understanding complex trauma: strengthening supporting learning environments through a trauma...
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Understanding Complex Trauma: Strengthening Supporting Learning
Environments through a Trauma Sensitive Lens
CLEARCollaborative Learning for Educational Achievement and
Resiliency January 11th, 2012
Copyright 2011 WSU Area Health Education Center
Complex TraumaThe exposure to continuous trauma in childhoodBoth the being exposed to and having to adjust
to this constant stressBegins early in lifeOccurs during most important time of
developmentChildren must be ready to react to the
environment which takes energy away from healthy development
UnpredictableChronicOften occurs in episodes
Trauma As A Fact Of LifeIn one large study, 90% of respondents
reported at least one lifetime traumatic event with the average number of 4.8 traumatic events in their lives (Breslau et al., 1999)
Reports of adverse events in childhood predict risk of◦ Lifetime physical health problems◦ Mental health problems◦ Health risk behaviors◦ Subsequent intimate partner victimization
Remember, the outcomes of trauma are not written in stone. Resilience, healthy relationship, and intervention can increase a child’s chance of success significantly Copyright 2011 WSU Area Health
Education Center
Copyright 2011 WSU Area Health Education Center
Copyright 2011 WSU Area Health Education Center
“Children are like wet cement. Whatever falls on
them makes an impression."
– Hiam Ginott
Copyright 2011 WSU Area Health Education Center
4 universal brain principles
1. Our brains are designed to benefit from rich and supportive intimate social relationships.
2. Brain function must occur in a certain order. We feel and then we think.
3. Brain systems change with use throughout life.
4. Persistent stress is toxic to the brain.◦ What we don’t use as our brain is
developing, we lose.
Copyright 2011 WSU Area Health Education Center
The brain cannot mature when it must respond to persistent threat
• The brain must focus on survival rather than normal development
• Can lead to delays in language and reasoning
• Can lead to difficulty with learning because of always looking for danger
• Trouble connecting reason with feelings• Many of the “human” brain functions like
reason and impulse control get lost because these brain functions are “use it or lose it”
Copyright 2011 WSU Area Health Education Center
Threat Appraisal and Detection in Traumatized Children
Implications Of Trauma On Biological Threat Response System
If we are using our trauma lens, we see that behavior is biological because it is filling a need. All behavior is functional. This means that when we look at the behavior in a child or adult, blame has no place.
Understanding the biological risks points to some of the actions we can take as caring adults
Copyright 2011 WSU Area Health Education Center
Copyright 2011 WSU Area Health Education Center
Labels we often give trauma-affected kidsLazyManipulativeAntisocialDefiantRebelliousUninterestedOppositionalLiar
ADHDUncaringOthers?
Copyright 2011 WSU Area Health Education Center
Overall Trauma Impact on Development Difficulty understanding
what they feel and how to cope with it
Difficulty expressing what they feel
Difficulty understanding the link between behavior, feelings, and experience
Difficulty maintaining comfortable arousal
Feel like they can’t impact their world
Difficulty planning, problem-solving, organizing information, and delaying response to stimuli.
Believe they are not capable or competent
Negative self-concept Blame themselves for not
succeeding Difficulty reading social cues Overly rigid or too diffuse
boundaries Lack of trust or over-
dependent on others Difficulty sustaining
attention and concentration And more
Implementation Science and Innovation Success
Social ,Political,
Fiscal
AdministrativeSupport, Program
EvaluationTraining, Coaching,
CQI, Support
Knowledge, Skills Building,
Relevance
Copyright 2011 WSU Area Health Education Center
Odds for Academic and Health Problems with Increasing ACEs
Academic Failure
Severe Attendance Problems
Severe School
Behavior Concerns
Frequent Reported
Poor Health
Three or More ACEs N =248
3 5 6 4
Two ACEsN=213
2.5 2.5 4 2.5
One ACEN=476
1.5 2 2.5 2
No Known ACEs =1,164
1.0 1.0 1.0 1.0
Copyright 2011 WSU Area Health Education Center
Odds Ratios for School and Behavioral Problems with Increasing ACEs in the RTL Population
Academic Failure*
Poor Attendance
School Behavior
Behavioral Health
Problems
Four or More ACES N=663 2.0 5.3 3.1 6.5
Three ACEs N=756 1 3.0 1.5 2.0
Two ACEs N=1,141 1 2.5 1.6 1.8
One ACE N=1,612 1 1.6 1.2 1.2
No Reported ACES N=1,020 --- 1 1 1
Copyright 2011 WSU Area Health Education Center
How do ACEs affect student performance?
No Reported ACEs N=578
One ACE N=800
Two ACEs N=537
Three ACEs N=409
Four or More ACEs N=383
Per-cent Initial Atten-dance K-12
0.912055133570518
0.901097482710267
0.880869735683679
0.875710656761504
0.847345306913891
81%
83%
85%
87%
89%
91%
93%
95%
97%
99%
ACEs and Percent Initial Attendance in Grades K-12
Mean I
nit
ial P
erc
ent
Att
endance
The ARC Model
Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005
Attachment
Self-
Regulation
Competency
Caregiver Affect Mgmt.
Attunement Consistent Response
Routines and
Rituals
Affect Identification
Modulation Affect Expression
Dev’tal Tasks
Executive Functions
Self Dev’t & Identity
Trauma Experience Integration
Copyright 2011 WSU Area Health Education Center
The 3-part model
What a child has come to
understand is dangerous
Will lead to a physical and/or
behavioral response that tries to fill a
need and find safety
Thus forcing the child to put energy into survival rather
than healthy development,
leaving them with developmental
deficits
How do I ‘do’ ARC?
Not a ‘recipe’- more of an artChanges to meet the needs of
individual childrenDoesn’t just target an outcome,
targets an understanding of “why”
Evaluation of a child’s needs must be on-going as needs may change
Attachment
Caregiver affect management- Keep Calm and Carry On
Attunement- Accurately read another’s cues and respond appropriately
Consistent Response- If you do A, I will do B
Routines and rituals- Provide a predictable sequence of events
Self-RegulationAffect Identification- The
ability to identify an emotion and tell it apart from other emotions
Modulation- The ability to maintain a comfortable, appropriate level of arousal
Affect Expression- The ability to share emotional experience with others and with self in a safe and healthy way
CompetencyExecutive functions- Learning to act
with thoughtfulness as opposed to reacting based solely on emotion and arousal
Self Development/Identity- Coming to know the intricacies of oneself in an accepting way, especially as it pertains toward personal growth
Trauma Integration- Finding ways the self is fragmented, identifying how to make a conscious choice, and processing specific events
Caregiver Affect Management
The main idea: Support staff in understanding, managing, and coping with their own emotional responses, so that they are better able to support the children in their class
Before a caregiver can help a child manage emotional experiences, the caregiver must manage their own emotional experiences
Foundational skill of the ARC model
Caregiver affect management directly impacts a child’s experience of environment
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents
The main idea: Support staff in learning to accurately and empathically understand and respond to children’s actions, communications, needs, and feelings
Attunement is the capacity to accurately read the emotional, cognitive, behavioral, and physiological cues of another that are both verbal and non-verbal and respond appropriately
Children who have experienced complex trauma often lack the skills to easily identify and communicate what they are feeling and cope with difficult emotions
How do we interpret the meaning behind behavior? Look pass the top of the iceberg and respond to what is underneath
Identifying student’s triggers and danger response
Reflective listening skills
Attunement
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents
Consistent Caregiver Response
The main idea: Support staff in building predictable, safe, and appropriate responses to children’s behavior in a manner that acknowledges and is sensitive to the role of past experiences in current behavior
Predictability builds sense of safety in environment
Limit setting as potential trigger for feeling powerless
Predictability over time allows children to relax vigilance and control and put their energy into normal development
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents
Routines and Rituals The main idea: Support
staff in building routine and rhythm into the daily lives of children and families
Again! Predictability builds sense of safety
Routine vs. ritual Target building routine
particularly around areas of vulnerability
Transitions can be especially difficult
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents
Affect Identification
The main idea: Work with children to build an awareness of internal experience, the ability to discriminate and name emotional states, and an understanding of why these states originate
Children who have experienced poor caretaking and poor emotional support may have never developed healthy ways to identify what they are feeling
Limited skill set may be easily overwhelmed by state of arousal
Children may miscue others as a way of protecting themselves from emotions that feel unsafe
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents
The main idea: Work with children to develop safe and effective strategies to manage and regulate physiological and emotional experience, in service of maintaining a comfortable state of arousal
“Children who experience unresponsive, inconsistent, or abusive caretaking may fail to develop healthy age-appropriate skills and instead must rely on primitive regulation strategies.”
Young children rely on their caregivers to
modulate for them, thus helping develop these skills
These strategies may include:◦ Failure to regulate
◦ Over-regulating/constricting
Children who can’t modulate may compensate by◦ Over-controlling or
shutting off emotional experience
◦ Manage emotional experience with physical stimulation
◦ Turning to external methods to alter or control physiological experience.
Modulation
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents
Affect Expression
The main idea: Help children build the skills and tolerance for effectively sharing emotional experience with others.
The ability to effectively communicate feeling is directly related to the ability to build relationship and master important developmental tasks.
When children’s emotional environment is rejecting, angry, or indifferent, they often learn their emotions are shameful and should be kept hidden.
Hiding emotions may help children who have experienced complex trauma feel more in control and able to navigate feeling unsafe.
Trauma may impact affect expression in children by:◦ Failure to share emotions◦ Emotions emerging in
unhealthy ways◦ Communicating
emotions ineffectively◦ Over-communication
Strengthen Executive Functions The main idea: Work with
children to act, instead of react, by using higher-order cognitive processes to solve problems and make active choices in the service of reaching identified goals
Include impulse control, purposeful decisions, considering consequences, understanding outcomes, problem-solving, etc.
Executive functions are sacrificed in developing individuals who are trauma affected. Instead, the danger response is activated
The development of executive functions can:◦ Serve as a way to modulate
intense arousal
◦ Provide a sense of control and ability to impact the world
◦ Bring conscious thought to actions
◦ Increase likelihood of developing high resilience
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents
Self-Development and Identity The main idea: Support
children in exploring and building an understanding of self and personal identity, including identification of unique and positive qualities, development of a sense of coherence across time, and support in the capacity to imagine and work toward a range of future possibilities
“Children who are routinely rejected, harmed, or ignored internalize an understanding of self as unlovable, unworthy, helpless, or damaged.”
Self development includes:◦ understanding self as separate
from others
◦ understanding of preferences and values
◦ identifying personal traits
◦ is an on-going process throughout life
State-dependent self-concepts may develop, where children feel their identity changes with their experience in the moment
Focusing on the immediate moment limits a child’s perception of self to what is rather than what could be
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents
Trauma Experience Integration The main idea: Work with children to actively
explore, process, and integrate historical experiences into a coherent and comprehensive understanding of self in order to enhance their capacity to effectively engage in present life
The ultimate goal for trauma affected individuals is to “build [capacity] to harness internal and external resources in service of effective and fulfilling navigation of their life, across domains of functioning, as they define and meet self-identified personal goals.”
2 ways: ◦ Integration of themes of fragments of self and the
associated early experience◦ Process specific events
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in Children and Adolescents
“The world breaks everyone and afterwards many are strong at the broken places.”
~ Ernest Hemingway
Copyright 2011 WSU Area Health Education Center
Some Do’s and Don’ts of Having a Trauma Sensitive LensDo
◦ Notice your tone, body language, and word choice
◦ Paraphrase before you correct
◦ Be consistent◦ Remember that behavior
comes from need◦ Practice calming yourself
before you respond◦ Respond to every child as if
there’s a possibility they’ve experienced trauma
◦ Praise efforts not character◦ Remember that every
interaction you have with a child tells them something, either positive or negative, about who they are
Don’t◦ Panic◦ Yell, grab, or intimidate◦ Feel like you have to ‘fix’ a
child’s trauma if they share with you
◦ Sum up the child’s character with a negative label
◦ Feel like you have to do it perfectly- being trauma sensitive takes practice and patience
◦ Blame, either the parents or the kid- Everyone is doing the best they can to cope all the time
◦ Mistake “Won’t” for “Can’t”
◦ Think you have to like every kid
Copyright 2011 WSU Area Health Education Center
Copyright 2011 WSU Area Health Education Center
What traumatized kids need…
Predictability◦ Routines◦ Consistent response from their caregiver
Understanding◦ Caregiver works to learn child’s triggers and sense them when they’re
going to happen Emotional coaching
◦ Help understanding when they’re feeling something◦ Help with calming their body down or energizing it◦ Help expressing feelings in a safe way
Patience Expectations Praise that focuses on their specific action rather than
character A chance to talk about what they’ve experienced A safe haven and a secure base
Copyright 2011 WSU Area Health Education Center
Things to ponder…How are you already using a trauma
sensitive lens and be curious about each of your families in your professional role?
What are the costs of having a trauma sensitive lens in your role?
What are the benefits of having a trauma sensitive lens in your role?
What are other things you’d like to try that would support being trauma sensitive in your organization?
Copyright 2011 WSU Area Health Education Center
If you’d like more informationwww.nctsn.orghttp://www.traumacenter.org/
research/ascot.phphttp://extension.wsu.edu/ahec/
trauma/Pages/ComplexTrauma.aspx
“Brain Rules” by John Medina“Helping Traumatized Children
Learn” report and policy agenda by the Massachusetts Advocates for Children