FROM ACES TO ACTION: HOW UNDERSTANDING TRAUMA …Title: Collaborative Learning for Educational...

Copyright © 2016 WSU Child and Family Research Unit. All Rights Reserved

FROM ACES TO ACTION: HOW UNDERSTANDING

TRAUMA BUILDS RESILIENCEChristopher Blodgett, Ph.D.

Washington State University

2Copyright © 2019 WSU Child and Family Research Unit. All Rights Reserved.

Key concepts to cover today

Adversity early in life places normal development at risk

As many as one-in-three people in the general population.

Our workforce reflects the population but may have elevated risk of trauma histories.

Among vulnerable families, significant adversity histories approach being universal.

Emotional regulation is the core skill for being successful despite experiencing stress.

Human beings principally understand themselves through their relationships with others.

Focusing on the quality of relationship in every exchange improves the quality of our work.

Co-regulating with the people we serve is a skill to develop.

Every human exchange has the potential to support or drag down.

Recovery from trauma is about prospering and becoming more resilient. Ending distress is the necessary but not sufficient goal.

In your setting, what does building resilience look like?

Your most effective trauma response is how you are able to connect and redirect.


The Adverse Childhood Experiences (ACEs) study

ACE exposure ‘piles on’

Adults with four or more ACEs compared to adults with no ACEs

4 to 12 times increase in alcoholism, drug abuse, depression, and suicide attempt

2 to 4 times increase in poor self-rated health

3 to 4 times increase in chronic illness (heart disease, liver disease)

The ACE DOSE effect

4


Core brain development principles for change

Risk and protection is based in brain

development and function

Principle 1: Our brains are designed

to benefit from rich and supportive intimate social relationships.

Principle 2: Brain function is

hierarchical. We feel and then we

think.

Principle 3: Brain development is

‘use dependent.’

Principle 4: Brain systems change with use throughout life.


We know ACEs are established early in life with

resulting risk

• In more than 1,200

Spokane families

• 50% of parents and

25% of these 2-4-year-

old children already

experienced four or

more ACEs

• As children’s ACEs

increase, teachers’

assessments of school readiness and social

emotional

development

demonstrate the ‘ACE

dose’ effect.


1

2

3

4

5

6

7

Academic Failure Significant Attendance Concerns Serious School Behavior Concerns

No known ACEs (56%) 1 1 1

One ACE (22%) 1.6 2 2.4

Two ACEs (10%) 2.5 2.7 4.8

Three ACEs (5%) 3.1 4.5 4.8

Four or more ACEs (7%) 3.4 4.9 6.9

Od

ds

Stu

den

ts a

re A

t-R

isk

Increasing Odds of Student School Problems with Increasing ACEs

CAFRUA framework for response:

Complex trauma

8


Complex Trauma- A mental health

concept we can adapt to guide how we

respond

Toxic stress and biology

The ‘complex’ in complex trauma risk:

Early exposure at times of critical

development

Multiple risks

Unpredictable and persistent.

Who you love is who you may not be able

to count on.

Moving from the ‘what’ to ‘how’ as the framework

for action

9


Common triggers for children who have experienced

developmental trauma

Perception of a lack of power

Unexpected change/transitions

Feeling shame

Feeling vulnerable or frightened

Feeling threatened or attacked

Intimacy and Positive attention

Understanding Systems of Meaning

The Assumption of Danger

10


In the absence of sensitive and consistent responses from a caregiver a child will develop

their own strategies

Common need fulfillment strategies

Emotional/Relational needs

Emotionally Demanding behavior (whiny, interrupting, dramatic)

Seeking negative attention

Poor interpersonal boundaries

Attempt to control the environment “lying or manipulative”

Mastery

Physical Needs

Physical nurturance-seeking behavior (Sexualized behaviors, poor physical boundaries)

Hoarding or stealing food, clothing, objects

Need Fulfillment Strategies


Magic Wand: Three Research Based Strands:

Key Factors Common To All Competent

Children

Relationship

Regulation

Competency

12


Interrupt continuing trauma

Are we traumatizing?

Reduce and replace traumatic

responses

Focus on social emotional

competence

Build resilience

Components for recovery from complex trauma

13


The ARC Framework and core areas of work in

trauma recovery

14


Facing the painful reality of what has happened, and knowing that we can overcome it

Convey hope

Highlight and build on strengths

Acknowledge progress

Build social and emotional skills

Emotional regulation/tolerance for change

Relational skills

Executive function

Build organizational wellness and self-care practices

Resilience


Resilience and the brain:

Re-writing limbic activation

Resilience is increased by action

Re-learning to tolerate stress takes repetition and variation

Experiencing and withstanding

distress in a safe, supportive

environment reduces activation

Repeated experiences of tolerating

the fear response tied to positive

outcomes increases the activation

of regulatory processes when the

fear response is activated.

Proper sleep hygiene and exercise

increase neuroplasticity


Building Resiliency

Build

Relationships

Show

others

they can

depend

on safety

Build a

sense of

controlProvide

opportunities

to strengthen regulation

skillsModel

positive

stress

responses

Copyright © 2016 WSU Child and Family Research Unit. All Rights Reserved

Three examples of trauma

informed action


Use of routines

Routines- a sequence of actions regularly followed; a regular procedure rather

than for a special reason

Routines establish a rhythm to life which allows us to be freer in our choices.

Routines support efficiency, predictability and as a result reduce the need to be alert

and on guard.

Rituals build sense of shared community.

Institutional challenges in the use of routines-

An over-emphasis on the rules and procedural steps at the cost to interpersonal

contact and support.

Insufficient attention to establish routines that support regulation and insufficient

awareness of what disruptions in routines can mean for children and families.

Insufficient attention to the impact of the process on staff.


Triggers and needs-driven behavior

The intentional design of

routines manages triggers

Safety-seeking, relationship

needs, and mastery needs are

the most common drivers of

challenging behaviors

We miscue with people when

we respond to the behavior

rather than the need.

Routines help prevent and

recover from loss of self-

regulation,

Common triggers for children

who have experienced

developmental trauma

Perception of a lack of power

Unexpected change/transitions

Feeling shame

Feeling vulnerable or frightened

Feeling threatened or attacked

Intimacy and positive attention

Baseline

Inte

nsi

ty o

f In

tera

ctio

n

Time

Trigger

(the need

arises)

Internal

escalation

Behavior arises

(meeting the

need)

Staff feels loss

of control

Disengagement

Family withdraws

or complies

Staff intervenes

Behavior escalates

(further attempts to meet need)

Some amount of

external and

internal

de-escalation

Disengagement

provides

intervention

Baseline

Copyright © 2016 WSU Child and Family Research Unit. All Rights Reserved.


Attunement as the core relational skill

Attunement- the ability to communicate an accurate understanding of the internal state

of another person.

Be present and aware.

Non-judgmental in how you experience the other person.

Practical application of the skill:

Staff anticipate and prevent through predictable and relational practices.

Staff have strategies to de-escalate difficult emotions when they occur in your setting.

Identification and management of triggers.

The loss of safety and the assumption of danger, threats to relationship.

In the face of triggered distress:

Flight

Freeze/withdrawal

Fight


Mindfulness is

Learning to focus attention on moment-by-moment experience with

an attitude of curiosity, openness, and acceptance

Intentionally acting to be aware of internal state and external

events.

Staying focused in the moment but flexible in attending to both the

whole experience and specifics.

Suspending snap judgment by not focusing but by intentionally

expanding the range of your awareness without moving to action.

Mindfulness is about making choices with intention based on our

best understand of ourselves, the other people we are engaging,

and the resources available to us.


Connecting attunement and routines

While often uniquely individual challenges, we can use space and routine in activities to

help attune.

When we have common issues, we can develop our practice to minimize barriers to to

time and space that support attunement.

When working to improve interpersonal routines, attend to procedural flow and physical

space.

‘Attuned space’- reduce visual confusion, noise levels. Provide confidential space for

problem-solving, avoid public conflict.

‘Attuned processes’-

Welcoming practices.

Families and students are oriented to processes in plain language.

Steps in any process are consistent, predictable, and understandable.

Disruptions to routines are explained and disruption to the student and family minimized.


Secondary trauma

• Empathic engagement with survivors’ trauma material

• A sense of responsibility or commitment to help above your commitment as a professional- often rapid onset compared to the progressive nature of burnout.

Symptoms include

Increased negative arousal

Intrusive thoughts/images of another's critical experiences

Difficulty separating work from personal life, lowered frustration tolerance

Increased outbursts of anger or rage

Dread of working with certain individuals

depression, ineffective and/or self destructive self soothing behaviors

Hyper-vigilance

Isolation


Complex Relationships- Issues in different domains

lead to different adjustment paths(adapted from Stamm)

Professional

Qualityof Life

Compassion Fatigue

Compassion Satisfaction

Work Environment

The people Environment

Personal Environment

Traumatized by work

Secondary Exposure (

Primary Exposure

Frustration

Anger

Exhaustion Depressed by Work

Environment(Burnout)


Compassion Satisfaction

• The positive aspects of helping

– Pleasure and satisfaction derived from working in helping, care giving systems

• Built through experiences including

– Providing effective care

– Contributing to the success of the system you are part of

– Supportive and positive work with colleagues

– Confirming your sense of self and beliefs

– Experience the act of altruism as a reward.

Adapted from Stamm

A leadership function

Supportive work setting

Enhancing effective coping skills

Reinforcing experience and sense of

personal efficacy in difficult work

Creating strengthened sense of

purpose through connection with

colleagues and the opportunity to

do challenging but meaningful work


Closing

Thank you!

FROM ACES TO ACTION: HOW UNDERSTANDING TRAUMA …Title: Collaborative Learning for Educational...

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