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Becoming Trauma Informed

for live presentation
by

amanda carrick

on 28 January 2014

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Transcript of Becoming Trauma Informed

Attachment, Trauma, and the Brain
What Can We Do?
Factors to Consider
Trauma 101
Becoming Trauma-Informed
Why Are We HERE?
Amanda Carrick, MA
Sarah Black, MA, MFT

Children, Attachment and Trauma
Reactions to Traumatic Stress
Emotions...
-intense fear
-helplessness
-disorganized
-agitation
-terror
-numbness
-tearfulness

Physical...
-loss of bowel control
-trembling
-dizziness
-rapid heart rate
-excitedness
-clinginess
how Childhood traumatic stress impacts children

the bio-psycho-social (and ecological) picture of child trauma

how to assess for trauma

consider evidence-based and trauma-specific treatments and practices

to identify, address, and reduce secondary or vicarious trauma in workers
To get out of here, you should understand....
Background of Trauma Framework in Practice
Chadwick Trauma-Informed Systems Project (CTISP) began as a Center within the National Child Traumatic Stress Network (NCTSN)
funded by SAMHSA
CTISP aims to help agencies and their staff become trauma-informed
ultimate goal is to help agencies and system to be multi-dimensional, trauma-informed, and evidence-based
3.4 million referrals ~ 6.2 million children ~ 19% substantiated
Small Group Exercise
with your group, come up with a definition of child trauma
what are some examples of trauma you have observed in your work?
is trauma different in children? why or why not?

appoint a SPOKESPERSON to share your consensus
Neurobiological Impact of Neglect
Perry, 2000
Neurobiological Impact
of Maltreatment
DeBellis et al., 1999
Impact of Family Violence -
Infants and Toddlers
Very vulnerable to brain damage – fight or flight
May be distressed & scared – from loud noises/yelling
May become scared to explore and play (and eventually may not try)
Will sense tension/stress in mom or primary caregiver
Risk Factors
Protective Factors
History of trauma
Poor parental relationship or connection
Psychopathology
Poor or lesser cognitive and language
development age (younger = higher risk)
difficult temperament
Less or no history of trauma
Strong & healthy connections with parent or caregiver
High perceived social support
Strong attachment with caregivers following trauma
Higher intelligence
Absence of psychopathology
easy temperament
Risk vs Protective - Child
Risk Factors
Risk vs Protective Factors - Environment/Parent
Low social support
Mental health/ substance abuse issues
Inability to be consistent, healthy authoritative parent
Socio-economic status
Peers
Community violence
lack of knowledge about child development
Protective Factors
High perceived social support
comfortable with child's needs
Controlled mental health/substance use issues
Supportive community
Lack of family violence
Healthy peers
The Normal Brain
-parental response
-perception of threat
-relationship to perpetrator
-developmental stage at time of “incident”
-multiple versus one-time event
-cultural issues
-severity (degree) of trauma(s)

...other factors?

How Do Children Experience Trauma?
depends on...
Complicating factors in child welfare
The top risk factors for out-of-home placements are substance abuse, untreated mental illness, & lack of parenting knowledge
specific to
substance abuse
in the home, these children may experience....
chaotic and unpredictable home lives
inconsistent parenting
inconsistent parental response/emotions
abandonment
physical and/or emotional abuse
Increased risk of....
negative and risky behaviors
substance abuse
mental illness
physical illness
impaired ability to learn
relationship struggles
additional abuse or violence
Long-term Consequences of Trauma
Felitti, et al., 1998
ACES study publication
The traumatized brain
Preschool
Trauma is...
Defining Trauma
2012 CAN Rates
Types of Trauma
-sudden
-uncontrollable
-negative
-Abuse or neglect
-DV
-Accidents
-Car crashes
-Death
-Medical illness
-Community violence
acute
chronic
complex
us dhhs, 2012
-This age worries
-Believes they are responsible – magical thinking
-not prepared to process complex emotions of trauma
-Confusion over “what I see” versus “what I am taught”
-May learn to ‘tune out’ by concentrating hard on TV or something else
-Separation anxiety
-Nightmares
-in cases of DV, May interfere or try to help a victim (loved one)
-Distress, guilt & grief
-Fear – may experience regression

School-aged
children & trauma
what does this mean for potential or likelihood of trauma?
may be concerned for: safety, things being fair
Will notice differences in ‘versions’ of what is recounted
with Dv, often sees one parent as aggressor, and one as victim
attention seeking behaviors

School and learning is negatively affected
Increased risk for bullying or to be bullied
Shame, guilt, grief (may blame self if DV)
sadness and irritability
School avoidance (to protect parent)
Trauma: What Lies Underneath?
People who have experienced childhood stressors such as abuse, neglect, familial mental illness, recurrent emotional abuse, or DV....
emotional
cognitive
developmental
observable reactions
Recommendations
Closure
Summary of Understanding
Treatment Considerations
learn who the providers are of specialized tx in your area
any adult or child with trauma history should be referred to trauma informed mh services
consider how you can be an advocate for a child and famlly as they face recovery from trauma

Case Vignettes
1. appoint one person as the "scribe"
2. as a group, outline areas (domains) of difficulty for this family
4. outline any areas of strengths
5. outline what is known about trauma history- and identify any other potential traumas not listed.
6. generate ideas for additional assessment, treatment, or case mgmt
7. what are next steps for you, and for DSS (if they are in picture)?
Parent-Child Interaction Therapy (PCIT)

Child-Parent Psychotherapy (kids ages 0-5 only)

Trauma-Focused CBT (TF-CBT)

CBT - for adults

Seeking Safety - teens & adults

EMDR - adults only
www.cebc4cw.org & www.nrepp.samhsa.gov
Healthy Brain
maltreated child's brain
Child
become trauma-informed

provide services under this framework

help others to understand needs of children who are impacted by trauma

stay abreast of advances in the field
Questions...
Thoughts....
Feedback....
The direct personal experience of an event that involves actual or threatened deathor serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another son; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1).
The person’s response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). (p. 463)
DSM IV-TR
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