Young Lives TodayYoung Lives Today

ScotlandScotland

1414thth March 2006 March 2006

Richard Cross (Operations Manager), CareVisions Group Ltd

UKCP registered Psychotherapist Author of ‘Invitation to Change’ - therapeutic interventions for Anti Social Youth (New Zealand

Corrections Dept)

e-mail: info@carevisions.co.uk telephone: 08700 428889

Outline of Presentation

• Why Look at the effects of trauma?

• What are the affects?

• What can we do to help?

• What if we do nothing?

• Conclusion.

Indications of the Problem…Indications of the Problem…Child Protection RegistersChild Protection Registers

• YEAR ENDED 31 MARCH 2002: 2,018 Children (0-15 yrs / 2.1 per 1000)(Scottish Executive),

• Year ended 31st March 2001: 26,840 – England, 2,126 – Wales, 1,414 – Northern Ireland (Department of Heath)

Trauma & DissociationTrauma & Dissociation

• Trauma can be understood to mean a profound emotional shock (Oxford Dictionary 1992)

• Dissociation = disruptions in the integration of memories, perception, and identity into a coherent sense of self, and may develop following childhood maltreatment. (see Marlene Steinberg (2001) ‘The Stranger in the Mirror’ Dissociation

the Hidden Epidemic)

Why Study Trauma?Why Study Trauma?

Numerous studies link trauma and criminal behaviour.• Mann (1995) – Found 74% of a small sample of

adolescents offenders held with secure conditions were experiencing symptoms consistent with PTSD.

• Boswell (1995) - Amongst those committing the most serious of crimes, over 90% experienced childhood trauma in the form of abuse and/or loss and frequently both.

Why Study Trauma?Why Study Trauma?

• Burgess et al (1987) - found a link between sexual abuse and the occurrence of drug abuse, juvenile delinquency and criminal behaviour a few years later.

• Dissociation may mediate the ‘cycle of violence’ – research indicates pathological dissociation in adolescent offenders 14.3 – 28.3 % (Moskowitz, 2004)

Trauma Symptoms and Trauma Symptoms and Conduct DisorderConduct Disorder

• AggressionAggression• ImpulsivityImpulsivity• Impaired empathyImpaired empathy• AngerAnger• Disregard for the Disregard for the

futurefuture

• Substance abuseSubstance abuse• Risk-seeking Risk-seeking

behaviourbehaviour• ReactivityReactivity

We need to look beneath We need to look beneath the behaviour?the behaviour?

The MechanismThe Mechanism

•Belief system Belief system

•Behavioural re-enactment Behavioural re-enactment

•Other mental health problemsOther mental health problems

•Developmental impactDevelopmental impact

•Physiological responsePhysiological response

•(Mal)adaptive coping strategies(Mal)adaptive coping strategies

Response to sexual traumaResponse to sexual traumaRe-enactmentRe-enactment

Visualisation

Flashbacks

Triggering of memories

Inappropriate sexual activities

HyperarousalHyperarousal

Startle

Nightmare & Sleep difficulties

Irritability

Distractibility

AvoidanceAvoidance

People / places

Things that remind of abuse

Dissociation

How children are affected by How children are affected by trauma: Belief systemtrauma: Belief system

Sense of trust and safety are Sense of trust and safety are undermined:undermined:

• I am not safe. • The world is a dangerous

and a scary place. • I have to fight and be

strong to keep myself safe.

Provide an environment that Provide an environment that feels safe:feels safe:

• I am safe here. • Adults will keep me safe

here. I can learn how to keep myself safe.

• I must not do things to make others feel unsafe, and others must not do things to make me feel unsafe either.

Behavioural Re-enactmentBehavioural Re-enactment• Young people can expose themselves, Young people can expose themselves,

seemingly compulsively, to situations seemingly compulsively, to situations reminiscent of the original trauma.reminiscent of the original trauma.

• In behavioural re-enactment of the trauma, In behavioural re-enactment of the trauma, the self may play the role of : the self may play the role of : victim/perpetrator/rescuer. victim/perpetrator/rescuer.

• Three key ways: Harm to Others; Self-Three key ways: Harm to Others; Self-destructiveness; Re-victimization. destructiveness; Re-victimization.

• Children seem more vulnerable than adults to Children seem more vulnerable than adults to compulsive behavioural repetition and loss of compulsive behavioural repetition and loss of conscious memory of the trauma.conscious memory of the trauma.

Drug use – self medicationDrug use – self medication

- Young people Young people may attempt to may attempt to

deal with deal with symptoms symptoms

associated with associated with trauma through trauma through self medicating self medicating

behaviour.behaviour.

Developmental ImpactDevelopmental Impact

• Survivors of childhood trauma can have mild to Survivors of childhood trauma can have mild to severe deficits in being able to:severe deficits in being able to:– self-soothingself-soothing– seeing the world as a safe placeseeing the world as a safe place– trusting others trusting others – organized thinking for decision-makingorganized thinking for decision-making– avoiding exploitationavoiding exploitation

Physiological ResponsePhysiological Response

• The normal physiological responses to extreme The normal physiological responses to extreme stress lead to states of physiological stress lead to states of physiological hyper hyper arousalarousal and and anxietyanxiety..

• When this happens repeatedly, our bodies learn When this happens repeatedly, our bodies learn to live in a constant state of to live in a constant state of ““readiness for warreadiness for war””::– Poor impulse control Poor impulse control – scanningscanning– aggression aggression – distrustdistrust

(Mal)adaptive Coping(Mal)adaptive Coping StrategiesStrategies

• It is useful to think of all trauma "symptoms" It is useful to think of all trauma "symptoms" as adaptations. These symptoms represent as adaptations. These symptoms represent the childs attempt to cope the childs attempt to cope the best way they the best way they couldcould with overwhelming feelings and with overwhelming feelings and events. events.

• They have been used to shield and defend They have been used to shield and defend themselves as much as possible from harm themselves as much as possible from harm at the time of the abuse, e.g. at the time of the abuse, e.g. hyper vigilance, hyper vigilance, dissociation, avoidance and numbing.dissociation, avoidance and numbing.

Fear

DetachmentDisintegration

Avoidance

Safety

Containment

Attachment

Openness…..

What can we do?What can we do?

•Safety Safety

•ContainmentContainment

•AttachmentAttachment

AssessmentAssessment

e.g. Trauma Symptom e.g. Trauma Symptom Child Checklist Child Checklist

(Briere)(Briere)

Nurturing safe

Environment

Therapeutic Parenting

Team

FoundationFoundation

Openness….Communication….Predictability…. Integrated workingOpenness….Communication….Predictability…. Integrated working

‘‘Potential Space’Potential Space’

For recoveryFor recovery

Formal TherapyFormal Therapy

Safety & Stabilisation Safety & Stabilisation •Be warm, empathic and understandingBe warm, empathic and understanding•BE NURTURING, COMFORTING AND BE NURTURING, COMFORTING AND AFFECTIONATE, AFFECTIONATE, BUTBUT BE SURE THAT THIS IS IN BE SURE THAT THIS IS IN AN APPROPRIATE 'CONTEXT‘,AN APPROPRIATE 'CONTEXT‘,•Avoid exploring the trauma until: The young Avoid exploring the trauma until: The young person is safe and risk has been minimised as person is safe and risk has been minimised as to possibility of further exposure.to possibility of further exposure.

•Help the young person develop the skills to Help the young person develop the skills to manage the emotions and symptoms arising manage the emotions and symptoms arising from the trauma.from the trauma.•The relationship and the nature of the The relationship and the nature of the environment can “hold” the young person on environment can “hold” the young person on their process of recovery.their process of recovery.

What can we do cont?What can we do cont?

• PROVIDE A CONSISTENT, PREDICTABLE PROVIDE A CONSISTENT, PREDICTABLE PATTERN FOR THE DAY,PATTERN FOR THE DAY,

• WATCH CLOSELY FOR SIGNS OF:WATCH CLOSELY FOR SIGNS OF:

1.1. RE-ENACTMENT (e.g., in play, drawing, RE-ENACTMENT (e.g., in play, drawing, behaviours), behaviours),

2.2. AVOIDANCE (e.g., being withdrawn, AVOIDANCE (e.g., being withdrawn, daydreaming, avoiding other children) daydreaming, avoiding other children)

3.3. HYPER REACTIVITY (e.g., anxiety, sleep HYPER REACTIVITY (e.g., anxiety, sleep problems, behavioural impulsivity)problems, behavioural impulsivity)

Using Drawing – with high risk Using Drawing – with high risk adolescentsadolescents

• Simple is best,

• Let young person create own symbols,

• Remember safety must be in place first,

• Young person has developed self care strategies,

• Remember, at times process might need to return to stabilisation phase.

What was happening around me

What was I thinking

What was I feeling?

6/10

If I don’t hit him first he will hit me!

Walking down street and see ‘Joe… who I don’t like.

He is laughing at me.

If we do nothing…… the Legacy?If we do nothing…… the Legacy?

• Increase in distress

•Higher Criminal Justice costs.

•We will be letting our children down

•We won’t be doing everything we can to stop victimisation,

•Higher society costs (Mental health, Health, social services).

•What might lay ahead for the ‘children of the children’.

Trauma and High Risk Trauma and High Risk Behaviour - SummaryBehaviour - Summary

• Trauma / dissociation regularly features in the lives of young people who are offending,

• Trauma can have a significant impact on young people and may link to offending behaviour.

• We can break the ‘cycle’… There are effective treatments for trauma and it’s effects – treat it.

The Future can be differentThe Future can be different