Trauma, Children, Families, Service

Systems

Chris Bray, Ph.D, M.A. LPPatty Ostberg- Speiker M.A.

The Institute for Translational Research in Children’s Mental Health

University of Minnesota

Introduction

The Institute for Translational Research in Children’s Mental Health UMN: To reduce the vast gap between research and practice

Ambit Network UMN: To improve access to quality care for traumatized children, families, communities

Agenda

Trauma-Informed PracticeAwareness Building

• Stress and the developing brain

• The impact of traumatic stress on behavior

Skill Building

• Screening, assessment, intervention

• Strategies to promote resilience and healing for caregivers and system providers

Disclaimers

This one hour presentationis an appetizer not a full course meal. We hope it makes you hungry for more

Central Questions

• What is a trauma lens?

• What does it mean to see a child through a trauma lens?

Trauma-Informed Practice

A philosophy

Moving from “What’s wrong with you?”to

“What’s happened to you?”

Not an intervention to address PTSD

Trauma-informed Practice Values

PHYSICAL & PSYCHOLOGY SAFETY TRUST

CHOICEEMPOWERMENT

COLLABORATION

Awareness/Knowledge Building

Know trauma h

istory

Understan

d

traumatic

stress

Understand trauma’simpact

Understand victimization

Help survivors heal

Skill Building

Has youth been screened?

Are caregivers knowledgeable?

Do your colleagues understand trauma?

Do you coordinate case plans?

Three Levels Of Stress

National Science Council on the Developing Child

Chowchilla California 1976

Terr, Lenore. 1985. Too Scared to Cry.

Adverse Childhood Experiences Study

Dr. Felitti – Kaiser Permanente Dr. Anda – Center for Disease Control and Prevention

Research On Psychological Trauma

Over 40 years of research• Lenore Terr. (1985). Too Scared to Cry

• Judith Lewis Herman. (1997). Trauma and Recovery

• ACE Study (1998)

Increasingly sophisticated• Are there underlying genetic mechanisms

that influence children’s responses totraumatic events (e.g. Caspi & Moffitt, Cicchetti)

• Epigenetics

The truth about childhood is stored up in our bodies and lives in the depths of our souls. Our intellect can be deceived, our feelings can be numbed and manipulated, our perceptions shamed and confused, our bodies tricked with medication, but our soul never forgets. And because we are one, one whole soul in one body, someday our body will present its bill. Alice Miller

Traumatic Stress

Child Traumatic Stress

• Physical & emotional responses to events threatening the “life or physical integrity” of a child or someone critically important to the child (e.g. parent/sibling)

• Traumatic events overwhelm an individual’s capacity to cope: create feelings of terror, powerlessness, & intense physiological arousal

NCTSN Child Welfare Trauma Training Toolkit

The 3 E’s= Child Traumatic Stress

The experience of an event by a child that is emotionally painful or distressful which often results in lasting mental and physical effects*

• Event

• Experience

• Effects

*National Institute of Mental Health

Traumatic Events (Exposures)

• Natural Disaster

• War/Terror

• Grief and Loss

• Accident/Illness

• Physical, Emotional, Sexual Abuse

• Witnessing Domestic Violence

• Neglect

• Removal from the home

• Historical Trauma

Traumatic Experiences

Traumatic Effects (Symptoms)

• Nightmares

• Flashbacks

• Intrusive thoughts

• Trauma triggers/reminders

• Feeling isolated

• Inability to recall key features of the trauma

• Hyperarousal

• Hypervigilance

The Brain: Why Do They Act Like They Do?

Five Core Concepts Of Brain Development

1. Experience shapes the architecture of the brain

2. Neural circuits are wired in a bottom up sequence

3. Neurodevelopment requires stimulation

4. Brains and skills are shaped by the “Serve and Return” nature of human interaction

5. Cognitive, emotional and social capacities are inextricably intertwined within the architecture of the brain

National Science Council on the Developing Child

Development’s Missing Stairs

When children endure multiple traumatic events over long

periods of time they are especially likely to have multiple gaps in their

development.

Experience Shapes the Brain

Synapses and Pruning

Experience Shapes the Brain

Limbic System

• Houses emotional life

• Supports hormonal system, emotion, behavior motivation, and formation of memories

• Collection of structures that includes the hypothalamus and hippocampus

We Learn By Experience

We Learn By Experience

How the Body Responds to Danger

Hypothalamus

Release of adrenaline and cortisol

Heart rate and blood pressure increase

Breathing rate increases

Hippocampus

Trauma Brain

31

– On constant alert for danger

– Quick to react to threats (fight, flight, freeze)

Exposure to trauma causes the brain to develop in a way that will help the person survive in a dangerous world:

Source: Teicher., M. H. (2002). Scars that won't heal: The neurobiology of child abuse. Scientific American, 286 (3),68-75.

Skill Building

Has youth been screened?

Are caregivers knowledgeable?

Do your colleagues understand trauma?

Do you coordinate case plans?

What You Can DoIndividual Level: Trauma Screening

What You Can Do: Referral

Make referrals to practitioners who use evidence-based interventions

Information In Presentation

• Dr. Abigail Gerwitz, Ph.D., L.P., Project Director for Center for Resilient Families, Institute for Translational Research in Children’s Mental Health

• Levine, P. A., & Kline, M. (2008). Trauma-proofing your kids: A parents guide for instilling confidence, joy and resilience. Berkeley, CA: North Atlantic Books.

• Siegel, D. J., & Bryson, T. P. (2012). The whole-brain child: 12 revolutionary strategies to nurture your child's developing mind. Brunswick, Vic.: Scribe Publications.

Why be Concerned with Trauma and Posttraumatic Stress in Parents, Caregivers, or Service Systems Professionals?

Associations between adult trauma and:– Child distress and child PTSD– Parenting/caregiving impairments

Ø How might caregivers respond differently to other adults (e.g. service providers) when they are dealing with traumatic stress?

Ø And most important, how might they deal differently with children?

Traumatized Caregivers May Be:

– Suffering from PTSD and related disorders (e.g., depression, anxiety)

– Using drugs to mask the pain

– Disempowered

– Parents of children who have become “parentified” (i.e. responsible beyond their years)

Traumatized Parents May Effect their Parenting and Caregiving:A history of traumatic experiences may:• Compromise parents’ ability to make appropriate safety

judgments• Make it challenging for parents to form and maintain secure

and trusting relationships, leading to: – Disruptions in relationships with infants, children, and

adolescents, and/or negative feelings about parenting; parents may personalize their children’s negative behavior, resulting in ineffective or inappropriate discipline.

– Challenges in relationships with caseworkers, foster parents, and service providers and difficulties supporting their child’s therapy.

A Trauma History Can:

• Impair parents’ capacity to regulate their emotions.

• Lead to poor self-esteem and the development of maladaptive coping strategies, such as substance abuse or abusive intimate relationships that parents maintain because of a real or perceived lack of alternatives.

• Result in trauma reminders—or “triggers”—when parents have extreme reactions to situations that seem benign to others

Pay Attention To Parents

Parenting is crucial – parents matter most to their children in very stressful contexts

– Effective parenting buffers children from the risks for depression and behavior problems (substance use, antisocial behavior, school dropout, etc)

– Parenting CAN be taught! There is a strong evidence base for parenting interventions

• Parent management training-Oregon model

• Effective directions (model)

• Triple P

• The Incredible Years

Helping Families Affected By Traumatic Stress

• Provide children and their parents with the effective prevention and treatment services they needo E.g. trauma-focused parent training o Trauma-focused cognitive behavior therapy

• Provide services that recognize what children have experiencedo Train the early childhood workforce to identify traumatic

stress (what happened to you? Vs. what did you do?)o Requires trauma-informed service systems ando Evidence-based intervention and prevention services

Role Of Adults In Building Children's Resilience

• Remain calm in crisis: strategies to responding to emotions

• Role model the capacity to withstand uncomfortable situations

• Be the “band-aid” for the child

• Calm presence through practice

• SIFT (Sensations, Images, Feelings, Thoughts)

Emotion Socialization (ES)

• ES is the process by which parents teach their children (explicitly or implicitly) about emotions

• Three ways by which children learn about emotions:o Observing their parents regulate emotions

o Parents’ responses to children’s ‘big’, usually negative emotions

o Explicit discussion about emotions

• Focusing on ES in parenting is particularly important in families affected by traumatic stress because traumatic events may overwhelm our capacity to effectively respond to emotions (i.e. cause emotion dysregulation)

Teaching About Emotions In Parent Training/Teachers, Caregivers

• Helping parents improve their own emotion regulation using mindfulness exercises, and strengthening intentionality (e.g. focusing on parenting values, and connecting them with parenting goals)

• Teaching parents emotion coaching – i.e. how to effectively teach, discuss, and respond to kids’ emotions

Let’s Practice!

Thank YouChris Bray: bray0021@umn.eduPatty Ostberg-Speiker: ostbe021@umn.edu

Institute for Translational Research in Children’s Mental Health (ITR) http://itr.umn.edu/

Ambit Network: http://www.ambitnetwork.org

ADAPT: www.adapt.umn.edu

Department of Veteran’s Affairs https://www.ptsd.va.gov

National Child Traumatic Stress Network (NCTSN): http://www.nctsnet.org/