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Creating a Trauma Informed Learning Environment

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Title: Creating a Trauma Informed Learning Environment


1
Creating a Trauma Informed Learning Environment
  • Presented by
  • Kym Asam, LICSW, QMHP

2
Objectives
  • 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

3
Polling Question 1
  • How many audience participants have had some
    training on developmental or complex trauma?

4
Grounding 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.

5
Definitions
  • 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.

6
What 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

7
Sources of Trauma
  • Sexual abuse
  • Physical abuse
  • Emotional abuse
  • Neglect
  • Domestic Violence
  • Neighborhood violence
  • Torture
  • Bullying
  • Prolonged exposure to traumatic stress
  • Intrauterine stress
  • Epigenetics

8
Toxic Stress Pyramid
9
Pervasiveness 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

10
The brain develops from the bottom up
Cortex
Limbic
Diencephalon
Brainstem
Prefrontal Cortex
Cerebral Cortex
Limbic
and the inside out
Diencephalon
Brain Stem
11
Early childhood synaptic growth
12
Brain 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
13
The still face experiment
  • http//www.youtube.com/watch?vapzXGEbZht0

14
Neuronal Connections
  • http//www.youtube.com/watch?v8NA_o1jOjsQ

15
Impact of Neglect on the Brain
16
Stages of Sleep
17
Polling question 2
  • How many of you have students who frequently go
    to the nurse?

18
Negative Interactions
  • Social experiences with caregivers become
    biologically embedded
  • .

19
Effects of Trauma on Brain Functioning
Thalamus Visual, auditory, olfactory,
kinesthetic, gustatory
Prefrontal Cortex (Integration and Planning)
Amygdala (Intensity/significance)
Hippocampus (cognitive map)
20
Normative Danger ResponsesAutonomic Nervous
Response System
  • Fight
  • Flight
  • Freeze
  • Flock

21
Emotional Identification
22
Facial Expression Recognition
23
Arousal 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
24
Typical path to reactions
25
Express Route to Reactions!
26
Arousal 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.
27
How to Intervene
  • Somatosensory interventions
  • Targeting the part of the brain that was impacted
    by developmental insults
  • EVERY DAY
  • EVERY GRADE
  • EVERY BODY

28
Targeting the Tiers, PBiS approaches
Brain stem/diencephalon
Intensive
limbic
targeted
universal
cortex
29
Building 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)
30
Building 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)
31
Polling 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?

32
Building 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)
33
Building 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)
34
Polling Question 4
  • Who in webinar land is familiar with the ARC
    model?

35
ARC Model - 10 Building Blocks
36
attachment
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
37
4 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

38
Healthy 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
39
Unhealthy 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
40
Affect Management
  • When caregivers modulate their own affect and
    emotional responses, they can create an
    emotionally safe environment in which children a
    can learn

41
Attunement
  • 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.

42
Attunement
  • Communicating unmet needs
  • What is the function of the behavior?
  • Being a feelings detective!

43
Consistent Response
  • Caregivers respond in a consistent way to both
    positive (desired) and negative/unsafe behaviors.
    Predictability reduces the childs need for
    control.

44
Routines 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).

45
SELF REGULATION
46
Self-Regulation A Stepped Approach
  • Affect Identification
  • Affect Modulation
  • Affect Expression

47
Islands 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)

48
Competency3 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.

49
Jessica
  • http//www.youtube.com/watch?vqR3rK0kZFkg

50
Possible 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.

51
Competing Demands
  • Survival vs. learning
  • It is nearly impossible to dedicate your full
    attention and energy to survival and learning at
    the same time.

52
The 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
53
Keys to Successful Intervention The 6 Rs
  • Relevant (developmentally matched)
  • Repetitive (patterned)
  • Rewarding (pleasurable)
  • Relational (safe)
  • Rhythmic (resonant with neural patterns)
  • Respectful (child, family, culture)

54
Relevent Links
  • http/studentsfirst.org
  • http/howardcenter.org
  • http//www.nctsn.org/
  • http//mentalhealth.vermont.gov/
  • http//healthvermont.gov/
  • http//www.ptophelp.org/

55
Questions?????
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