Understanding Complex Trauma: Strengthening Supporting Learning Environments through a Trauma...

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


“Children are like wet cement. Whatever falls on

them makes an impression."

– Hiam Ginott


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.


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”


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



Labels we often give trauma-affected kidsLazyManipulativeAntisocialDefiantRebelliousUninterestedOppositionalLiar

ADHDUncaringOthers?


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


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


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


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


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


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


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


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


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


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


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


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


“The world breaks everyone and afterwards many are strong at the broken places.”

~ Ernest Hemingway


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



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


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?


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

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