, substitute teachers,
unstructured activities/days).
45SELF REGULATION
46Self-Regulation A Stepped Approach
- Affect Identification
- Affect Modulation
- Affect Expression
47Islands of Competence
- When the student is allowed to be successful in
his or her area of competence, the learning
process can begin to take hold and develop.
Focusing on an island of competence should not be
misunderstood as dumbing-down an activity or
lesson rather, it is tailoring learning to a
childs interests in order to achieve academic
success. Not only does success bolster learning,
but it is also central to developing a positive,
trusting relationship with the student. - (From, Helping the Traumatized Child Learn)
48Competency3 Key Principles
- Build student executive functioning skills
- Target self-development and identity
- Target additional key developmental tasks
- The child develops an ability to evaluate
situations, inhibit impulsive responses and
actively make choices.
49Jessica
- http//www.youtube.com/watch?vqR3rK0kZFkg
50Possible Collision Points at School
- Schools focus on preparing children for and
information related to the external world - Students with DT focus on the present and
internally to stay safe. - Much of school is motivated by connection and
participation with others - Schools often use delayed gratification
- Students with DT are focused on the present to
stay safe. Delaying gratification is dangerous
and unpredictable. - Teachers often set limits/goals for the common
good - Youth with DT dont operate with a template that
understands the common good.
51Competing Demands
- Survival vs. learning
- It is nearly impossible to dedicate your full
attention and energy to survival and learning at
the same time.
52The Healthy Mind Platter
- Physical time
- Sleep time
- Focus time
- Time in (flossing your brain)
- Down time
- Plan time
- Connecting time
The Whole Brain Child, Dan Siegal
53Keys to Successful Intervention The 6 Rs
- Relevant (developmentally matched)
- Repetitive (patterned)
- Rewarding (pleasurable)
- Relational (safe)
- Rhythmic (resonant with neural patterns)
- Respectful (child, family, culture)
54Relevent Links
- http/studentsfirst.org
- http/howardcenter.org
- http//www.nctsn.org/
- http//mentalhealth.vermont.gov/
- http//healthvermont.gov/
- http//www.ptophelp.org/
55Questions?????