Trauma 101
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  • Here it is recommended that you provide a summary of the base development of humans from birth to death. After a general understanding is reached by audience you can focus more on numbers 4 and 5
  • Here it is recommended that you provide a summary of the base development of humans from birth to death. After a general understanding is reached by audience you can focus more on numbers 4 and 5
  • This slide is intended to help participants realize that while many of these signs may signal a mental health problem, there are other possible non-mental health related causes that need to be ruled out. For example a child who is late each day, may be depressed or may be taking care of younger sibling or have other health concerns that are contributing to the lateness
  • Review what is meant by industry and what it means for a 6 to 12 year old. Consider what happens at next age level if this stage is not met or the prior stage wasn’t met
  • Discuss what is meant by some of these terms and try to get examples from the group
  • Let group take a few minutes to go back and think of own experiences. Have fun with this slide
  • Review examples of what it means to develop identity and capacity for intimacy
  • Again just a joke
  • Just a joke, but good disussion
  • Emphasize that these are all typical. Remind audience though that not all adolescents experience a challenging/bumpy ride
  • Emphasize that kids come to school with a lot of baggage that will impact learning
  • Not only do kids experience issues, but so do teachers!
  • Kids need stable environments. It helps to have consistent, positive adults
  • 1952 first addition. Diagnostic and Statistical Manual of Mental Illness– Text Revision
  • Read over this list of the different kinds of anxiety disorders.
  • Read over these stats.
  • Both of the following criteria need to be met in order for a person to have PTSD. More criteria on next few slides. Explain the difference in children…this may be expressed through disorganized or agitated behavior instead of having insight into what is causing the fear.
  • Our kids are growing up in an unsafe chaotic unpredictable world who see things as threatening even when they are not because that is what their experience has taught them.
  • This may result in being sent to the principals office for being disrespectful. Teachers personalize the behavior, the child is publicly shamed, removed from the learning setting and behaviors don’t change.
  • Immediate reaction of caregivers or those close to child Type, quality of, and access to, constructive supports Attitudes and behaviors of first responders and caregivers Degree of safety for victim following the event Prevailing community attitudes and values Cultural and political considerations
  • Parenting values, community values, peer values, age of parents ,
  • Either “fight” or “flight,” enabling individual to take emergency action in response to fear, terror, and danger. “ Fight” = self-defense. “ Flight” = removing self from danger
  • Hyperarousal the primary problem. Catecholamine release, and over-activation of hypothalamic-pituitary axis. A previously adaptive, emergency response becomes maladaptive. Adaptive emergency “state” becomes maladaptive “trait.”
  • traumatized children’s behavior in the classroom can be highly confusing, and children suffering from the behavioral symptoms of trauma are frequently profoundly misunderstood.”
  • You may want to do a short mental imagery/relaxation exercise with the audience using the information on this slide as a guide.
  • See following website for examples of downloadable relaxation tapes: http://www.utexas.edu/student/cmhc/RelaxationTape/index.html
  • Time out- can be a form of response cost
  • Break down multi step, be specific not ambiguous
  • Remind people that how you respond to a child should depend on where the child is in this acting out cycle. At the height of an outburst, reasoning won’t work.
  • Tangible reward system as well- PBIS
  • Review of strategies that may be helpful to promote mental health and wellness in schools

Trauma 101 Trauma 101 Presentation Transcript

  • Trauma 101 Lincoln Child Center
  • Erik Erickson’s Stages of Development 50+, old age, grandparents Mature Age   8. Integrity v Despair 30-65, middle age, parenting Adulthood   7. Generativity v Stagnation 18-40, courting, early parenthood Young Adult   6. Intimacy v Isolation 13-18 yrs, puberty, teens* Adolescence   5. Identity v Role Confusion 5-12 yrs, early school School Age   4. Industry v Inferiority 3-6 yrs, pre-school, nursery Play Age   3. Initiative v Guilt 1-3 yrs, toddler, toilet training Early Childhood   2. Autonomy v Shame and Doubt 0-1½ yrs, baby, birth to walking Infancy   1. Trust v Mistrust age range, other descriptions Life Stage   Psychosocial Crisis Stage
  • Contemporary Urban Stages of Development 50+, old age, grandparents Mature Age   8. Integrity v Despair 30-65, middle age, parenting Adulthood   7. Generativity v Stagnation 18-40, courting, early parenthood Young Adult   6. Middle class v working class 13-18 yrs, puberty, teens* Adolescence   5. Banking v Resistance 5-12 yrs, early school School Age   4. Racism v Poverty 3-6 yrs, pre-school, nursery Play Age   3. Spanking v talking 1-3 yrs, toddler, toilet training Early Childhood   2. Baby sitter/Daycare v Home 0-1½ yrs, baby, birth to walking Infancy   1. Trust v Mistrust age range, other descriptions Life Stage   Psychosocial Crisis Stage View slide
  • Mental Health Issue or Not? Red Flags or Not?
    • If a child falls asleep every afternoon in class during the lesson?
    • If a child is late for school often?
    • If a child has frequent suspensions for not following directions in class?
    • If a child has a temper tantrum?
    • If a child is unkempt?
    View slide
  • Developmental Goals (6 to 12)
    • Ages 6 to 12
      • To develop industry
        • Begins to learn the capacity to work
        • Develops imagination and creativity
        • Learns self-care skills
        • Develops a conscience
        • Learns to cooperate, play fairly, and follow social rules
  • Normal Difficult Behavior Ages 6 to 12
    • Arguments/Fights with Siblings and/or Peers
    • Curiosity about Body Parts of males and females
    • Testing Limits
    • Limited Attention Span
    • Worries about being accepted
    • Lying
    • Not Taking Responsibility for Behavior
  • Cries for Help/More Serious Issues Ages 6-12
    • Excessive Aggressiveness
    • Serious Injury to Self or Others
    • Excessive Fears
    • School Refusal/Phobia
    • Fire Fixation/Setting
    • Frequent Excessive or Extended Emotional Reactions
    • Inability to Focus on Activity even for Five Minutes
    • Patterns of Delinquent behaviors
  • Adolescence
  • Let’s Visit Ages 13-18
    • Think about your experiences in 8th grade
    • Who was your favorite teacher?
    • Were you dating or not dating?
    • Who was your best friend?
    • How would you have described your parent/caregiver?
    • What did you do for fun?
    • What was the latest and greatest technology?
    • What was your favorite movie, song, or tv show?
  • Developmental Goals
    • Developing Identity-the child develops self-identity and the capacity for intimacy
      • Continue mastery of skills
        • Accepting responsibility for behavior
        • Able to develop friendships
        • Able to follow social rules
  •  
  •  
  • Normal Difficult Behavior
    • Moodiness!
    • Less attention and affection towards parents
    • Extremely self involved
    • Peer conflicts
    • Worries and stress about relationships
    • Testing limits
    • Identity Searching/Exploring
    • Substance use experimentation
    • Preoccupation with sex
  • Cries for Help- Ages 13-18
    • Sexual promiscuity
    • Suicidal/homicidal ideation
    • Self-mutilation
    • Frequent displays of temper
    • Withdrawal from usual activities
    • Significant change in grades, attitude, hygiene, functioning, sleeping, and/or eating habits
    • Delinquency
    • Excessive fighting and/or aggression (physical/verbal)
    • Inability to cope with day to day activities
    • Lots of somatic complaints (frequent flyers)
  • “ Could someone help me with these? I’m late for math class.”
  •  
  • Schools: The Most Universal Natural Setting
    • Over 55 million youth attend 114,700 schools (K-12) in the U.S.
    • 6.8 million adults work in schools
    • Combining students and staff, approximately 20% of the U.S. population can be found in schools during the work week.
  • Overview of Children’s Mental Health Needs
      • Between 20% to 38% of youth in the U.S. have diagnosable mental health disorders
      • Between 9% to 13% of youth have serious disturbances that impact their daily functioning
      • Between one-sixth to one-third of youth with diagnosable disorders receive any treatment
      • Schools provide a natural, universal setting for providing a full continuum of mental health care
  • Workforce Issues
    • 15% of teachers leave after year 1
    • 30% of teachers leave within 3 years
    • 40-50% of teachers leave within 5 years
    • (Smith and Ingersoll, 2003)
  • What is the DSM-IV-TR?
    • A reference guide for diagnosing mental health concerns
    • Published by the American Psychiatric Association in May 2000
    • For each Diagnosis provides specific criteria that needs to be met
    • Next update (DSM-V) will be published in 2011 or later
  • Anxiety
    • Panic Disorder
    • Obsessive Compulsive Disorder
    • Specific Phobias
    • Separation Anxiety Disorder
    • Posttraumatic Stress Disorder
    • Generalized Anxiety Disorder
  • Anxiety - Prevalence
    • 13% of youth ages 9 to 17 will have an anxiety disorder in any given year
    • Girls are affected more than boys
    • ~1/2 of children and adolescents with anxiety disorders have a 2 nd anxiety disorder or other co-occurring disorder, such as depression
  • Post-traumatic Stress Disorder (PTSD)
    • The person has been exposed to a traumatic event in which both of the following were present:
    • (1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
    • (2) The person's response involved intense fear, helplessness, or horror. (Note: In children, this may be expressed instead by disorganized or agitated behavior.)
  • Complex Trauma
    • Pervasive, Episodic trauma that persists over time and often occurs with poverty, family violence, substance abuse, community violence
  • Complex Trauma
    • Constant stress induced by complex trauma appears to cause changes in the brain leading to difficulties with motor skills, language, social behaviors and self control
    • (For example, the child response for quiet by looking away, putting his or her head on the desk, or simply ignoring the teacher)
  • Events that Cause PTSD in Children
    • Survival of natural disasters (floods)
    • Violent crimes(kidnapping, rape, murder of a parent, shootings, car accidents)
    • Severe burns
    • Exposure to community violence
    • Exposure to Domestic Violence
    • Bullying
    • Traumatic Loss
    • Medical Trauma
    • Peer suicide
    • Sexual and Physical Abuse
  • PART I: TRAUMA – BASIC CONSIDERATIONS
    • CHARACTERISTICS OF THE TRAUMATIC EVENT(S)
    • Frequency, severity, & duration of event(s)
    • Degree of physical violence and bodily violation
    • Level of terror and humiliation experienced
    • Persistence of threat
    • Physical and psychological proximity to event and perpetrator
  • PART I: TRAUMA – BASIC CONSIDERATIONS
    • CHARACTERISTICS OF THE INDIVIDUAL CHILD
    • Age and stage of development
    • Prior trauma history
    • Intelligence
    • Strengths, coping, and resiliency skills
    • Vulnerabilities
    • Child’s culturally based understanding of the trauma
  • TRAUMA – CULTURAL CONSIDERATIONS
    • SIGNIFICANCE OF CULTURE IN UNDERSTANDING IMPACT OF TRAUMA ON CHILDREN
    • Traumatic event – influenced by cultural beliefs and parenting practices.
    • Environment – may or may not recognize event as traumatic, such that trauma not acknowledged and support not offered.
    • Child – may or may not cognitively experience event as traumatic, but body responds anyway.
  • TRAUMA – IMPACT
    • CHILDHOOD TRAUMA OVERVIEW
    • Multiple variables determine impact, as discussed.
    • Single events disrupt the life of child and family, but often resolve without serious long-term damage.
    • Severe, chronic, and/or recurring trauma can have serious, long-term consequences.
    • These consequences can affect every aspect of a child’s functioning, including mental & physical health, values & beliefs, learning, and behavior.
  • PART II: TRAUMA – IMPACT
    • CONSEQUENCES OF SEVERE, CHRONIC TRAUMA
    • Neurobiological abnormalities.
    • Effect on brain size and activity.
    • Disruption of normal developmental process.
    • Likelihood of additional victimization.
    • Likelihood of aggression & violence.
  • PART II: TRAUMA – IMPACT
    • SEVERE, CHRONIC TRAUMA: CONSEQUENCES (2)
    • Likelihood of negative lifestyle & unhealthy habits.
    • Physical health problems, during childhood and throughout the life cycle, and shorter life expectancy.
    • Increased risk of psychiatric disorders.
    • Increased risk of substance abuse.
  • PART II: TRAUMA – IMPACT
    • VICTIMS AND VICTIMIZERS: SAD REALITY:
    • Many juvenile offenders were victimized earlier.
    • Childhood and youth victims are, as result of their victimization, at higher risk of becoming victimizers.
    • Dramatic example, per Philadelphia police: 90% of city’s murderers, and also 90% of city’s homicide victims, have prison records.
    • Trauma increases likelihood of arrest – 53% more for juveniles, and 38% more for young adults.
  • PART II: TRAUMA – IMPACT
    • TRAUMA AS PRECURSOR TO VIOLENCE
    • Violent crime leading to arrest: 38% more likely.
    • Adjudicated females (2 separate studies) :
      • Over 75% of adjudicated females had been sexually abused.
      • Over 90% of incarcerated females reported some form of childhood maltreatment (2 separate studies).
  • PART II: TRAUMA – NEUROBIOLOGY
    • THE BOTTOM LINE: LONG-TERM EFFECTS OF TRAUMA ON THE BRAIN
    • Severe, prolonged childhood abuse damages the developing brain via hormonal and structural changes.
    • Potentially irreversible, although the brain is dynamic and continues to grow into mid-20’s.
    • Childhood violence a significant causal factor in 10-25% of all developmental disabilities .
  • PART II: TRAUMA – NEUROBIOLOGY
    • BASIC SURVIVAL RESPONSES TO DANGER AND THREAT (NORMAL PROCESSES):
    • Hyperarousal responses: “fight” or “flight”, in support of active mastery and/or
    • Dissociation responses: passive, surrender response, to escape/avoid situation.
        • Both responses are normal and of adaptive benefit, increasing the likelihood of survival.
  • PART II: TRAUMA – NEUROBIOLOGY
    • THE HYPERAROUSAL RESPONSE (2):
    • Physiological responses associated with hyperarousal:
        • Increased heart rate.
        • Increased blood pressure.
        • Increased energy availability in skeletal muscles.
    • Observable manifestations of hyperarousal:
        • Highly focused attention
        • Sweating
        • Erect posture
  • PART II: TRAUMA – NEUROBIOLOGY
    • THE DISSOCIATION RESPONSE
    • Dissociation = “disengaging from stimuli in the external world and attending to an internal world” (Perry et al, 1995), in order to “camouflage” oneself and child and buy time.
    • Dissociation involves emotional numbing and withdrawal.
    • A dissociation continuum, depending on trauma severity and circumstances.
    • Mediating neurobiology: Increase in vagal tone.
  • PART II: TRAUMA – NEUROBIOLOGY
    • THE DISSOCIATION RESPONSE (2)
    • Physiological responses associated with dissociation:
        • Decrease in heart rate.
        • Decrease in blood pressure.
    • Observable manifestations of dissociation:
        • Decreased movement
        • Compliance
        • Avoidance
        • Restrictive affect
  • PART II: TRAUMA – NEUROBIOLOGY
    • POSSIBLE IMPACT OF STUDENT’S TRAUMA RESPONSE ON SCHOOL STAFF
    • Student’s trauma response misperceived by adult as a personal challenge, or as intentional defiance.
    • With above mindset, adult less likely to respond sympathetically to the student.
    • Staff anger, feeling challenged or devalued.
    • Counter-aggression may occur.
  • PART III: DIRECT EFFECTS ON STUDENT LEARNING AND BEHAVIOR
    • FEAR AND SURVIVAL AS THE ORGANIZING FORCES FOR TRAUMATIZED STUDENTS
    • Student may anticipate that the school environment will be threatening, and constantly scrutinizes it for signs of danger.
    • Such a response “often sabotages the (student’s) ability to hear and understand a teacher’s positive messages, to perform well academically, and to behave appropriately.”
    • Students are often unaware of the above process.
  • PART III: DIRECT EFFECTS ON STUDENT LEARNING AND BEHAVIOR
    • IMPACT OF CHILDHOOD TRAUMA ON ACADEMIC PERFORMANCE
    • Language and communication skills:
      • Learning & retrieving new verbal information – hyperarousal interferes with learning readiness and ability to connect words to experience.
      • Social and emotional communication – language used to regulate behavior, not for social and emotional exchange.
      • Problem solving – requires adequate receptive/ expressive language, & ability to “extract key ideas” from what is said.
  • PART III: DIRECT EFFECTS ON STUDENT LEARNING AND BEHAVIOR
    • IMPACT OF CHILDHOOD TRAUMA ON ACADEMIC PERFORMANCE (2)
    • Organizing narrative material – difficulty establishing sequential ordering and remembering.
    • Cause-and-effect relationships – due to lack of predictability of environment. Lack of cause-and-effect helps explain student’s “resistance to behavior management techniques that assume understanding of cause and effect.”
  • PART III: DIRECT EFFECTS ON STUDENT LEARNING AND BEHAVIOR
    • IMPACT OF CHILDHOOD TRAUMA ON ACADEMIC PERFORMANCE (3)
    • Taking another’s perspective – sense of self too fragile, so unable to develop or offer empathy.
    • Attentiveness to classroom tasks – child is attentive, but often “paying attention to the wrong things.” Mediated by anxiety and fear, misinterpretation, and/or dissociation. As result, child falls behind, may give up.
  • PART III: DIRECT EFFECTS ON STUDENT LEARNING AND BEHAVIOR
    • IMPACT OF CHILDHOOD TRAUMA ON ACADEMIC PERFORMANCE (3)
    • Taking another’s perspective – sense of self too fragile, so unable to develop or offer empathy.
    • Attentiveness to classroom tasks – child is attentive, but often “paying attention to the wrong things.” Mediated by anxiety and fear, misinterpretation, and/or dissociation. As result, child falls behind, may give up.
  • PART III: DIRECT EFFECTS ON STUDENT LEARNING AND BEHAVIOR
    • IMPACT OF CHILDHOOD TRAUMA ON CLASSROOM BEHAVIOR (3)
    • Understanding the traumatized student’s aggressive behavior:
      • “… aggressive behavior is less akin to the willful defiance of an obstinate student than the response of a frightened child to his or her experience of traumatic violence.”
      • E.B. Carlson
  • PART III: DIRECT EFFECTS ON STUDENT LEARNING AND BEHAVIOR
    • IMPACT OF CHILDHOOD TRAUMA ON CLASSROOM BEHAVIOR (4)
    • Defiance – due to fear, anxiety and anger. Threats from adults to impel compliance “make the child feel more anxious, threatened, and out of control.”
    • Withdrawal – a conscious response due to anxiety, fear or depression, or a dissociative response.
    • Perfectionism – child’s response to inability to meet expectations at home and avoid trauma. May lead child to be easily frustrated and then give up.
  • PART III: DIRECT EFFECTS ON STUDENT LEARNING AND BEHAVIOR
    • IMPACT OF CHILDHOOD TRAUMA ON RELATIONSHIPS
    • Relationships with school personnel:
      • Essential for students to experience meaningful relationships with caring adults.
      • Adults must overcome student’s distrust and the tendency to overreact and challenge authority.
      • These behaviors can “frustrate educators and evoke exasperated reprisals.”
  • PART III: DIRECT EFFECTS ON STUDENT LEARNING AND BEHAVIOR
    • IMPACT OF CHILDHOOD TRAUMA ON RELATIONSHIPS (2)
    • Relationships with peers:
      • Absence of social skills creates awkwardness.
      • Low threshold for feeling “dissed” & over-stimulated.
      • May strike preemptively.
      • May use, rather than truly engage, peers.
      • Need assistance in initiating and maintaining friendships.
  • Impact of trauma on learning
    • Decreased IQ and reading ability (Delaney-Black et al., 2003)
    • Lower grade-point average (Hurt et al., 2001)
    • More days of school absence (Hurt et al., 2001)
    • Decreased rates of high school graduation (Grogger, 1997)
    • Increased expulsions and suspensions (LAUSD Survey)
  • PART IV: MAINTAINING TRAUMA INFORMED EDUCATIONAL SETTINGS
    • TRAUMA INFORMED STRATEGIES – FIRST STEPS:
    • Recognize child’s “negative behaviors” as adaptive and default responses, not intentional.
    • Determine if externally based trauma or danger continues, and address. Don’t change defenses when still needed for safety.
    • Discard use of certain terms and connotations, particularly “manipulative” and “attention-seeking.”
    • Understand culture of child and family.
    • Avoid coercion, shaming, and humiliation.
  • PART IV: MAINTAINING TRAUMA INFORMED EDUCATIONAL SETTINGS
    • TIC INVOLVES EFFORTS TO AVOID USE OF SECLUSION AND RESTRAINT
    • S/R only an emergency intervention of last resort.
    • S/R are re-traumatizing and non-therapeutic.
    • Use of S/R can also traumatize staff and observers.
    • S/R reduction & elimination are part of broader commitment to avoid interpersonal coercion.
    • Coercion traumatizes, and models violent responses to anxiety and stress.
  • PART IV: MAINTAINING TRAUMA INFORMED EDUCATIONAL SETTINGS
    • SPECIFIC COMPONENTS OF TRAUMA INFORMED EDUCATION (KEY ASPECTS)
    • Review policies and procedures with awareness of trauma informed practice.
    • Help students feel safe, physically & emotionally.
    • Balance accountability with understanding of traumatic behavior.
    • Use positive behavioral supports for accountability, based on affirmation and support.
  • PART IV: MAINTAINING TRAUMA INFORMED EDUCATIONAL SETTINGS
    • SPECIFIC COMPONENTS OF TRAUMA INFORMED EDUCATION (2)
    • Build on student strengths.
    • Create meaningful, structured opportunities for student decision-making (sense of agency).
    • Promote student involvement – school & community.
    • Teach self-regulation skills to students.
    • Reduce bullying and harassment.
  • PART IV: MAINTAINING TRAUMA INFORMED EDUCATIONAL SETTINGS
    • SPECIFIC TRAUMA INFORMED APPROACHES TO ACADEMIC INSTRUCTION
    • Offer predictability & safety– in routines and in expectation of positive responses; no surprises.
    • Break academic tasks down into smaller parts.
    • Use frequent support and encouragement.
    • Identify common triggers, with goal of prevention or mitigation of incidents.
  • PART IV: MAINTAINING TRAUMA INFORMED EDUCATIONAL SETTINGS
    • TRAUMA INFORMED APPROACHES TO ACADEMIC INSTRUCTION (2)
    • Use language-based teaching approaches:
      • Present information and directions in multiple (auditory and written) ways. Have child repeat and practice.
      • Process specific information by repeating sequences of events and highlighting cause-and-effect relationships.
      • Review & preview material, placing in familiar context.
      • Identify & process feelings – identifying, verbalizing, and understanding feelings promote self-regulation.
    • Ensure appropriate evaluations and Rx.
  • PART IV: MAINTAINING TRAUMA INFORMED EDUCATIONAL SETTINGS
    • USING RELATIONSHIPS TO PROMOTE TRAUMA INFORMED CULTURE IN EDUCATION
    • Understand that trauma is a central, life-organizing experience, which impairs neurobiological function & normal development.
    • Assume all students have experienced trauma (“universal precautions”).
    • Be aware of your attitudes and reactions.
    • Discover the person behind the behavior.
  • PART IV: MAINTAINING TRAUMA INFORMED EDUCATIONAL SETTINGS
    • USING RELATIONSHIPS TO PROMOTE TRAUMA INFORMED CULTURE IN EDUCATION (2)
    • Work hard to develop a trusting relationship, and let youth know you want to work together.
    • Model qualities that the youth needs to learn.
    • Manage your emotions, and remain professional.
    • Support skill acquisition & promote competence, to help youth improve self-control and coping.
  • PART IV: MAINTAINING TRAUMA INFORMED EDUCATIONAL SETTINGS
    • USING RELATIONSHIPS TO PROMOTE TRAUMA INFORMED CULTURE IN EDUCATION (3)
    • Help student see you as an ally & “a carrier of hope.”
    • Avoid intimidation, humiliation, shaming, and angry, punitive responses.
    • Help student identify potential triggers and how to manage them.
    • Address issues of safety, and ensure that the student is committed to own safety.
  • PART IV: MAINTAINING TRAUMA INFORMED EDUCATIONAL SETTINGS
    • USING RELATIONSHIPS TO PROMOTE TRAUMA INFORMED CULTURE IN EDUCATION (4):
    • Work with the student’s family.
    • Work with student’s school team and MH team, with school counselor as point person.
    • Help the student make positive changes in life – e.g. less risk-taking, resisting peer pressure, and associating with positive people.
    • Encourage the student to identify meaningful goals, accept responsibility, & put forth the effort.
  • CONCLUSION
    • Transformation, through use of trauma informed care
    • Taking care of ourselves, so we can help others
    • Outcomes of Trauma Informed Care (Hodas)
    • From To
    • Danger Safety
    • Fear Security
    • Uncertainty Predictability
    • Confusion Understanding
    • Disrespected Respected
  • CONCLUSION
    • Outcomes of Trauma Informed Care (3)
    • From To
    • Hyperaroused Calm
    • Reactive Reflective
    • Fragmented Coherent
    • Mistrusting Trusting
  • CONCLUSION
    • TAKING CARE OF OURSELVES AS HELPERS
    • Dealing with traumatized students and their behavior is itself traumatizing.
    • Range of possible internal reactions:
      • Sadness and anxiety.
      • Anger & rage.
      • Rescue fantasy.
      • Emotional depletion. “Compassion fatigue.”
    • In addition, many helpers themselves experienced trauma in their lives, and this can be reactivated.
  • CONCLUSION
    • HELPER COPING STRATEGIES INCLUDE:
    • Make calm and therapeutic responses a priority.
    • “ Don’t take it personally.”
    • View self as agent of prevention and empowerment.
    • Remember, child doing best he/she can, right now.
    • Keep goals realistic.
    • Don’t try to “make it all better” – you can’t.
    • Maintain personal boundaries with clients.
  • Other Effects of Trauma
    • Fear
    • Anxiety
    • Depression
    • Anger and hostility
    • Aggression
    • Sexually inappropriate behaviors
    • Self destructive behaviors
  • Other Effects of Trauma
    • Feelings of isolation and stigma
    • Poor self esteem
    • Difficulty in trusting others
    • Substance abuse and other high risk behaviors
  • Effective Practice Strategies
    • Modeling
    • Relaxation
    • Cognitive/Coping
    • Exposure
  • What is Modeling ?
    • Demonstration of a desired behavior by a therapist, confederates, peers, or other actors to promote the imitation and subsequent performance of that behavior by the identified youth
  • What is Relaxation ?
    • Techniques or exercises designed to induce physiological calming, including muscle relaxation, breathing exercises, meditation, and similar activities.
    • Guided imagery exclusively for the purpose of physical relaxation is considered relaxation.
  • Relaxation: Deep Breathing
    • Breathe from the stomach rather than from the lungs
    • Can be used in class without anyone noticing
    • Can be used during stressful moments such as taking an exam or while trying to relax at home
    • Children should breathe in to the count of 5, and out to the count of 5. Adolescents should breathe in and out to the count of 8
    • Have them take 3 normal breaths in between deep breaths
    • Have them imagine a balloon filling with air, then totally emptying
  • Relaxation: Mental Imagery/Visualization Tips
    • Have the student close his/her eyes and imagine a relaxing place such as a beach
    • While they imagine this, describe the place to them, including what they see, hear, feel, and smell
    • Younger students may use a picture or drawing to help them
  • Relaxation: Progressive Muscle Relaxation
    • Alternating between states of muscle tension and relaxation helps differentiate between the two states and helps habituate a process of relaxing muscles that are tensed
    • Many good tapes/c.d.’s available on relaxation
  • Praise
    • Praising correctly increases compliance in youth with ADHD
      • Praise can include
        • Verbal praise, Encouragement
        • Attention
        • Affection
        • Physical proximity
  • Giving Effective Praise
    • Be honest, not overly flattering
    • Be specific
    • No “back-handed compliments” (i.e., “I like the way you are working quietly, why can’t you do this all the time?”)
    • Give praise immediately
  • Ignoring and Differential Reinforcement
    • Train staff and teachers to selectively
      • Ignore mild unwanted behaviors
      • AND
      • Attend to and REINFORCE alternative positive behaviors
  • How to ignore
    • Visual cues
      • Look away once child engages in undesirable behavior
      • Do not look at the child until behavior stops
    • Postural cues
      • Turn the front of your body away from the location of child’s undesirable behavior
      • Do not appear frustrated (e.g., hands on hip)
      • Do not vary the frequency or intensity of your current activity (e.g., talking faster or louder)
  • How to ignore
    • Vocal cues
      • Maintain a calm voice even after your child begins undesirable behavior
      • Do not vary the frequency or intensity of your voice (e.g., don’t talk faster or shout over the child)
    • Social cues
      • Continue your intended activity even after your child begins undesirable behavior
      • Do not panic once child’s begins inappropriate behavior (i.e., do not draw more attention to child)
  • When to Ignore
    • When to ignore undesirable behavior
      • Child interrupts conversation or class
      • Child blurts out answers before question completed
      • Child tantrums
    • Do not ignore undesirable behavior that could potentially harm the child or someone else
  • Differential reinforcement
    • Step One : Ignore (stop reinforcing) the child’s undesirable behavior
    • Step Two : Reinforce the child’s desirable behavior in a systematic manner
      • The desirable behavior should be a behavior that is incompatible with the undesirable behavior
    • Example:
    • Target behavior: Interrupting
    • Desirable behavior: Working by himself
    • Reward schedule: 5 minutes
      • If child goes 5 minutes without interrupting, the child receives reinforcement
      • If child interrupts before 5 minutes is up, the child does not receive reinforcement and the reward schedule is reset
  • Practices that Work with Disruptive Behaviors
    • Praise
    • Commands/limit setting
    • Tangible rewards
    • Response cost
    • Psychoeducation
    • Problem solving
  • Steps to Making Effective Commands
    • To make eye contact with the child before giving command
    • To reduce other distractions while giving commands
    • To ask the child to repeat the command
    • To watch the child for one minute after giving the command to ensure compliance
    • To immediately praise child when s/he starts to comply
  • Effective Commands/Limit Setting with Adolescents
      • Praise teens for appropriate behavior
      • Tell teen what to do, rather than what not to do
      • Eliminate other distractions while giving commands
      • Break down multi-step commands
      • Use aids for commands that involve time
      • Present the consequences for noncompliance
      • Not respond to compliance with gratitude
  • Acting Out Cycle Calm Trigger Agitation Acceleration Peak De-escalation Recovery Adapted from The Iris Center: http://iris.peabody.vanderbilt.edu
  • Setting up a Reward System for Children at School
    • School staff tracks the child’s behavior and reports it to the parent daily.
      • Rewards can given at home or at school
    • Choose a few target behaviors at school
      • Choose one that the child will be successful with most of the time
      • Set up a system for school report card or school/home note system
    • Set up a daily report card targeting one to three behaviors
    • Can also set up guidance counselor, tutor or peer as “coach” for organizational skills or other targets
  • General Strategies
    • Use active listening
    • Don’t be afraid to show that you care
    • Be a good role model
    • Take the time to greet students daily
    • Show genuine interest in their lives and hobbies
    • Find and reinforce the positives
    • Move beyond labels and leave assumptions at home!
    • Smiles are contagious
    • Take the time to problem solve with students
    • Involve families in a child’s education
    • Instill hope about the future