1
A trauma informed child protection system
Inaugural Australian
Child Protection Forum
Dr Cathy Kezelman,
President ASCA
...
22
Child protection system
Works to ensure health, safety and wellbeing of children and
young people
Children are at risk ...
33
What is trauma?
• State of high arousal in which normal coping
mechanisms are overwhelmed in response to real or
percei...
44
Adaptation to trauma
With trauma the sustained attention the child must
pay to environmental threats inevitably pulls e...
55
Child development
Adaptation to trauma, especially early in life,
becomes a `state of mind, brain and body’ around
whic...
66
Complex vs. single incident
• More common - interpersonal, premeditated, often
repeated, extreme and prolonged, inescap...
77
Adverse Childhood Experiences Study
Stressful overwhelming experiences in childhood ->
compromised mental and physical ...
88
Personal solutions -> public health impacts
• Results of this magnitude are rare in epidemiology’ (Vincent Felitti,
201...
99
Study on Women – Co-occurring disorders
Many individuals labelled as ‘mentally ill’, ‘substance
abusers’ or ‘criminals’...
1010
Unresolved trauma
Unresolved trauma:
• has negative effects across the life-cycle for those who
directly experience i...
1111
Unresolved parental trauma
‘Emotional abuse, loss of caregivers, inconsistency, and
chronic misattunement showed up a...
1212
Unresolved parental trauma
• When parent is sensitive to stress (as result of unresolved
trauma) and easily overwhelm...
1313
Trauma can be resolved
`Insecure’ attachment generated by adverse childhood experiences
can be converted to `secure’ ...
1414
The impact of experience: `the social brain’
Neural networks are activated by experiences of
relationship (`neurons t...
1515
Trauma – current situation
High incidence of unresolved trauma among
parents/families who engage with child protectio...
1616
Case for Trauma Informed Care
• Supported by a wide evidence base
• Experience of relationships registers in the brai...
1717
Systemic change and transformation
`Changes to a trauma-informed organizational service
system environment will be ex...
1818
Trauma informed practice
• Recognises that many problems, disorders & conditions
are trauma-related (Perry, 2008; Ros...
1919
Trauma Informed Principles
• Safety
• Trustworthiness
• Choice
• Collaboration
• Empowerment (Fallot & Harris, 2009)
...
2020
Changes include…
• A view of trauma as pervasive in its effects (Jennings,
2004; Fallot & Harris, 2009)
• Understandi...
2121
First steps…
Commit to & act upon the core principles of safety,
trustworthiness, choice, collaboration & empowerment...
2222
Positive interactions
In contrast to the traumatized person who has
experienced a sense of safety and well-being prio...
2323
Worker/ practitioner wellbeing/self-care
• Your stress levels impact your clients
• Worker and practitioner sensitivi...
2424
ASCA Contact Details
Phone
Professional Support Line: 1300 657 380
National Office: 02 8920 3611
Email
Office: info@a...
Upcoming SlideShare
Loading in...5
×

Dr. Cathy Kezelman, Adults Surviving Child Abuse - Complex Trauma

833

Published on

Dr. Cathy Kezelman, President, Adults Surviving Child Abuse delivered the "Complex Trauma" presentation at the Child Protection Forum 2013.

She defined complex trauma and effects of adverse childhood events, how unresolved trauma affect the next generation, neuroplasticity and possibilities for recovery, and trauma informed care and practice.

Find out more at http://www.informa.com.au/childprotectionforum2013

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
833
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
34
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Dr. Cathy Kezelman, Adults Surviving Child Abuse - Complex Trauma

  1. 1. 1 A trauma informed child protection system Inaugural Australian Child Protection Forum Dr Cathy Kezelman, President ASCA © ASCA 2013
  2. 2. 22 Child protection system Works to ensure health, safety and wellbeing of children and young people Children are at risk of • abuse in all its forms • neglect • impacts of witnessing or experiencing domestic and family violence and/or community violence Risk is heightened when parents have own histories of unresolved trauma and exacerbated by additional stressors – illness, isolation, grief, loss, loneliness, or when parents are living with mental illness, substance abuse, criminal justice issues
  3. 3. 33 What is trauma? • State of high arousal in which normal coping mechanisms are overwhelmed in response to real or perceived threat (Cozolino, 2002:270). • Activation of the instinctive `fight‐flight’ response; mobilisation of this biological `survival’ response leads to a `freeze’ response when the threat cannot be escaped • The trauma of child abuse requires movement from a `learning brain’ to a `survival brain’ (Ford, 2009: 35) `Survival’ responses only become pathological if not resolved following precipitating event/s. If trauma is not resolved, the person remains on `high alert’, is easily triggered by seemingly minor stress, and cannot `move on’
  4. 4. 44 Adaptation to trauma With trauma the sustained attention the child must pay to environmental threats inevitably pulls energy and focus away from the developmental task of self- awareness. At a time when loved and well-treated children are becoming acquainted with self – celebrating a developing sense of discovery, autonomy, and fledging impressions of self-efficacy – the abuse victim is absorbed in the daily task of psychological survival (Briere, 1992: 45-46)
  5. 5. 55 Child development Adaptation to trauma, especially early in life, becomes a `state of mind, brain and body’ around which all subsequent experience organizes’ (Cozolino, 2002: 258-259) ‘Because of the importance of a context of safety and bonding in the early construction of the brain, childhood trauma compromises core neural networks’ (Cozolino, 2002:258). Neural integration is necessary to respond flexibly to daily challenges (van der Kolk, 2003; Cozolino 2002; Siegel, 2012).
  6. 6. 66 Complex vs. single incident • More common - interpersonal, premeditated, often repeated, extreme and prolonged, inescapable • Often developmental, compounded ; impacts cumulative • Erodes health and wellbeing • Potentially impairs wide range of functioning Combination of ongoing trauma exposure and its developmental impact typifies complex trauma
  7. 7. 77 Adverse Childhood Experiences Study Stressful overwhelming experiences in childhood -> compromised mental and physical health in adulthood US longitudinal study >17000 participants - predominantly white middle-class; average age 57; had some college education; lacked obvious markers of social disadvantage Yet two major findings are that: (1) Adverse childhood experiences are `vastly more common than recognized or acknowledged’ (2) They powerfully impact both mental and physical health `a half-century later’ (Felitti, 2002:45).
  8. 8. 88 Personal solutions -> public health impacts • Results of this magnitude are rare in epidemiology’ (Vincent Felitti, 2010:82) • Almost 2/3 of participants reported at least one adverse childhood experience of physical or sexual abuse, neglect, or family dysfunction, > twenty percent reported 3 or > ACE Study establishes: the conversion, over time, of childhood coping mechanisms into adult health problems Initially protective coping mechanisms to deal with childhood adversity lose their protective function over time and undermine emotional and physical health in adulthood (Felitti, Anda et.al., 1998)
  9. 9. 99 Study on Women – Co-occurring disorders Many individuals labelled as ‘mentally ill’, ‘substance abusers’ or ‘criminals’ had severe trauma histories. “This understanding helps us view much of what we once considered pathological – such as IV drug use or self-injury – as coping mechanisms that have allowed individuals to survive some of the most horrific experiences a person can endure” SAMHSA 1998 , 5 year study
  10. 10. 1010 Unresolved trauma Unresolved trauma: • has negative effects across the life-cycle for those who directly experience it • intergenerational impacts on the children of parents whose trauma histories are unresolved (Hesse, Main et al, in Solomon & Siegel, 2003)
  11. 11. 1111 Unresolved parental trauma ‘Emotional abuse, loss of caregivers, inconsistency, and chronic misattunement showed up as the principal contributors to a large variety of psychiatric problems’ (Dozier, Stovall, & Albus, 1999; Pianta, Egeland, & Adam, 1996; van der Kolk, ibid) Parents do not need to be actively abusive for their children to be adversely affected. Unresolved parental trauma increases the risk of transmission of impaired attachment styles to infants, and difficulties in relating to both self and others
  12. 12. 1212 Unresolved parental trauma • When parent is sensitive to stress (as result of unresolved trauma) and easily overwhelmed; -> child overwhelmed • When parent is source of distress – child cannot self-regulate, cannot process, attribute meaning • Child cannot not learn how to respond appropriately • Child learns cannot rely on others `Interactions with loved ones are our major stress-modulating mechanism’ (Perry, 2006:90)
  13. 13. 1313 Trauma can be resolved `Insecure’ attachment generated by adverse childhood experiences can be converted to `secure’ attachment (`earned security’) Transmission of insecure attachment to the next generation is also avoided when parental trauma is resolved : These are adults who appear to have had difficult childhoods, but have come to create a coherent narrative. They have made sense of their lives. The children attached to these adults have secure attachments and do well! History is not destiny – if you’ve come to make sense of your life (Siegel, 2003:16)
  14. 14. 1414 The impact of experience: `the social brain’ Neural networks are activated by experiences of relationship (`neurons that fire together, wire together’) It is not nature OR nurture but nature AND nurture The `social brain’ is built over time and neural growth and change can take place across the lifespan (neuroplasticity) But early care-giving relationships are vital: `[t]he organization of the social brain is initially sculpted via parent-child interactions’ (Cozolino, 2002:217)
  15. 15. 1515 Trauma – current situation High incidence of unresolved trauma among parents/families who engage with child protection system Many trauma survivors have not connected their current problems and behaviours with their past traumatic experiences and nor have the workers who support them Re-traumatisation by and within services is highly prevalent `Trauma has often occurred in the service context itself’ (Jennings, 2004:6; Bloom & Farragher, 2011; Davidson, 1997)
  16. 16. 1616 Case for Trauma Informed Care • Supported by a wide evidence base • Experience of relationships registers in the brain, correlates with neural activity, & is crucial to well-being (Siegel, 2009; Doidge, 2007; Cozolino, 2002). Positive relational experiences have great healing potential while negative relational experiences compound emotional and psychological problems Since healing is relational, positive experiences need to take place within services and organisational settings accessed by those with trauma histories
  17. 17. 1717 Systemic change and transformation `Changes to a trauma-informed organizational service system environment will be experienced by all involved as a profound cultural shift in which consumers and their conditions and behaviours are viewed differently, staff respond differently, and the day-to-day delivery of services is conducted differently’ (Jennings, 2004: 15) When a human service program seeks to become trauma-informed, every part of its organisation, management, and service delivery system is assessed and modified to ensure a basic understanding of how trauma impacts the life of an individual who is seeking services
  18. 18. 1818 Trauma informed practice • Recognises that many problems, disorders & conditions are trauma-related (Perry, 2008; Ross & Halpern, 2009) • Rests on awareness of the impacts of trauma • Is sensitive to the context in which treatment/service is offered • Is attuned to diverse coping mechanisms • Minimises the potential for re-traumatisation
  19. 19. 1919 Trauma Informed Principles • Safety • Trustworthiness • Choice • Collaboration • Empowerment (Fallot & Harris, 2009) Cultural attunement Hope, optimism
  20. 20. 2020 Changes include… • A view of trauma as pervasive in its effects (Jennings, 2004; Fallot & Harris, 2009) • Understanding client behaviour as adaptive attempts to cope • A focus on what has happened to the person rather than what is wrong with the person (Bloom, 2011; Fallot&Harris, 2009) • Emphasis on skill building and acquisition
  21. 21. 2121 First steps… Commit to & act upon the core principles of safety, trustworthiness, choice, collaboration & empowerment (Fallot & Harris, 2009:3). Remember: • Experience of relationships & environment (both positive & negative) affects brain structure, functioning & well-being • Positive relational experiences – including experience of services - assists integration • Integration is the hallmark of well-being, & necessary for the healing of trauma
  22. 22. 2222 Positive interactions In contrast to the traumatized person who has experienced a sense of safety and well-being prior to onset of the (single-incident) trauma, the survivor of complex trauma does not start with this advantage (Shapiro, 2010) The capacity of positive interactions to be soothing and validating (even in the most routine aspects of relating) should not be underestimated This applies to all of us, and especially to those with trauma histories
  23. 23. 2323 Worker/ practitioner wellbeing/self-care • Your stress levels impact your clients • Worker and practitioner sensitivities can be ignited in interactions with clients, particularly if both parties have unresolved trauma histories Vicarious trauma (VT) is `[t]he negative transformation in the helper’ from exposure to traumatic material in the context of a helping relationship (Pearlman & Caringi, 2009). Stress breeds stress & attentiveness to well-being is the antidote: applies to practitioners & clients
  24. 24. 2424 ASCA Contact Details Phone Professional Support Line: 1300 657 380 National Office: 02 8920 3611 Email Office: info@asca.org.au Counsellor: counsellors@asca.org.au Website: www.asca.org.au Guidelines: www.asca.org.au/guidelines Dr. Cathy Kezelman, ASCA President ckezelman@asca.org.au 0425 812 197
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×