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Mario Martinez

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. . . .
Post-Traumatic Stress Disorder

Erica Brauer
Mario Martinez
Susan Samm Enman
Nathaniel Jones
Brian Padgett
Definition - A mental health condition that is triggered by a traumatic event.

Acute - Lasts less than three months.

Chronic- Persisting three months or more

Delayed Onset-Symptoms occurring six months to many years later (Mayo Clinic Staff, 2013)
Following this presentation, participants will:
Understand and recognize causes and effects of PTSD
Possess a working knowledge of federal, state, and local policies regarding students with PTSD
Have access to practical techniques to implement when serving students with PTSD.
Statistics:
1 out of 10 Americans will experience PTSD after a traumatic event. (Skelton, 2012)
60% of men and 50% of women will be exposed to a trauma severe enough to potentially cause PTSD. Of those, 8% of men and 20% of women will develop PTSD. (Skelton, 2012)
5 million children are exposed to a traumatic event every year. 1.8 million (36%) will develop PTSD. (WebMD, 2013)
Studies of identical and fraternal twins have shown that, 30% of the time, different responses to trauma could be attributed to genes. (Skelton, 2012)
School Shooting Trends
Columbine
Santa Monica
Sandy Hook
Virginia Tech
Gang Violence Trends
Why Participate in the violence?
Cyclical activity
Preventative solutions
Domestic and Child Abuse Trends
Witnessing abuse
Victim of abuse
Sexual Abuse Trends
Adult-on-Child Abuse
Grooming
Child-on-Child Abuse
Loss of Home
"LAUSD currently has 15,217 homeless students identified within our district boudnaries. Our program (LAUSD Homeless Education Program) provides advocacy and support services to a high-risk and often overlooked student population in an effort to decrease drop-out rates and increase high-school graduation [rates]." (LAUSD, 2012)
Loss of Loved Ones
Parents due to divorce or violence
Friends or other family members due to violence
Kids may choose to cope with loss using drugs or alcohol and not seek professional help
Foster Care
PTSD is the starting point for RAD
Reactive Attachment Disorder (RAD) occurs when there is a "failure to form normal attachments to primary caregivers in early childhood. Such a failure could result from severe early experiences of neglect, abuse, abrupt separation from caregivers between the ages of six months and three years, frequent change of caregivers, or a lack of caregiver responsiveness to a child's communicative efforts." (Wikipedia, 2013)
At-Risk Youth and PTSD
At-Risk Youth - "One who is in danger of failing to complete his or her education with an adequate level of skills." (Slavin, 1989)
1 out of 5 kids are at risk


Why Are They Important?
At-Risk Youth are more likely to be misdiagnosed (by 45%) with other disorders like Oppositional Defiant Disorder (ODD) or Attention Deficit Hyperactivity Disorder (ADHD). (Miele, 2010)
"At-Risk Youth are often evaluated multiple times over several years by different clinicians, with considerable diagnostic confusion and minimal continuity of care." (Miele, 2010)
More susceptible to traumas (risk factors) such as:
Loss of home or dwelling due to income challenges
Loss of parent through divorce or death
Loss of loved one (friend, sibling, or other family member) (Slavin, 2012)
These traumas are more likely to occur multiple times and/or simultaneously
Greater likelihood of being placed in Foster Care
Often ignored or missed trauma (Slavin, 2012)
PTSD Symptoms
PTSD Signs in 12-18 Year Olds
Sexual activity and risk-taking behaviors
Depression and/or social withdrawal
Sleeping and/or eating disturbances
Rebellion
Monophobic traits
Change in social dynamics
Panic attacks
Memory problems and/or trouble concentrating
Negative changes in hygiene
(MayoClinic, 2013)
Treatments:
Therapy
Cognitive Processing Therapy (CPT)
Restructure dysfunctional beliefs
Identify "stuck points"
Clarify and/or modify beliefs
Prolonged Exposure (PE)
Re-experience the trauma
Habituation
"Flooding"
40-50% of patients don't improve
(MayoClinic, 2011)
Treatments:
Other Therapies
Eye Movement Desensitization and Reprocessing (EMDR)
Patient recounts trauma while moving eyes bilaterally
Combines elements of exposure and cognitive restructuring

Stress-Inoculation Training
Identify anxiety "cues"
Muscle relaxation and deep breathings"
(Şalcioğlu, 2013)

Treatments:
Medication
Only FDA-approved treatment - Selective Serotonin Reuptake Inhibitors (SSRIs)
Sertraline (Zoloft)
Paroxetine (Paxil)









Others: Fluoxetine (Prozac), Venlafaxine (Effexor), Prazosin (Minipress), Anti-Anxiety Medication, Marijuana (Jefferey, 2012)
New medication being developed - promote Cannabinoid receptor (CB1) equilibrium (Neumesiter, 2013)
Treatments:
Meditation
Mindfulness therapy
73% of patients displayed meaningful improvement vs. 33% in treatment-as-usual groups (Rosenthal, 2011)
Reduction in avoidance symptoms
Decrease in self-blame
Decrease in perception of world as dangerous
Treatment:
Other Tips
To help others:
Strong supportive presence
Model expressing feelings
Routines with flexibility
Opportunities for self-expression
To help one's self:
Nature
Art therapy
Avoid drugs and alcohol
Exercise
Talk with others
(MayoClinic, 2011)
What Can Teachers Do?
Be informed!
Talk to school counselors
Be aware of individual school policies and procedures
Be aware of what to look for in your students
What is traumatic to one individual may not be to another
Get to know your students!
Model good behavior!
Look for warning signs!
Sexual activity and risk-taking behaviors
Depression and/or social withdrawal
Sleeping and/or eating disturbances
Rebellion
Monophobic traits
Change in social dynamics
Panic attacks
Memory problems and/or trouble concentrating
Negative change in hygiene
Talk to parents!
Explain what PTSD is
Explain how children's behavior can be affected
Explain that PTSD episodes or symptoms can be triggered by a variety of events
Be Proactive, but remember, you are NOT a trained professional!!
Programs and Resources
School Mental Health (SMH)
Clinic and Wellness Centers
Established throughout district
Referral system
School-Based Mental Health Services
Psychiatric Social Worker (PSW)
Mental Health Consultation and Education
Indirect method of intervention
Focused on systemic concerns
(LAUSD 2013)
Psychological First Aid for Schools (PFA)
Developed for school-wide traumas
Helps teachers respond to students following trauma
Can help establish system to help students and faulty deal with future challenges
(Berger, 2013)
Listen, Protect, Connect (LPC)
Derivative of PFA
Evidence-informed 5-step model
(Berger, 2013)
Policies and Procedures
LAUSD Policies
Violence Prevention
Bullying and Hazing
Child Abuse
Code of Conduct
Gun-Free Schools
Parent Involvement
Suspension and/or Expulsion
(LAUSD, 2012-2013)
ED Code
Behavioral Intervention
Legal and Social Ramifications
Termination
Lawsuit
Loss of License
Imprisonment
Reputation damage
Incident Rate
Mortality/Morbidity Rate
References
30%-50% of people diagnosed with PTSD experience severe depression (Skelton, 2012)
In a study lasting 16 years, PTSD veterans had an 11.8% mortality rate as opposed to 4.9% in veterans without PTSD. (Skelton, 2012)
Berger, F. (March 2013). Post traumatic stress disorder. A.D.A.M Medical Encyclopedia. Retrieved
from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001923/
Posttraumatic stress disorder. Retrieved from http://en.wikipedia.org/wiki/Posttraumatic_stress_disorder

California Education Code. California Law. Retrieved from
http://www.leginfo.ca.gov/cgi-bin/calawquery?codesection=edc&codebody=&hits=20

How Stuff Works (2013). How foster care works. Retrieved from
http://people.howstuffworks.com/foster-care3.htm

Jeffreys, M., Dr. (01/07/2009) Clinician's guide to medications for ptsd. Retrieved from
http://www.ptsd.va.gov/professional/pages/clinicians-guide-to-medications-for-pt
sd.asp

Kataoka, S., Langley, A., Wong, M., Baweja, S., Stein, B. (January 2012) Responding to students
with ptsd in schools. Child and Adolescent Psychiatric Clinics of North America 21(1),
119–133. doi: 10.1016/j.chc.2011.08.009
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287974/

LAUSD homeless education program. Retrieved from
http://notebook.lausd.net/portal/page?_pageid=33,1163060&_dad=ptl&_schema=PTL_EP

Mayo Clinic Staff. (2011). Post-traumatic stress disorder. Mayo Foundation for Medical Education
and Research. Retrieved from
http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246

Mayo Clinic Staff. (2013). Symptoms. Post-traumatic stress disorder. Retrieved from
http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246/DSECTION=sympt
oms

Mayo Clinic Staff. (2013). Treatments and Drugs. Post-traumatic stress disorder. Retrieved from
http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246/DSECTION=treatm
ents%2Dand%2Ddrugs

Miele, D. & O'Brien, E.J. (2010). Underdiagnoses of posttraumatic stress disorder in at risk yout. Trauma Stess. 23(5) 591-8.

Neumeister, A., (02/2013).The endocannabinoid system provides an avenue for evidence-based
treatment development for ptsd. Depression and Anxiety. 30-2, 93-96 DOI:
10.1002/da.22031. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/da.22031/full

Parent student handbook. Retrieved from
http://home.lausd.net/pdf/Families_Forms/Parent_Student_Handbook_2012-13_English.pdf
2013) Post-traumatic stress disorder. WEbmd.com. Retrieved from
http://www.webmd.com/mental-health/post-traumatic-stress-disorder-ptsd?page=4


Rosenthal, J. Z., Grosswald, S., Ross, R., Rosenthal, N. (June 2011). Effects of transcendental
meditation in veterans of operation enduring freedom and operation iraqi freedom with
posttraumatic stress disorder: a pilot study.Military Medicine. 176-6,626-630(5). Retrieved
from http://www.ingentaconnect.com/content/amsus/zmm/2011/00000176/00000006/art00019

Şalcıoğlu, E., & Başoğlu, M. (2013). Current state of the art in treatment of posttraumatic stress
disorder, new insights into anxiety disorders, Dr. Federico Durbano (Ed.), ISBN:
978-953-51-1053-8, InTech, DOI: 10.5772/54197. Retrieved from
http://www.intechopen.com/books/new-insights-into-anxiety-disorders/current-state-of-the-art-i
n-treatment-of-posttraumatic-stress-disorder

School mental health. Retrieved from
http://notebook.lausd.net/portal/page?_pageid=33,922882&_dad=ptl&_schema=PTL_EP

Skelton, K., Ressler, K., Norrholm S., Jovanovic T., and Bradley-Davino, B. (February 2012) Ptsd
and gene variants: new pathways and new thinking. Neuropharmocology. 62,2. 628-637.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136568/

Slavin, E. R., & Madden, N. A. (1989). What works for students at risk. Educational Leadership.
Retrieved from http://literacyconnects.org/img/2013/03/What-Works-for-Students-At-Risk.pdf

Slavin, E.R. (2012). Educational Psychology: Theory and Practice. Boston, Prentice Hall.

Smith, M., and Segal, J. (April 2013) Post traumatic stress disorder. Helpguide.org. Retrieved from
http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm

Wikipedia. (2013). Reactive attachment disorder. Reactive attachment disorder. Retrieved from
http://en.wikipedia.org/wiki/Reactive_attachment_disorder.
(Berger, 2013)
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