Complex Trauma Training, Natalie Turner, 01.11.12

Report
Understanding Complex Trauma:
Strengthening Supporting Learning
Environments through a Trauma Sensitive
Lens
CLEAR
Collaborative Learning for Educational Achievement and Resiliency
January 11th, 2012
Complex Trauma
The exposure to continuous trauma in childhood
Both the being exposed to and having to adjust to
this constant stress
 Begins early in life
 Occurs during most important time of
development
 Children must be ready to react to the
environment which takes energy away from
healthy development
 Unpredictable
 Chronic
 Often occurs in episodes


Copyright 2011 WSU Area Health
Education Center
Trauma As A Fact Of Life

In 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
Copyright 2011 WSU Area Health
Education Center
“Children are like wet
cement. Whatever falls on
them makes an impression."
– Hiam Ginott
Copyright 2011 WSU Area Health
Education Center
4 universal brain principles
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.
1.
◦
What we don’t use as our brain is developing, we
lose.
Copyright 2011 WSU Area Health
Education Center
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”
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Education Center
Threat Appraisal and Detection in
Traumatized Children
Copyright 2011 WSU Area Health
Education Center
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
Copyright 2011 WSU Area Health
Education Center
Labels we often give traumaaffected kids
Lazy
 Manipulative
 Antisocial
 Defiant
 Rebellious
 Uninterested
 Oppositional
 Liar

ADHD
 Uncaring
 Others?

Copyright 2011 WSU Area Health
Education Center
Overall Trauma Impact on Development
Difficulty understanding what they  Negative self-concept
feel and how to cope with it
 Blame themselves for not
 Difficulty expressing what they feel
succeeding


Difficulty understanding the link
between behavior, feelings, and
experience

Difficulty reading social cues

Overly rigid or too diffuse
boundaries

Difficulty maintaining comfortable
arousal

Lack of trust or over-dependent on
others

Feel like they can’t impact their
world

Difficulty sustaining attention and
concentration

Difficulty planning, problem-solving,  And more
organizing information, and delaying
response to stimuli.

Believe they are not capable or
competent
Copyright 2011 WSU Area Health
Education Center
Implementation Science and
Innovation Success
Odds for Academic and Health
Problems with Increasing ACEs
Academic
Severe
Attendance
Failure
Problems
Three or More
ACEs N =248
Severe
School
Behavior
Concerns
Frequent
Reported
Poor
Health
3
5
6
4
Two ACEs
N=213
2.5
2.5
4
2.5
One ACE
N=476
1.5
2
2.5
2
No Known
ACEs =1,164
1.0
1.0
1.0
1.0
Copyright 2011 WSU Area Health
Education Center
Odds Ratios for School and Behavioral
Problems with Increasing ACEs in the RTL
Population
Academic
Failure*
Poor
Attendance
School
Behavior
Behavioral
Health
Problems
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
Four or More ACES N=663
Copyright 2011 WSU Area Health
Education Center
How do ACEs affect student performance?
ACEs and Percent Initial Attendance in
Grades K-12
100%
Mean Initial Percent Attendance
98%
96%
94%
92%
90%
88%
86%
84%
82%
80%
Percent Initial Attendance K-12
No Reported
ACEs N=578
91%
One ACE
N=800
90%
Two ACEs
N=537
88%
Three ACEs
N=409
88%
Four or More
ACEs N=383
85%
Copyright 2011 WSU Area Health
Education Center
The ARC Model
Trauma
Experience
Integration
Competency
Executive
Functions
Self Dev’t
& Identity
Dev’tal Tasks
Affect
Identification
Caregiver
Affect
Mgmt.
Attunement
Modulation
SelfAffect
Expression
Consistent
Response
Routines
and
Rituals
Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005
Regulation
Attachment
The 3-part model
Thus forcing the child to
put energy into survival
rather than healthy
development, leaving
them with
developmental deficits
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
Copyright 2011 WSU Area Health
Education Center
How do I ‘do’ ARC?
Not a ‘recipe’- more of an art
 Changes to meet the needs of individual
children
 Doesn’t just target an outcome, targets an
understanding of “why”
 Evaluation of a child’s needs must be ongoing 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-Regulation
Affect 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

Competency
Executive 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
Attunement

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
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
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

Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
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
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
Affect Identification
The main idea: Work with
 Children may miscue others as a
children to build an awareness of
way of protecting themselves
internal experience, the ability to
from emotions that feel unsafe
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
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
Modulation


◦ Failure to regulate
The main idea: Work with
children to develop safe and
◦ Over-regulating/constricting
effective strategies to manage  Children who can’t modulate
and regulate physiological and
may compensate by
emotional experience, in
◦ Over-controlling or shutting off
service of maintaining a
emotional experience
comfortable state of arousal
“Children who experience
unresponsive, inconsistent, or
abusive caretaking may fail to
develop healthy ageappropriate 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:
◦ Manage emotional experience
with physical stimulation
◦ Turning to external methods to
alter or control physiological
experience.
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic
Stress in Children and Adolescents
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 higherorder 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, problemsolving, 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
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress
in Children and Adolescents
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
◦ understanding of preferences and values
The main idea: Support children in
exploring and building an
◦ identifying personal traits
understanding of self and personal
◦ is an on-going process throughout life
identity, including identification of
 State-dependent self-concepts may
unique and positive qualities,
develop, where children feel their
development of a sense of coherence
identity changes with their experience
across time, and support in the
in the moment
capacity to imagine and work toward
 Focusing on the immediate moment
a range of future possibilities
limits a child’s perception of self to
 “Children who are routinely rejected,
what is rather than what could be
harmed, or ignored internalize an
understanding of self as unlovable,
unworthy, helpless, or damaged.”


Self development includes:
◦ understanding self as separate from
others
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
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
Blaustein, M. & Kinniburgh, K. (2010) Treating Traumatic Stress in
Children and Adolescents
“The world breaks everyone and
afterwards many are strong at the
broken places.”
~ Ernest Hemingway
Copyright 2011 WSU Area Health
Education Center
Some Do’s and Don’ts of Having a
Trauma Sensitive Lens

Do
◦ 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
Copyright 2011 WSU Area Health
Education Center
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
Copyright 2011 WSU Area Health
Education Center
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?

Copyright 2011 WSU Area Health
Education Center
If you’d like more information
www.nctsn.org
 http://www.traumacenter.org/research/asc
ot.php
 http://extension.wsu.edu/ahec/trauma/Pag
es/ComplexTrauma.aspx
 “Brain Rules” by John Medina
 “Helping Traumatized Children Learn”
report and policy agenda by the
Massachusetts Advocates for Children

Copyright 2011 WSU Area Health
Education Center

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