presented by - in:ciite events€¦ · healing ourselves, healing our children - cindy lee creating...

PRESENTED BY:

This viewing guide is intended for use by participants at the Empowered to Connect Conference. The conference is a joint effort of Show Hope (showhope.org), the Karyn Purvis Institute of Child Development (child.tcu.edu), and Empowered to Connect (empoweredtoconnect.org). The conference honors the legacy of Dr. Karyn Purvis by focusing on Trust-Based Relational Intervention®, thereby bringing practical and effective tools to adoptive parents and the professionals who

support them.

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CONFERENCE SCHEDULE

HONORING DR. KARYN PURVIS

SPEAKERS AND CONTRIBUTORS

CHILDREN FROM HARD PLACES AND THE BRAIN - DR. DAVID CROSS

HOPE AND HEALING FOR THE FUTURE - DR. DAVID CROSS

CREATING HEALING CONNECTIONS - DR. AMANDA HOWARD

WE DIDN’T KNOW WHAT WE DIDN’T KNOW- DAN AND TERRI COLEY

EMPOWERING OUR KIDS TO SUCCEED - DR. CASEY CALL

SHAPING OUR KIDS BEHAVIOR (PART 1 + PART 2) - DAREN JONES

HEALING OURSELVES, HEALING OUR CHILDREN - CINDY LEE

CREATING A SAFE PLACE - RYAN AND KAYLA NORTH

PUTTING IT ALL TOGETHER AND TAKING IT HOME - PANEL

GLOSSARY OF TERMS

REFERENCES

ACES QUESTIONAIRE

TABLE OFCONTENTS

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28

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38

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46

49

50

This symbol, found with the title of each segment both here and on the workbook pages, shows which of the three TBRI practices: Connecting (big C), Empowering (E), or Correcting (little c), the segment focuses on. Because all three are vital to TBRI, there will be overlap, and many segments focus on all three equally. But, this symbol can help you remember the emphasis of any given segment.

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DAY 1 – FRIDAY

10:00 TO 10:30 AM

10:30 TO 11:45 AM

11:45 AM TO 12:00 PM

12:00 TO 1:00 PM

1:00 TO 2:30 PM

2:30 TO 3:45 PM

3:45 TO 4:00 PM

4:00 TO 4:45 PM

4:45 TO 5:45 PM

5:45 TO 6:00 PM

DAY 2 – SATURDAY

10:00 TO 10:15 AM

10:15 TO 11:30 AM

11:30 TO 11:45 AM

11:45 AM TO 1:00 PM

1:00 TO 2:30 PM

2:30 TO 3:30 PM

3:30 TO 3:45 PM

3:45 TO 4:30 PM

4:30 TO 5:45 PM

5:45 TO 6:00 PM

EASTERN AND MOUNTAIN TIME ZONES

WELCOME, INTRODUCTIONS, AND OVERVIEW

CHILDREN FROM HARD PLACES AND THE BRAIN

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HOPE AND HEALING FOR THE FUTURE

LUNCH

CREATING HEALING CONNECTIONS

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WE DIDN’T KNOW WHAT WE DIDN’T KNOW

EMPOWERING OUR KIDS TO SUCCEED

CLOSING REMARKS

WELCOME AND OVERVIEW

SHAPING OUR KIDS’ BEHAVIOR: PART 1

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LUNCH

HEALING OURSELVES, HEALING OUR CHILDREN

BREAK

CREATING A SAFE PLACE

PUTTING IT ALL TOGETHER AND TAKING IT HOME

CLOSING REMARKS

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DAY 1 – FRIDAY

9:00 TO 9:30 AM

9:30 TO 10:45 AM

10:45 TO 11:00 AM

11:00 AM TO 12:00 PM

12:00 TO 1:30 PM

1:30 TO 2:45 PM

2:45 TO 3:00 PM

3:00 TO 3:45 PM

3:45 TO 4:45 PM

4:45 TO 5:00 PM

DAY 2 – SATURDAY

9:00 TO 9:15 AM

9:15 TO 10:30 AM

10:30 TO 10:45 AM

10:45 AM TO 12:00 PM

12:00 TO 1:30 PM

1:30 TO 2:30 PM

2:30 TO 2:45 PM

2:45 TO 3:30 PM

3:30 TO 4:45 PM

4:45 TO 5:00 PM

WELCOME, INTRODUCTIONS, AND OVERVIEW


BREAK


LUNCH


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CLOSING REMARKS

WELCOME AND OVERVIEW


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LUNCH


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CLOSING REMARKS

CENTRAL AND PACIFIC TIME ZONES

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“TBRI helped prepare us and gave us confidence as first time parents to love our son through structure and grace. TBRI helped us understand our role as our son’s advocates, and gave us language to communicate with his teachers and therapists some of his needs as a child from a hard place.

Even with all that amazing training and support we struggle and fail perfection daily. I feel like I ask “Are you askin’ or tellin’?” a hundred times a day. I want to be as simultaneously calm, and firm, and loving as Dr. Purvis. But in my worst moments I can imagine her wrapping her arm around my shoulders—applying just the perfect amount of calming pressure and saying “Mama, how ‘bout a re-do?” The grace, encouragement, and connection we are working to offer to our little ones is offered to us daily by our Heavenly Father.

And every so often the precious one entrusted to my care says something precious like, “Tan I ‘ave a tompra’ise (Can I have a compromise)?” and I am reminded that we are on a God given mission that will change the lives of our children —and through them the world.”

—BRITTANY, ADOPTIVE PARENT

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HONORING DR. KARYN PURVIS Dr. Karyn Brand Purvis, co-founder and former Director of the Institute of Child Development, was an internationally renowned child development expert who devoted her life to bringing healing to “children from hard places.” Dr. Purvis passed away in April 2016 after a valiant fight with cancer. The love and respect we have for Dr. Purvis cannot be adequately expressed in words. But we believe that our children, grandchildren, and the future generations of our family will experience healthier lives because of the influence she had in our lives as a personal friend and through her work. When we read “The Connected Child” in 2007, we were able to again feel compassion for our child and gain an understanding of how his past, as well as our own, could affect the future. She never offered a magic formula or quick fix, but offered HOPE born of her personal experiences and proven tools supported by scientific research. She was an amazing woman of God with the kindest heart, soft-spoken voice, and a glowing presence. She could whisper to a child’s heart.... and ours. She was truly a gift personally, but also to the ministry of Show Hope. We are honored to continue partnering with The Karyn Purvis Institute of Child Development to carry her work forward as we serve families and help bring healing to children and adults impacted by trauma. Under the leadership of co-founder and Rees-Jones Director Dr. David Cross, the work of Dr. Purvis will continue to flourish at The Karyn Purvis Institute of Child Development. The staff of the Institute are honored to carry her work forward, both in legacy and in name. As we consider what Dr. Purvis might say to us today, we often remember a blessing that she would pray over her children: “The Lord bless you and keep you; the Lord make his face to shine upon you and be gracious to you; the Lord lift up his countenance upon you and give you peace.” Peace was ultimately her hope for the children and families she tirelessly served, and each of us involved in the Empowered to Connect Conference echo that prayer for you this weekend. —DAN AND TERRI COLEY

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Friends,

We are grateful and excited that you are here. It is our prayer that over the next two days you gain insight, are encouraged, and above all, experience hope.

Some of you have just begun the adoption or foster care journey, and we consider it a privilege to have you with us. By accessing this information in the early stages, we believe it brings clarity and understanding regarding the hard places from which many of these children enter our families and the ways we can work to create loving, healing homes.

Others of you have arrived at this conference worn out from traveling life’s deep valleys. Take a moment to look around. You are not alone. Having lived through the fear and isolation of hard times, our faith and experience compel us to encourage you with this simple truth: Jesus is alive and making all things new...spring is coming.

And here’s the beautiful thing—Jesus invites us to be a part of this redemptive process. This love is relational, vulnerable, transformative, and empowering. In exploring our own hurts and journeying toward healing, we are invited to help share Jesus’ healing love in the lives of those around us, particularly our children.

The research-based, holistic approach presented at this conference is profoundly impactful. It has been proven effective time and time again. We are confident that you will leave with helpful tools and practical advice to affect positive change for you and your family. Additionally, we hope the information leaves you inspired by how intricately God has designed and created each one of us. Despite our differences, we all share one common bond—a desire to love and be loved. God’s character is revealed very specifically through humanity’s inherent need for relationship, and we have an opportunity to experience this as we journey in relationship with our children.

May this conference be like the first warm breeze of spring...a signpost on the journey toward redemption, healing, and new life. —MARY BETH AND STEVEN CURTIS CHAPMAN

“See what great love the Father has lavished on us, that we should be called children of God! And that is what we are!” —1 John 1:3

FROM THE FOUNDERS OF SHOW HOPE

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SHOW HOPE believes that each child has the inherent, God-given right to be a part of a loving, caring family. This movement began in 2003, when Mary Beth and Steven Curtis Chapman founded Show Hope after having their own eyes and hearts opened to the global orphan crisis. Since then, Show Hope has worked to holistically approach orphan care, helping children in four key areas: Adoption Aid, Care Centers, Pre+Post Adoption Support, and Student Initiatives.

Through Adoption Aid grants, Show Hope has helped more than 5,500 children from more than 50 countries, including the U.S., come to know the love of a family. More than 2,300 waiting children with acute medical and special needs have received loving care through Show Hope’s Care Centers in China. Show Hope’s partnership with the Karyn Purvis Institute of Child Development and Empowered to Connect has helped bring hope and healing to children around the world with encouraging, research based teaching in Pre+Post Adoption Support. And Show Hope prepares for the future with our Student Initiatives by educating and empowering the next generation of leaders to make a difference in the lives of children who are orphaned. EMPOWERED TO CONNECT was founded by Dr. Karyn Purvis, together with Michael and Amy Monroe, to provide online resources and parent training that is designed specifically for adoptive and foster parents. The ETC Parent Training relies heavily on the Trust-Based Relational Intervention® (TBRI®) model developed by Dr. Karyn Purvis and her colleagues at the Karyn Purvis Institute of Child Development. Ryan North is the Executive Director of Tapestry at Irving Bible Church and leads Empowered to Connect. THE KARYN PURVIS INSTITUTE OF CHILD DEVELOPMENT (TCU ICD) is a program in the College of Science & Engineering at Texas Christian University in Fort Worth, Texas. Their mission is research, education, and outreach that improves the lives of children who have experienced abuse, neglect, and/or trauma. The Institute conducts research to deepen understanding about the complex needs of these children and how to help them overcome social, behavioral, and emotional challenges. Through various outreach initiatives, the ICD trains professionals in their evidence-based therapeutic model, Trust-Based Relational Intervention®, or TBRI®. The Karyn Purvis Institute of Child Development was created as an outgrowth of the Hope Connection, a research and intervention project developed in 1999 by the late Dr. Karyn Purvis and Dr. David Cross. The Hope Connection began as a summer camp for adopted children who experienced early orphanage care. The results proved so remarkable, they sparked a compelling scientific and personal journey for Drs. Purvis and Cross. By the end of the first week and into the second week of camp, they saw dramatic changes in attachment, social competency with peers, and language. These outcomes formed the empirical foundations for Trust-Based Relational Intervention®, a model for children from “hard places.”

ABOUT US

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DAVID R. CROSS, PH.D.

Dr. David Cross is the Rees-Jones Director of the Karyn Purvis Institute of Child Development and a professor in the TCU Department of Psychology. Dr. Cross leads the Institute in its triple mission of research, education, and outreach to improve the lives of children who have experienced abuse, neglect, and/or trauma. He has authored many peer-reviewed publications about issues regarding at-risk children. Dr. Cross earned his B.S. from California State University Fresno with a major in Psychology, and then attended The University of Michigan in Ann Arbor for graduate study, beginning in 1980. He earned an M.A. in Psychology and an M.A. in Statistics. He later earned a Ph.D. in Education and Psychology. In 1985, he accepted a position as Assistant Professor in TCU’s Department of Psychology. Dr. Cross, with his former colleague Dr. Karyn Purvis, co-authored “The Connected Child: Bringing Hope and Healing to Your Adoptive Family” to help adoptive parents understand the needs of children from hard places. “The Connected Child” continues to be a best-seller among adoption books. Together, Drs. Purvis and Cross created Trust-Based Relational Intervention® (TBRI®), a holistic, attachment based, trauma-informed, and evidence-based intervention for children who have experienced relational trauma. Dr. Cross and his staff at the Institute regularly train professionals from around the world in TBRI®. The Institute is actively engaged in research that not only demonstrates the efficacy of TBRI® as an evidence-based intervention, but also in research about how to grow trauma-informed organizations and communities. In addition to his responsibilities at the Karyn Purvis Institute of Child Development, Dr. Cross teaches many TCU courses including Case Studies in Child Development, Generalized Linear Models, and Graduate Developmental Psychology. Dr. Cross’s wife, Trudy, is a retired Kindergarten teacher and a practicing Grandmother. They have two adult children.

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AMANDA R. HILES HOWARD, PH.D.

Amanda Hiles Howard is an Assistant Professor of Psychology at Samford University. She came to Samford after serving as the Assistant Director of the Karyn Purvis Institute of Child Development at TCU for six years. Amanda earned her B.A. from The Ohio State University with a major in Psychology, and then attended TCU for graduate study under the mentorship of Drs. David Cross and Karyn Purvis. She earned an M.S. in Experimental Psychology with an emphasis on Quantitative Analysis, and then earned a Ph.D. in Experimental Psychology with an emphasis on Developmental Psychology. Her work integrates theory, research, and practice in a concentrated effort to increase understanding of the interpersonal processes underlying mental health and quality of life for youth in the child welfare system. Amanda and her husband John have two sons.

CASEY CALL, PH.D.

Casey Call is the Assistant Director at the Karyn Purvis Institute of Child Development, and a passionate advocate for vulnerable children and families. Her responsibilities include research, training, and outreach connected to Trust-Based Relational Intervention®. Casey also teaches, advises, and mentors TCU students in the Child Development undergraduate and graduate programs. Casey is a Licensed Professional Counselor Supervisor and is a registered Circle of Security® parent educator. She has also received training in Theraplay® Level One and in scoring the Strange Situation Protocol. Casey has earned advanced degrees in elementary education, counseling, and developmental psychology. She is passionate about bringing trauma-informed interventions into systems of care, especially educational systems. Casey is married to Brian, a lieutenant in the Fort Worth Fire Department. They have two children and reside in Fort Worth, TX.

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DAREN JONES

Daren Jones is a Training Specialist with the Karyn Purvis Institute of Child Development. Daren began his career as a behavior instructor of a therapeutic day treatment program serving children and youth who could no longer function in a regular academic school setting. After serving as a behavior instructor, Daren decided to obtain his Masters in Social Work from Spalding University in Louisville, Kentucky. Daren also obtained his Bachelor’s Degree in Social Work from the University of Arkansas at Fayetteville. He has spent the past 12 years serving youth and families within residential and foster care settings as a direct-care worker, residential group home supervisor, Licensed Child Care Administrator, and trainer. Daren currently resides in Fort Worth, Texas with his wife, Katie, and two children.

CINDY R. LEE

Cindy Lee, LCSW, LADC, specializes in providing counseling services for children, adolescents and adults as well as crisis intervention services and substance abuse treatment. In an effort to better serve families experiencing relational trauma, Cindy completed the TBRI® professional training program developed by Dr. Karyn Purvis and Dr. David Cross. Realizing the healing value of TBRI®, Cindy co-founded the HALO Project and currently serves as the Executive Director. HALO is a 10-week intensive intervention program for children in foster care and children who have been adopted, and is based on the principles of TBRI®.

In collaboration with Dr. Karyn Purvis & Dr. David Cross, Cindy has published a series of children books based upon the valuable lessons of TBRI®, including “Baby Owl Lost Her Whoo,” “It’s Tough to Be Gentle: A Dragon’s Tale,” “Doggie Doesn’t Know No,” “The Penguin and the Fine-Looking Fish,” “The Elephant with Small Ears” and “The Redo Roo.” Proceeds of the books are donated to the Institute of Child Development and HALO Project. Cindy resides in Edmond, Oklahoma with her husband, children and pets.

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DAN AND TERRI COLEY

Dan and Terri Coley are Show Hope founding board members who live in Franklin, Tennessee. Dan also serves on staff at Show Hope as the Senior Director of Programs and Growth Strategies. Terri serves on staff in pre+post adoption support. They have served as foster parents for more than 40 infants and birthmothers, and have adopted children domestically and internationally. Their family is multi-racial and includes children with special needs. It is their heart’s desire for every child to have a family. Through personal experience, they have come to know the importance of understanding the challenges and needs of children from “hard places.” Dan and Terri are committed to helping educate and prepare families for the adoption journey, and empowering them with the tools to help children heal, while maintaining healthy families. The Coleys have nine children and 10 grandchildren.

RYAN AND KAYLA NORTH

Ryan and Kayla North have six children through birth and foster care adoptions. They began their foster care journey in 2004 and welcomed close to 30 foster children into their home. Although their home is closed to foster care, they continue to support those who are walking this journey. Ryan is the Executive Director of Tapestry, the Adoption and Foster Care Ministry of Irving Bible Church in the Dallas area. Tapestry serves to connect families in community, equip them for the journey, and encourage them along the way. In his capacity as the Executive Director of Tapestry, Ryan leads Empowered to Connect. Kayla left the classroom, after a decade of teaching third grade, to stay home with their six children, five of whom she home schools. She oversees all ETC Parent Trainers and leads Tapestry’s crisis intervention efforts.

They are Empowered to Connect Parent Trainers and Trainer of Trainers. Ryan and Kayla write about the blessings and challenges of their parenting journey at “One Big Happy Home” and “The Ryan Blog,” and contribute to both Empowered to Connect and the Tapestry blogs.

- 14 - Copyright 2017 Karyn Purvis Institute of Child Development. Please do not copy without the express written permission of the Karyn Purvis Institute of Child Development.


Much of the information in this presentation is available in the Healing Families video “Children from Hard Places and the Brain”—see child.tcu.edu.

FIVE B’S OF STRESS AND TRAUMA

BRAIN

BELIEFS

BEHAVIORS

BODY

BIOLOGY

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- 15 -Copyright 2017 Karyn Purvis Institute of Child Development. Please do not copy without the express written permission of the Karyn Purvis Institute of Child Development.

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SIX RISK FACTORS

1. Prenatal risks such as drug or alcohol exposure

or a STRESSFUL PREGNANCY

2. Perinatal risks such as a DIFFICULT BIRTH or

complications

3. Postnatal risks such as EARLY

HOSPITALIZATION or NICU experiences

4. Maltreatment such as physical, sexual, or

emotional ABUSE

5. NEGLECT such as abandonment,

institutionalization, or parents’ psychological

unavailability

6. Natural or man-made TRAUMAS such as car

accidents, floods, and multiple placements

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UPSTAIRS BRAIN, DOWNSTAIRS BRAIN

The human brain is like a two-story house: The downstairs brain is colored orange and yellow in this diagram, the upstairs brain is colored red, blue, and green in this diagram.

The upstairs brain is mostly not wired at birth, and it allows us to think, reason, learn, remember, and regulate our emotions. It takes time and experience for the upstairs brain to become hard wired.

When a child experiences trauma and other risk factors, it can skew the wiring and chemistry of the brain - the lower, more primitive part of the brain can over-develop, from reacting to fear, while the more sophisticated upstairs brain remains underdeveloped.

The downstairs brain is mostly wired at birth, and allows the newborn to eat, sleep, drink, stay warm or cool, and eliminate. The newborn’s reflexes and basic bodily functions are rooted here.

Repeated nurturing experiences can strengthen the upstairs brain, so that the upstairs brain can help regulate the downstairs brain, and there is balance between the two parts of the brain.

If a child spends too much time being afraid, the brain reorganizes itself around the survival response—fight, flight, or freeze —and the downstairs brain is running the show.


Right hemisphere is connected to our emotions, our sensations, the big picture, and more random aspects of what is going on in the world.

When children experience trauma, the left hemisphere is strong, but the right hemisphere is weak, and children struggle with emotions, sensations, and social situations.

The upstairs brain, which is mostly cortex, can be divided into two hemispheres; each hemisphere tends to specialize, as do the various regions: green for visual processing, blue for sensory and motor processing, and red for relationships, emotions, and the executive functions (e.g., planning).

The prefrontal cortex is especially vulnerable to traumatic experiences; it is important for emotion regulation, mindful awareness, and attachment.

Left hemisphere processing is logical, literal, linear, and linguistic.

LEFT BRAIN, RIGHT BRAIN


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ACES STUDIES

ACES: ADVERSE CHILDHOOD EXPERIENCES

The question the ACEs researchers asked is, “Do

ACEs make a difference in terms of our long-term

health and well-being?” Their answer, “Yes!”1

SELECTED ACES EXPERIENCED

WITHIN THE FAMILY

(percentage of sample who checked each ACE)

SUBSTANCE ABUSE (26%)

SEXUAL ABUSE (23%)

MENTAL ILLNESS (18%)

DOMESTIC VIOLENCE (13%)

PSYCHOLOGICAL ABUSE (12%)

PHYSICAL ABUSE (11%)

CRIMINAL BEHAVIOR (4%)

ANY CATEGORY (53%)

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SELECTED CO-MORBID HEALTH OUTCOMES

(percentage of sample who checked each co-morbid health outcome) Co-morbid means that these outcomes were co-occurring, and indicators of poor health. • Current Smoker (8%)• Severe Obesity (7%)• Depressed Mood (24%)• Attempted Suicide (4%)• Alcoholism (6%)• Illicit Drug Use (13%)• Ever Had STD (8%)• Heart Disease (4%)• Chronic Bronchitis (4%)

This graph depicts the expected number of co-morbid health problems (y-axis) for persons with different ACEs scores (x-axis). As you can see, those individuals who experienced a greater number of ACEs also experienced greater numbers of health problems.

ACES INITIATE A TOXIC CASCADE

The authors of the ACEs studies suggest this developmental cascade to explain the long-term impact of ACEs on health problems, including early death.

ADVERSE CHILDHOOD EXPERIENCES

SOCIAL, EMOTIONAL & COGNITIVE IMPAIRMENT

ADOPTION OF HEALTH-RISK BEHAVIORS

DISEASE, DISABILITY, AND SOCIAL PROBLEMS

EARLY DEATH

6

4

2

06420


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THREE PILLARS OF TRAUMA-INFORMED CARE

TBRI was designed to meet the most pressing needs of children and adolescents who “come from hard places”—their needs correspond to the Three Pillars of Trauma-Informed Care.4

FELT

SA

FET

Y

CO

NN

ECT

ION

SELF

-REG

ULA

TIO

N


THE ATTACHMENT CYCLE

The attachment cycle shows how connection is crucial for both felt-safety and self-regulation. Parents are not only important for connection, but also for security and regulation.

The attachment cycle represents the behavioral, emotional, and psychological events that occur tens of thousands of times during a child’s life. The repeated exercise of both sides of the attachment cycle leads to emotional, regulatory, and behavioral balance.

Disruptions in the attachment cycle occur when caregivers are unavailable, unresponsive, harsh, or abusive. These kinds of experiences program the child’s brain so that the child is afraid, stressed, and hypervigilant—their “fight, flight, or freeze” response (right side of the diagram) is overdeveloped, whereas their regulatory response (left side of the diagram) is underdeveloped.


The infant’s capacity for self-regulation is limited, so adults must scaffold their emerging ability to self-regulate. As the child matures, he or she is able to take on more and more responsibility for self-regulation. Importantly, adopted or foster children may have missed out on many of the experiences that would have built their capacity for self-regulation.

Attachment: It’s not just a connecting relationship, it’s a regulatory relationship!

ATTACHMENT

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TBRI is a set of principles and strategies that give parents and professionals the tools to bring healing and well-being to children and adolescents who “come from hard places.”5

TRUST BASED RELATIONAL INTERVENTION (TBRI)

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More information about TBRI is available in the video “Trust-Based Parenting”—see child.tcu.edu.



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MINDFUL AWARENESS

Mindful awareness is the core ability for the

practice of TBRI. Benefits of mindful awareness:6

• FEAR EXTINCTION AND MODULATION

• ATTUNED COMMUNICATION

• RESPONSE FLEXIBILITY

• EMPATHY AND MORALITY

• EMOTIONAL BALANCE

• INTUITION AND INSIGHT

• REGULATION OF BODILY PROCESSES

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More information about attachment is available in the Healing Families video “Attachment: Why It Matters”—see child.tcu.edu.


ENGAGEMENT STRATEGIES

The TBRI Engagement Strategies emphasize

nonverbal modes of communication, which carry

most of the information during most interactions

with our children. The Engagement Strategies

include:

• AUTHORITATIVE VOICE

(tone, volume, cadence)

• VALUING EYE CONTACT

• BEHAVIORAL MATCHING

• PLAYFUL INTERACTION

• APPROPRIATE TOUCH

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NURTURE GROUPS AND THE FOUR SKILLS

A core TBRI activity is the Nurture Group—Nurture Groups are designed to teach the Four Skills

of Close Relationships.

NURTURE GROUP PRINCIPLES AND PRACTICES

• THREE RULES:7 “Stick together, no hurts, have fun!”

• CORE ACTIVITIES: Feeding and band-aids

• LIFE SKILL ACTIVITIES (e.g., role play)

THE FOUR SKILLS OF CLOSE RELATIONSHIPS8

• BE ABLE TO GIVE CARE

• BE ABLE TO RECEIVE CARE

• BE ABLE TO NEGOTIATE YOUR NEEDS (e.g., choices, compromises)

• BE CAPABLE OF AUTONOMY — “Autonomy within relationship, relationship within autonomy”

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DEVELOPMENTALGOAL GENERAL INSIGHTS EXAMPLES OF

MECHANISMS/TOOLSADULT OUTCOME

(JUDE CASSIDY ARTICLE)

Attachment

Eye ContactSafe Touch

Prosodic VoicePlayful Interaction

Joy & Laughter

• Creating playful games

• Disarming fear through play

• Touch games such as temporary tattoos, Band- Aids, foot or hand massages, shoulder rubs, & other playful activities

Capacity to receive nurture

Trust

Shared PowerGiving Voice

Giving ChoicesGiving Compromises

Creating PredictabilityProviding Transitions

• Feeding each other

• Keeping favorite Band- Aids for nurture

• Adults modeling vulnerability

• Creating opportunities to say “YES!”

• Letting the child know that what they want/feel/need matters to you!

Capacity to give & receive nurture

Self-Worth

EnjoymentAdmiration/Praise

EncouragementSharing Power

Insightful behavioralCorrection

• Spending time doing favorite activities

• Being purposeful about eye- contact & touch

• Creating daily rituals for special time

• Creative tools to bridge “Giving Voice”

Autonomous self

Self-Efficacy

Giving Voice!!!Giving Choices

Giving CompromisesGiving Full Attention

Sharing Power

• Creating playful games

• Disarming fear through play

• Touch games such as temporary tattoos, Band- Aids, foot or hand massages, shoulder rubs, & other playful activities

Ability to negotiate

Behavioral Regulation

Scripts Such As:“Listen & Obey”“Gentle & Kind”

“Obey First Time”“Showing Respect”“With Permission &

Supervision”

• Playing “Simon- Says”

• Playing “Red- Light/Green Light”

• Regulation games (squirt guns & water play…)

• “Engine checks”

• Deep breathing exercises

• Self- calming practices

Autonomous self & Ability to negotiate

Mental Health

Teaching Self- Regulatory SkillsTeaching Insight About

Emotional StatesGiving Skills For Dealing With

EmotionsAdults Modeling Their Emotions

• Feeling chart

• Shared stories

• Journaling

• Adults must model feelings/emotions

• Adults model self- calming/regulation

Autonomous self & Ability to negotiate

INFANT ATTACHMENT STYLES AND ADULT ATTACHMENT STATES OF MIND


ATTACHMENT STYLE

HISTORY WITH CAREGIVER

INFANT’S STRATEGY WHEN UPSET

Secure Caregiver consistently, warmly responds when infant is upset

Cries; infant knows thatcaregiver will soothe

Anxious-AvoidantCaregiver does not respond in emotionally warm way when

infant is upset

Infant has learned not to cryto get needs met

Anxious-Ambivalent Caregiver inconsistentlyresponds when infant is upset

Infant cries (and it is difficultto soothe) in an effort to stay

in caregiver’s attention

Disorganized Caregiver is frightening/traumatic

Infant has no clear strategywhen upset

THE ATTACHMENTDANCE

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“A CHILD WITHOUT A VOICE WILL USE VIOLENCE, AGGRESSION, TRIANGULATION, MANIPULATION, AND

CONTROL TO GET THEIR NEEDS MET.”

—DR. KARYN PURVIS

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“EQUIPPED WITH DEEP UNDERSTANDING OF ATTACHMENT, SENSORY PROCESSING, BRAIN CHEMISTRY OF FEAR, THE IMPACT OF MY HISTORY, AND STRATEGIES TO CONNECT, WE

CAN BRING DEEP HEALING TO OUR CHILDREN.”

—DR. KARYN PURVIS

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“IF WE ATTACK BEHAVIOR WITHOUT COMPASSIONATE INSIGHT AS TO WHY A BEHAVIOR EXISTS, THEN WE NEVER GENERATE TRUE LASTING

HEALING FOR OUR CHILDREN.”

—DR. KARYN PURVIS

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“FORCE IS ALL CONQUERING BUT ITS VICTORIES ARE SHORT LIVED.”

—ABRAHAM LINCOLN

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“IF WE ARE WILLING TO PIECE TOGETHER OUR STORIES AND SEE THE RELATIONSHIPS BETWEEN WHAT HAPPENED THEN AND WHAT’S HAPPENING NOW, WE CAN MAKE

CHOICES ABOUT WHAT HAPPENS NEXT.”

—SCOTT MCCLELLAN, TELL ME A STORY

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“A CHILD BORN TO ANOTHER WOMAN CALLS ME MOMMY. THE MAGNITUDE OF THAT TRAGEDY AND THE DEPTH OF THAT PRIVILEGE ARE NOT

LOST ON ME.”

—JODY LANDERS

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In this presentation, we focus on the Empowering Principles (see p. 23), which provide a foundation for effective Connecting and Correcting.

ECOLOGICAL STRATEGIES

The Ecological Strategies help us design our

schedule and the environment so that we can

avoid common breakdowns during the day.

• MANAGING TRANSITIONS, such as getting

up in the morning or going to bed at night

• CREATING ARTIFACTS, such as schedules or

engine plates

• CREATING RITUALS, such as reading a story

at bedtime.

PHYSIOLOGICAL STRATEGIES

The Physiological Strategies are based on the

realization that a child’s social, emotional, and

cognitive well-being depends upon their physical

well-being.

• MANAGING SLEEP

• MANAGING HYDRATION

• MANAGING BLOOD SUGAR

• REGULAR PHYSICAL ACTIVITY

• MEETING NUTRITIONAL NEEDS

• HEALTHY TOUCH (e.g., massage)

• SENSORY DIETS (e.g., weighted blankets)

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INTERNAL SENSES

VESTIBULAR SENSE

• IS CONTROLLED BY FLUID IN THE INNER EAR

• TELLS THE BODY WHERE IT IS IN RELATION TO THE EARTH

• HAS CONNECTIONS ALL OVER THE BRAIN

• ROCKING, DANCING, SPINNING, RIDING BIKES, ROLLING, SWINGING

PROPRIOCEPTIVE SENSE

• REGISTERS THE FEELING OF TOUCHING AND BEING TOUCHED with deep pressure

• HELPS THE BRAIN AND BODY ORGANIZE when they receive firm, gentle muscle pressure

• IS SENSITIVE TO THE AMOUNT OF PRESSURE with which we are touched or held

• LIFTING AND CARRYING HEAVY LOADS, WEIGHTED BLANKETS, PUSHING AND PULLING,

CHEWING BUBBLE GUM, CHAIR SIT-UPS AND PUSH-UPS, MONKEY BARS

TACTILE SENSE

• NURTURING TOUCH HAS MANY BENEFITS, STARTING IN INFANCY

• IS FULLY FUNCTIONAL AT BIRTH

• BEAN POOL, RICE BUCKETS, DIGGING IN DIRT, STRESS BALLS, COOKING, MASSAGE.

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More information about sensory processing is available in the Healing Families video “It’s A Sensory World: Why It Matters”—see child.tcu.edu.


SHAPING OUR KIDS’ BEHAVIOR

In this presentation, we focus on the Correcting Principles, which build on the foundation created by Connecting and Empowering (see p. 23); because Correcting (Shaping) brings it all together, we do this presentatoin in two separate sessions.

CAN’T MINDSET VS. WON’T MINDSET 9

WON’T Mindset• “This child is being willfully disobedient!”• “The could if they wanted to—they just don’t want to!”

This figure depicts the downward spiral that often occurs when parents or caregivers believe that their child is misbehaving because they don’t want to do the right thing—parents believe their children are being willfully disobedient.


CAN’T Mindset• “This child is doing the best they can right now!” • “These are survival behaviors - fight, flight or freeze!”

CAN’T MINDSET VS. WON’T MINDSET 9

This figure depicts the upward spiral that can occur when parents or caregivers recognize that their children are doing the best that they can—that their behaviors are actually driven by the downstairs brain, which is in “fight, flight, or freeze” mode.

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Recommended reading: “Anatomy of the Soul” by Curt Thompson


CONNECTED DISCIPLINE VS.

DISTANCING DISCIPLINE

• TIME-IN VS. TIME-OUTS

• BRINGING THE CHILD CLOSER VS. SENDING

HIM AWAY

• RESOLUTION VS. CONSEQUENCES

• PROBLEM SOLVING VS. LECTURES AND

SERMONS

• ADVOCACY STANCE VS. ADVERSARY STANCE

• FOCUS ON THE CHILD’S PRECIOUSNESS VS.

FOCUS ON FAILURES

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PROACTIVE STRATEGIES

TBRI includes two sets of Correcting (Shaping) strategies — the Proactive Strategies and the

Responsive Strategies (see p. 23); the Proactive Strategies include the “Life Value Terms” and

“Behavioral Scripts:”

LIFE VALUE TERMS, THE LANGUAGE OF A TRAUMA-INFORMED CULTURE, INCLUDE:

• “GENTLE AND KIND”

• “USING YOUR WORDS”

• “WHO’S THE BOSS?”

• “WITH PERMISSION AND SUPERVISION”

• “WITH RESPECT”

BEHAVIORAL SCRIPTS, THE ACTIONS OF A TRAUMA-INFORMED CULTURE, INCLUDE:

• CHOICES (“You have two choices”)

• COMPROMISES (“Would you like a compromise?”)

• BEHAVIORAL RE-DO’S (“Can you try that again with respect?”)


RESPONSIVE STRATEGIES

The Responsive Strategies are guides for responding to children and adolescents, especially

when their behavior is challenging; there are two strategies, the IDEAL Response© and Levels

of Response.

THE IDEAL RESPONSE© IS A GENERAL-PURPOSE GUIDE FOR INTERACTING WITH OTHERS

• IMMEDIATE (3 seconds or less)

• DIRECT (Engagement Strategies)

• EFFICIENT (Levels of Response)

• ACTION-BASED (Behavioral Scripts)

• LEVELED AT THE BEHAVIOR, and not the child

LEVELS OF RESPONSE complement the IDEAL Response©, and provide a framework for

matching adult responses to the child’s or adolescent’s behavioral and emotional challenge:

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In this presentation we focus on some therapeutic strategies that draw upon all of the TBRI principles—these strategies are good examples of how TBRI can be applied in therapeutic settings with parents and families.

FELT SAFTEY

The development of Felt Safety as well as Making

Sense of the Past are needed to bring healing to

children and families.

We achieve Felt Safety by applying Connecting,

Empowering, and Correcting Strategies in the

home and we assist children in developing an

understanding of the events that have occurred in

their lives by making sense of our child’s history.

We achieve an “Earned Secure” attachment state

of mind by making sense of our own histories.

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MAKING SENSE OF THE PAST

As parents we can help our children makes sense of their past by first making sense of our own past.

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ACTION HEALING RESULT

Making Sense of Our Own Past

Allows caregivers to move towards an “earned secure” attachment state of mind thus providing

caregivers with the insight, strength, and patience to provide a balance of nurture

and structure within the home.

Making Sense of OurChild’s Past

Allows for the healing needed to achieve the compassion and understanding necessary to support a child in understanding their history.

Helping Our Child Make Sense of Their Own Past

Allows for a child to heal by understanding and processing the details of what has occurred in their past. Eliminates any confusion the child is

experiencing.

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ONE ON ONE TIME

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Eye Contact

VOice Quality

Playful INteraction

MatchiNg Behavior

CharactEr Praise

TouCh

Eye ConTact

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PURPOSEFUL LEARNING ACTIVITIES FOR YOUNGSTERS

• The purpose of the PLAY Box is to help you and your family practice all the skills you have

learned. Practicing life skills when we are calm and having fun will help us automatically

recall what we have learned when caregivers and children are in the heat of the moment.

• Putting all the skills together and practicing is difficult to do. Often we read self-help books

and we think “I should do that” or “I am going to start doing that” but we always fall short.

We fall short because we have not figured out how to add the new habit to our schedule.

• The PLAY Box is designed to be out in a public place to hold you accountable. Playing the

games in the PLAY Box daily ensures you and your family are learning these valuable skills.

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One of the most important things we’ve learned as parents is the difference between being safe and feeling safe. For many years we thought that they were the same thing, but we have come to understand and live the difference. Our kids need us to create an environment of Felt Safety for them. It is an essential part of their healing.

CREATING AN ENVIRONMENT OF FELT SAFETY

IN ORDER TO CREATE AN ENVIRONMENT OF FELT SAFETY WE NEED TO:

• BE ACTIVE IN OUR OWN HEALING

• EXAMINE OUR LIVES AND START TO PROCESS OUR HURTS AND HANG-UPS

• REALIZE WHAT OUR TRIGGERS ARE

• OWN OUR STUFF

BUT THAT IS NOT ENOUGH. WE NEED TO PRACTICE MINDFULNESS IN:

• HOW WE SPEAK TO OUR KIDS

• OUR NON-VERBAL COMMUNICATION

• OUR EMOTIONAL HEALTH

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PARENT TRAINING

As participants in the Empowered to Connect

Parent Training you will be equipped with a

holistic understanding of your child’s needs and

development while empowering you with the

tools and strategies to effectively meet those

needs, build trust, and help your child heal and

grow.

Visit empoweredtoconnect.org for helpful

resources that you can use today and a map

showing Empowered to Connect Parent Trainers.

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HOW TO SET THE BAR

HISTORICAL BAR

• HISTORY OF NEGLECT, ABUSE, TRAUMA,

ORPHANAGE CARE

• IN UTERO EXPOSURE TO DRUGS/ALCOHOL

• SENSORY PROCESSING ISSUES

• FEARFULNESS

• MULTIPLE PLACEMENTS

CURRENT BAR

• FOOD

• WATER

• FATIGUE

• SENSORY OVERLOAD

• SENSORY NEEDS

• TRANSITION

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STRUCTURE OR NURTURE?

• TBRI has efficacy because of emphasis on

structure/nurture balance.

• The question is whether to lead with the

structure “foot” or the nurture “foot.”

• The alternate foot follows immediately or

there is no progress.

FIVE QUESTIONS TO ASK YOURSELF

• AM I CONNECTED?

• AM I EMPOWERING?

• AM I TEACHING PROACTIVELY?

• AM I CATCHING IT LOW (LEVEL 1)?

• DO I HAVE A PLAN FOR CALMING

ENGAGEMENT?

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ADVERSE CHILDHOOD EXPERIENCES (ACES) include a variety of stressful or traumatic experiences that put people at risk for a lifetime of poor health and mental health outcomes. An excellent source for information about ACEs is the website acestoohigh.org, where you can find and take the ACEs questionnaire yourself. There have been a number of scientific and medical publications based on the ACEs studies that demonstrate a strong correlation between ACEs and later health outcomes. A goodreview of this work has been written by Donna Jackson Nakazawa, in her book Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal (Atria Books, 2015). See also the Six Risk Factors. ATTACHMENT CYCLE refers to the cycle of distress and comfort that infants and children experience thousands of times during their young lives (for example, when an infant is hungry, and then is fed). The Attachment Cycle highlights all of the layers, biological and behavioral, that occur when children experience cycles of distress and comfort. For example, distress is accompanied by the release of epinephrine and the stress hormone cortisol, whereas parental comfort causes the child’s body to apply a cortisol brake and release the neurotransmitter serotonin. The attachment cycle conveys how experience programs the child’s brain, biology, and body so that she can self-regulate when stressed, and is the foundation for secure parent-child attachment (see Attachment Theory). ATTACHMENT THEORY is perhaps the single most important body of research and theory available for parents and the professionals who serve them. Attachment theory tells us how children (and adults) differ in the security of their relationships, what kinds of parenting predict secure (and insecure) attachment, and why secure attachment is so important for the developing person. Attachment theory is an important foundation for TBRI® (see below), and other effective interventions for children who experience Complex Trauma (see below). An excellent resource for information about attachment research, theory, and application is Robert Karen’s book, Becoming Attached: First Relationships and How They Shape Our Capacity to Love (Oxford University Press, 1998). BEHAVIORAL SCRIPTS include Choices, Compromises, and Re-Dos. Behavioral Scripts are part of the TBRI® Correcting Principles, and can be used in a wide variety of situations. It is best to practice them proactively, during the “good times,” so you can rely on them during the “hard times,” when you and/or your child are not so well regulated. There are lots of examples of Behavioral Scripts in the TBRI Pocket Guide and in the Trust-Based Parenting video (see child.tcu.edu). See also the Proactive Strategies. COMPLEX TRAUMA is a new diagnosis intended to replace the old diagnosis of “Reactive Attachment Disorder,” which is no longer considered valid by experts in relational trauma. “Complex Trauma” is said to be complex because of its complex origins, which most often occur in the context of an abusive or neglectful parent-child relationship, and because of its complex symptoms, as can be seen in the “Five B’s of Trauma.” A good source of information about Complex Trauma is the website www.nctsn.org/traumatypes/complex-trauma. An excellent review of research and clinical experience aboutcomplex trauma is the book written by Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (Penguin, 2015). See also Adverse Childhood Experiences and the Five B’s of Trauma.

GLOSSARY

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CONNECTING PRINCIPLES are TBRI® principles and strategies designed to promote felt safety,build connections, and teach self-regulation. The Connecting Principles include Mindful Awareness and the Engagement Strategies (see below). The Connecting Principles are grounded in Attachment Theory and the Attachment Cycle (see above), and are the essential core principles of TBRI.

CORRECTING PRINCIPLES are TBRI® principles and strategies designed to teach social skills and shape behavior. The Correcting Principles include Proactive Strategies and Responsive Strategies (see below). The Correcting Principles are the primary “tool box” of TBRI®, but the effective use of these powerful tools depends crucially on Connecting and Empowering.

ECOLOGICAL STRATEGIES focus on transitions, touchpoints, artifacts, and rituals. The Ecological Strategies are part of the TBRI® Empowering Principles (see below), and focus on managing the environment and daily schedules to optimize felt-safety, self-regulation, and social learning. One simple strategy is to help children cope with transitions by giving them warnings such as “We will clean up to go outside in five minutes.” EMPOWERING PRINCIPLES are TBRI® principles and strategies designed to provide a foundation for Connecting and Correcting (see above). There are two sets of Empowering strategies, the Ecological Strategies and the Physiological Strategies. Each set of strategies is designed to facilitate Connecting and Correcting, often by promoting the child’s sense of felt-safety, and scaffolding the child’s ability to self-regulate. ENGAGEMENT STRATEGIES include voice quality (tone, volume, cadence), eye contact (“soft eyes”), healthy touch, behavioral matching, and playful interaction. The Engagement Strategies are part of the TBRI® Connecting Principles (see above) and are a prescription for how to interact with children “who come from hard places.” It is important to realize that the Engagement Strategies emphasize nonverbal channels of communication, which are the most impactful with children and adolescents who have traumatic backgrounds. The Engagement Strategies are related to the “D” in the IDEAL Response© (see below). “FIVE B’S OF TRAUMA” is a mnemonic created by Dr. Karyn Purvis to remember the many ways that early trauma can impact children and adults. The Five B’s are “brain, body, behavior, beliefs, and biology.” For example, trauma impacts the brain by making the amygdala hypersensitive and hyper-reactive to physical and social cues, so that traumatized children tend to be chronically afraid, behaviorally over-reactive, and may believe that they are unworthy of love, and that even safe adults are “out to get them.” See also Complex Developmental Trauma. IDEAL RESPONSE© is part of the TBRI® Correcting Principles, and is an acronym for the best way to respond when challenged by the behavior of children or adolescents. The best adult responses are Immediate (within 3 seconds if possible), Direct (using the Engagement Strategies), Efficient (using the lowest possible Level of Response), Action-based (the child is actively involved, and is given a voice), Leveled at the Behavior, and not the Child (the child’s preciousness is never in doubt). LEVELS OF RESPONSE are part of the TBRI® Correcting Principles, and correspond to the “Efficient” in the IDEAL Response© - which means to keep your responding at the lowest level possible. The four Levels of Response are (1) Playful Engagement, (2) Structured Engagement, (3) Calming Engagement, and (4) Protective Engagement. Good sources for Levels of Response and the IDEAL Response© are The Connected Child: Bring Hope and Healing to Your Adoptive Family (McGraw-Hill, 2007) by Dr. Karyn Purvis and Dr. David Cross, and the the Trust-Based Parenting video (see child.tcu.edu).

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LIFE VALUE TERMS are part of the TBRI® Correcting Principles, and reflect the language and culture of trauma-informed caregiving. Life Value Terms include “Using Words,” “With Respect,” “Who’s the Boss?” and “Gentle and Kind.” Children from hard places may not have had the opportunity to learn a respectful and considerate way of speaking, and Life Value Terms can really help them learn to “use their words.” Using Life Value Terms, which are short, meaningful, and succinct, can help adults avoid long drawn-out lectures and rants. See also the Proactive Strategies. MINDFUL AWARENESS, part of the TBRI® Connecting Principles, includes awareness of the child’s emotional and mental state, awareness of one’s own emotional and mental state, and awareness of the overall situation. Important aspects of Mindful Awareness include a compassionate understanding of how your own relationship history might impact your parenting, and a compassionate understanding of how your child’s history (see Six Risk Factors, below) might be at the root of their challenging behaviors (see Five B’s of Trauma, above). PHYSIOLOGICAL STRATEGIES focus on physical activity, hydration, sensory experiences, adequate nutrition, and adequate sleep. The Physiological Strategies are part of the TBRI® Empowering Principles (see above), and focus on helping children manage their physiological states and processes. For example, we know from research that it is important to manage blood sugar levels, because when blood sugar drops, attention and other cognitive functions deteriorate. An excellent resource for some of the Physiological Strategies is the book Spark: The Revolutionary New Science of Exercise and the Brain (Little Brown, 2008), written by John J. Ratey. PROACTIVE STRATEGIES include the Life Value Terms and the Behavioral Scripts (see above). The Proactive Strategies are part of the TBRI® Correcting Principles (see above), and focus on practicing simple yet powerful phrases and scripts that replace lectures and punishments. One example of a Behavioral Script is the Re-Do, for example, when a child speaks to us in a sassy tone of voice, the adult can simply say, “Can you say that again with respect?” RESPONSIVE STRATEGIES include the IDEAL Response© and Levels of Response (see above). The Responsive Strategies are part of the TBRI® Correcting Principles (see above), and provide a template or structure for effective interactions with children, adolescents, or even other adults. Effective application of the TBRI® Responsive Strategies is closely linked to Mindful Awareness—the Responsive Strategies are like a tool kit, but the tools are no more effective than the mind of the person wielding the tools. For example, a core aspect of mindfulness is remaining calm, maintaining your balance—however, if you lose your composure, the tools will be useless. SIX RISK FACTORS include (1) prenatal risks such as drug exposure or a stressful pregnancy, (2) perinatal risks such as a difficult delivery, (3) postnatal risks such as NICU experiences or early hospitalization, (4) physical, emotional, or sexual abuse, (5) neglect, abandonment, or institutionalization, and (6) catastrophic events such as car accidents, fires, or natural disasters. An important lesson from this is that there are other ways than abuse for children and adolescents to be traumatized. See also Adverse Childhood Experiences and the Five B’s of Trauma. TRUST-BASED RELATIONAL INTERVENTION® (TBRI®) is an intervention created by Dr. Karyn Purvis and Dr. David Cross for children “who come from hard places.” Originally described in their best-selling book, The Connected Child: Bring Hope and Healing to Your Adoptive Family (McGraw-Hill, 2007), TBRI® consists of three complementary sets of principles: Connecting, Correcting, and Empowering (see above). TBRI® is attachment-based, trauma-informed, evidence-based, and whole-child. You can learn more about TBRI® and available resources by visiting the website of the Karyn Purvis Institute of Child Development, at child.tcu.edu.

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1 Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., Dube, S. R., and Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256:174– 186. 4 Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming Children and Youth, 17(3):17–21. 8 Cassidy, J. (2001). Truth, lies, and intimacy: An attachment perspective. Attachment and Human Development, 3(2):121–155. 9 Henry, J., Sloane, M., and Black-Pond, C. (2007). Neurobiology and neurodevelopmental impact of childhood traumatic stress and prenatal alcohol exposure. Language, Speech, and Hearing Services in Schools, 38:98–108. 6 Purvis, K. B., Cross, D. R., Dansereau, D. F., and Parris, S. R. (2013). Trust-based relational intervention (TBRI): a systemic approach to complex developmental trauma. Child & Youth Services, 34(4):360– 386. 2 Purvis, K. B., Cross, D. R., Federici, D. R., Johnson, D., and McKenzie, L. B. (2007a). The Hope Connection: A therapeutic summer camp for adopted and at-risk children with special socio-emotional needs. Adoption & Fostering, 31:38–48. 5 Purvis, K. B., Cross, D. R., and Lyons-Sunshine, W. (2007b). The Connected Child: Bring hope and healing to your adoptive family. McGraw- Hill, New York.

7 Rubin, P. B. and Tregay, J. (1989). Play with them—Theraplay groups in the classroom: A technique for professionals who work with children. Charles C Thomas, Springfield, IL.

6 Siegel, D. J. (2009). Mindful awareness, mindsight, and neural integration. The Humanistic Psychologist, 37(2):137–158.

REFERENCES

ACE QUESTIONNAIRE

What’s Your ACE Score? There are 10 types of childhood trauma measured in the ACE Study and each type of trauma counts as one. The most important thing to remember is that the ACE score is meant as a guideline. If you experienced other types of toxic stress over months or years, then those would likely increase your risk of health consequences. Prior to your 18th birthday: 1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?

No ___ If Yes, enter 1 __ 2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?

No ___ If Yes, enter 1 __ 3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?

No ___ If Yes, enter 1 __

4. Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?

No ___ If Yes, enter 1 __ 5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

No ___ If Yes, enter 1 __ 6. Were your parents ever separated or divorced?


7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?


8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

No ___ If Yes, enter 1 __ 9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

No ___ If Yes, enter 1 __ 10. Did a household member go to prison?


Now add up your “Yes” answers: ______ is your ACE Score.

This instrument and additional resources are available at acestoohigh.com.

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