Creating a Trauma Creating a Trauma Informed Learning Informed Learning

EnvironmentEnvironment

Presented by: Presented by:

Kym Asam, LICSW, QMHPKym Asam, LICSW, QMHP

ObjectivesObjectives

• Differentiate between PTSD and developmental traumaDifferentiate between PTSD and developmental trauma• Understand the impact of trauma on the brain utilizing Understand the impact of trauma on the brain utilizing

the Neuro-Sequential Model of Therapeutics (NMT)the Neuro-Sequential Model of Therapeutics (NMT)• Impact on students’ capacity to learnImpact on students’ capacity to learn• Brain regions and a tiered (PBiS) approach to interventionBrain regions and a tiered (PBiS) approach to intervention

• Understand the students’ states of arousal and how it Understand the students’ states of arousal and how it impacts their functioning in schoolimpacts their functioning in school

• Key skills in working with children who have experienced Key skills in working with children who have experienced developmental traumadevelopmental trauma• ARC and its intersect with a tiered approachARC and its intersect with a tiered approach

• AdultsAdults• StudentsStudents

Polling Question #1Polling Question #1

How many audience participants How many audience participants have had some training on have had some training on developmental or complex trauma?developmental or complex trauma?

Grounding PrinciplesGrounding Principles

Trauma-Sensitive Schools benefit all Trauma-Sensitive Schools benefit all children – those whose trauma children – those whose trauma

history is known, those whose trauma history is known, those whose trauma will never be clearly identified and will never be clearly identified and

those who may be impacted by their those who may be impacted by their traumatized classmates.traumatized classmates.

Schools are the Central Community for Schools are the Central Community for most children.most children.

DefinitionsDefinitions

What is trauma?What is trauma?

Trauma is not an event itself, but Trauma is not an event itself, but rather a response to a stressful rather a response to a stressful

experience in which a person’s ability experience in which a person’s ability to cope is dramatically undermined.to cope is dramatically undermined.

What is Developmental What is Developmental Trauma?Trauma?

• A psychological and neurobiological injury that A psychological and neurobiological injury that results from results from protractedprotracted exposure to stressful exposure to stressful eventsevents

• Derails typical development across all Derails typical development across all domains (neurological, psychological, domains (neurological, psychological, cognitive, social, self/identity)cognitive, social, self/identity)

• Experiences often occur in the caregiving Experiences often occur in the caregiving system. system.

• Impact is immediate and long termImpact is immediate and long term• Effects will require all tiers of interventionEffects will require all tiers of intervention

Sources of TraumaSources of Trauma

Sexual abuse Sexual abuse Physical abusePhysical abuse Emotional abuseEmotional abuse NeglectNeglect Domestic ViolenceDomestic Violence

Neighborhood violenceNeighborhood violence TortureTorture BullyingBullying Prolonged exposure to traumatic stressProlonged exposure to traumatic stress Intrauterine stressIntrauterine stress EpigeneticsEpigenetics

Toxic Stress PyramidToxic Stress Pyramid

Pervasiveness in childrenPervasiveness in children

Overall substantiated child maltreatment in 2011 = Overall substantiated child maltreatment in 2011 = approximately 681,000 (705 in Vermont)approximately 681,000 (705 in Vermont)

9.1% experienced sexual abuse (67% in Vermont)9.1% experienced sexual abuse (67% in Vermont) 17.6% experienced physical abuse (37.1% in Vermont)17.6% experienced physical abuse (37.1% in Vermont) 78.5% experienced neglect (2.6% in Vermont)78.5% experienced neglect (2.6% in Vermont) 48.6% were males48.6% were males 51.1% were females51.1% were females

Source = National Children’s Alliance and US Department of Health and Human Services, 2011 reportSource = National Children’s Alliance and US Department of Health and Human Services, 2011 report

Child Welfare League of AmericaChild Welfare League of America

The brain The brain develops from develops from

the the bottom upbottom up

Cortex

Limbic

Diencephalon

Brainstem

and the inside out

Early childhood synaptic Early childhood synaptic growthgrowth

Brain FunctionBrain Function

Cortex

Limbic

Diencephalon

Brainstem

Abstract ThoughtConcrete ThoughtAffiliation/RewardAttachmentSexual BehaviorEmotional ReactivityMotor RegulationArousalAppetite /SatietySleepBlood PressureHeart RateBody Temperature

Perry, B. 2006

Encourage Abstract Thought

Facilitate Socio-emotional Growth

Introduce Somato-Sensory Integration

Establish State Regulation

The still face experimentThe still face experiment

http://www.youtube.com/watch?http://www.youtube.com/watch?v=apzXGEbZht0v=apzXGEbZht0

Neuronal ConnectionsNeuronal Connections

http://www.youtube.com/watch?http://www.youtube.com/watch?v=8NA_o1jOjsQv=8NA_o1jOjsQ

Impact of Neglect on the Impact of Neglect on the BrainBrain

Stages of SleepStages of Sleep

Polling question #2Polling question #2

How many of you have students who How many of you have students who frequently go to the nurse?frequently go to the nurse?

Negative InteractionsNegative Interactions

Social experiences with caregivers become Social experiences with caregivers become biologically embeddedbiologically embedded

..

Effects of Trauma on Brain Effects of Trauma on Brain FunctioningFunctioning

Prefrontal Cortex(Integration and Planning)

Amygdala(Intensity/significance)

ThalamusVisual, auditory, olfactory,

kinesthetic, gustatory

Hippocampus(cognitive map)

Normative Danger ResponsesNormative Danger ResponsesAutonomic Nervous Response Autonomic Nervous Response

SystemSystem FightFight FlightFlight FreezeFreeze FlockFlock

Emotional IdentificationEmotional Identification

Facial Expression Facial Expression RecognitionRecognition

Arousal ContinuumArousal Continuum

State Calm Arousal, Attention

Alarm Fear Terror

Adaptive Response Rest Vigilance Freeze Fight Flight

RegulationBrain Region

NeocortexCortex

CortexLimbic

LimbicMidbrain

MidbrainBrainstem

BrainstemAutonomic

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

Typical path to reactionsTypical path to reactions

Express Route to Reactions!Express Route to Reactions!

Arousal and CognitionsArousal 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.

A child in a hyper-aroused state can not be reasoned with, she needs you to help her reduce her arousal level.

How to InterveneHow to Intervene

Somatosensory interventionsSomatosensory interventions Targeting the part of the brain that Targeting the part of the brain that

was impacted by developmental was impacted by developmental insultsinsults EVERY DAYEVERY DAY EVERY GRADEEVERY GRADE EVERY BODYEVERY BODY

Targeting the Tiers, PBiS Targeting the Tiers, PBiS approachesapproaches

Intensive

targeted

universal

Brain stem/diencephalon

limbic

cortex

Building up from the baseBuilding up from the base

Brainstem

Establish State Regulation -- IntensiveSchool 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 child’s 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.

Bruce Perry (2006)

Building up from the baseBuilding up from the base

Diencephalon

Introduce Somato-Sensory Integration – targeted, intensive 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)

Polling Question #3Polling Question #3

How many of you work with students How many of you work with students who receive targeted or intensive who receive targeted or intensive level of supports who struggle with level of supports who struggle with playing games or taking turns?playing games or taking turns?

Building up from the baseBuilding up from the base

Limbic

Facilitate Socio-emotional Growth – targeted

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)

Building up from the baseBuilding up from the base

CortexEncourage Abstract Thought – Universal

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)

Polling Question #4Polling Question #4

Who in webinar land is familiar with Who in webinar land is familiar with the the ARC model?ARC model?

Blaustein & Kinniburgh, 2010; Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005Kinniburgh & Blaustein, 2005

ARC Model - 10 Building ARC Model - 10 Building BlocksBlocks

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

Modulation

Executive Functioning

Self Dev’t & Identity

Affect Identification

Trauma Experience Integration

Affect Expression

Caregiver Affect Mgmt

Attunement Consistent Response

Routines and Rituals

Dev’tal Tasks

universal

targeted

intensive attachment

Self-regulation

competency

Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

4 Key Principles of 4 Key Principles of AttachmentAttachment

Build school staff Build school staff capacity to capacity to manage manage affectaffect

Build school staff-child Build school staff-child attunementattunement

Build Build consistencyconsistency in in school staff school staff responseresponse to child behaviorto child behavior

Build Build routinesroutines and and ritualsrituals into classroom into classroom and schooland school

Healthy Attachment Healthy Attachment SequenceSequence

Physical or psychological needPhysical or psychological need

Security, trust, attachment, self-

regulation, object constancy

State of high arousal

Attunement/satisfaction of need

Relaxation (parasympathetic ANS)

Beverly James

Unhealthy Attachment Unhealthy Attachment SequenceSequence

Physical or psychological needPhysical or psychological need

Shame, mistrust, disregulation,

disturbed mental blueprint

State of high arousal

Needs are disregarded/attunement

disrupted

Anxiety, rage, numbing

Beverly James

Affect ManagementAffect Management

When caregivers modulate their own When caregivers modulate their own affect and emotional responses, they affect and emotional responses, they

can create an emotionally safe can create an emotionally safe environment in which children a can environment in which children a can

learnlearn

AttunementAttunement

Caregivers accurately read cues to Caregivers accurately read cues to respond to underlying emotion rather respond to underlying emotion rather

than overt behavior. Behavior is than overt behavior. Behavior is usually a front for feeling that a child usually a front for feeling that a child

has difficulty expressing in a more has difficulty expressing in a more effective way.effective way.

AttunementAttunement

Communicating unmet needsCommunicating unmet needs

What is the function of the behavior?What is the function of the behavior?

Being a feelings detective!Being a feelings detective!

Consistent ResponseConsistent Response

Caregivers respond in a consistent way Caregivers respond in a consistent way to both positive (desired) and to both positive (desired) and negative/unsafe behaviors. negative/unsafe behaviors.

Predictability reduces the child’s need Predictability reduces the child’s need for control.for control.

Routines and RitualsRoutines and Rituals

Routines increases predictability and Routines increases predictability and the child’s ability to anticipate next the child’s ability to anticipate next steps. Establishing classroom and steps. Establishing classroom and school-wide routines helps reduce school-wide routines helps reduce

trouble spots (transitions, substitute trouble spots (transitions, substitute teachers, unstructured activities/days).teachers, unstructured activities/days).

SELF REGULATIONSELF REGULATION

Self-RegulationSelf-Regulation A Stepped Approach A Stepped Approach

Affect IdentificationAffect Identification

Affect ModulationAffect Modulation

Affect ExpressionAffect Expression

Islands of CompetenceIslands of Competence

““When the student is allowed to be successful in his When the student is allowed to be successful in his or her area of competence, the learning process can or her area of competence, the learning process can

begin to take hold and develop. Focusing on an begin to take hold and develop. Focusing on an island of competence should not be misunderstood island of competence should not be misunderstood as “dumbing-down” an activity or lesson; rather, it as “dumbing-down” an activity or lesson; rather, it is tailoring learning to a child’s interests in order to is tailoring learning to a child’s interests in order to achieve academic success. Not only does success achieve academic success. Not only does success bolster learning, but it is also central to developing bolster learning, but it is also central to developing a positive, trusting relationship with the student.”a positive, trusting relationship with the student.”

(From, “Helping the Traumatized Child Learn”)(From, “Helping the Traumatized Child Learn”)

CompetencyCompetency3 Key Principles3 Key Principles

Build student executive functioning Build student executive functioning skillsskills

Target self-development and identityTarget self-development and identity Target additional key developmental Target additional key developmental

taskstasks

The child develops an ability to evaluate situations, inhibit The child develops an ability to evaluate situations, inhibit impulsive responses and actively make choices. impulsive responses and actively make choices.

Jessica

http://www.youtube.com/watch?v=qR3rK0kZFkg

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 don’t operate with a template that

understands the common good.

Competing Demands Survival vs. learning

It is nearly impossible to dedicate your full attention and energy to survival and learning at the same time.

The Healthy Mind PlatterThe Healthy Mind Platter

Physical timePhysical time Sleep timeSleep time Focus timeFocus time Time in (flossing your brain)Time in (flossing your brain) Down timeDown time Plan timePlan time Connecting timeConnecting time

The Whole Brain Child, Dan Siegal

Keys to Successful InterventionKeys to Successful Intervention

The 6 R’sThe 6 R’s Relevant (developmentally matched)Relevant (developmentally matched) Repetitive (patterned)Repetitive (patterned) Rewarding (pleasurable)Rewarding (pleasurable) Relational (safe)Relational (safe) Rhythmic (resonant with neural Rhythmic (resonant with neural

patterns)patterns) Respectful (child, family, culture)Respectful (child, family, culture)

Relevent LinksRelevent Links

http:/studentsfirst.orghttp:/studentsfirst.org http:/howardcenter.orghttp:/howardcenter.org http://www.nctsn.org/http://www.nctsn.org/ http://mentalhealth.vermont.gov/http://mentalhealth.vermont.gov/ http://healthvermont.gov/http://healthvermont.gov/ http://www.ptophelp.org/http://www.ptophelp.org/

Questions?????Questions?????