1<br />Treating Traumatized Children: 	Risk, Resilience, and Recovery<br />Danny Brom, Ph.D.<br />Director<br />Best Pract...
2<br />Objectives of the lecture<br />1. Get acquainted with an integrative model of intervention to protect children in t...
3<br />
4<br />What do we know about the influence of trauma on children?<br />When she hears the alarm again everything freezes. ...
5<br />What we also know <br /><ul><li>The literature on traumatized children is far behind the literature on traumatized ...
Traumatized children hardly show up for services</li></li></ul><li>6<br />From:Sent:Wednesday, July 16, 2008 5:18 PMTo:rgi...
7<br />
8<br />What is resilience?<br />Individual Resilience is the ability of the organism to adapt positively in the context of...
9<br />What is societal Resilience<br />Societal resilience is the ability of society to adapt positively to adversity and...
10<br />What are the challenges for society after massive trauma?<br />Survival mode (focus on short term immediate soluti...
11<br />1. Survival mode<br />Focus on Preparedness <br />	(preparing for the past)<br />Focus on prevention, often to the...
12<br />2. Patterns of Traumatic Bonding<br />Strong bonding in peak periods (in-group)<br />Wild growth of volunteer orga...
13<br />Traumatic bonding long-term: an example from Israel<br />	Life in Israel has grown cheap. In place of asociety of ...
14<br />A New Orleans example<br />01/08/2009 Katrina&apos;s Hidden Race War<br />Repost from The Nation; an investigative...
15<br />3. Feelings of helplessness<br />Strong emphasis on doing and helping<br />Emphasis on heroism<br />Depression and...
16<br />3. Feelings of helplessness<br />Multi-layered traumatic memories are based in personal, familial, cultural experi...
17<br />4. Isolation of victim groups<br />Estrangement between victims and non-victims is a two-way process<br />Victims ...
18<br />5. Isolation of victim groups(cont..)<br />Care of victims may perpetuate their special (i.e. isolated) status<br ...
19<br />5. Sensation seeking<br />Keeping up alertness<br />Addiction to alertness (adrenaline)<br />Risk-taking behavior<...
20<br />6. Disregulation<br />Exhaustion<br />Disregulation of anger<br />Perception of time<br />Memory for immediate pas...
21<br />So, what can we do when massive trauma hits?<br /><ul><li>Prevention/building resilience ?
Early detection ?
Therapy ?</li></ul>How do we build all of this into one integrated system?<br />
22<br />Third Generation Trauma Services<br />First Generation = Trauma – Pathology - Treatment<br />Second Generation = P...
23<br />Five Main Fields of Services<br /><ul><li>Building Resilience
Immediate Intervention
Detection of disorders
Treatment
Training</li></li></ul><li>24<br />Integrative intervention for protecting children:Community and Clinical Intervention Mo...
25<br />Direct care for children:Community and Clinical Intervention Model<br />Ecological – systemic intervention<br />Co...
26<br />Capacity building for trauma care:Community and Clinical Intervention Model<br />Ecological – systemic interventio...
27<br />Integrative intervention for protecting children:Community and Clinical Intervention Model<br />Ecological – syste...
28<br />Continuum of Services<br />Pre-event<br />Long- term<br />Immediate Care<br />Community<br />Event<br />Target gro...
29<br />Example of school intervention<br /><ul><li>Discussion with principal and leading team
Workshop for school staff
Parent meeting
Information and consent regarding screening
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"An ecological model of taking care of traumatized children" by Dr. Danny Brom

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"An ecological model of taking care of traumatized children" by Dr. Danny Brom

  1. 1. 1<br />Treating Traumatized Children: Risk, Resilience, and Recovery<br />Danny Brom, Ph.D.<br />Director<br />Best Practices In Disaster Mental Health and Resilience: What Is, What Could Be!<br />New Orleans, <br />March 19, 2009 <br />
  2. 2. 2<br />Objectives of the lecture<br />1. Get acquainted with an integrative model of intervention to protect children in the face of war and disaster2. Understand the organizational and communal resources needed for community wide implementation of resilience programs.3. Share some thoughts about how to bring new models of care into the system<br />
  3. 3. 3<br />
  4. 4. 4<br />What do we know about the influence of trauma on children?<br />When she hears the alarm again everything freezes. She regressed back to behaving like a baby, bedwetting and asking for a bottle, or pacifier.<br />At first he was very afraid of the Kassams and the sounds. Slowly a new process begun, I think- repression. When a Kassam falls he opens the door and runs out to see where it fell, and what is happening, he became very involved with all this, like Wow- great a Kassam fell, fascinating. He is not afraid any more.<br />I prefer to decide what to do with my life and not let them decide for me… (when asked why he took risks)<br />
  5. 5. 5<br />What we also know <br /><ul><li>The literature on traumatized children is far behind the literature on traumatized adults
  6. 6. Traumatized children hardly show up for services</li></li></ul><li>6<br />From:Sent:Wednesday, July 16, 2008 5:18 PMTo:rgill@herzoghospital.orgSubject:Israel Center for the Treatment of Psychotrauma - Ask The Expert<br />שם פרטי: רשם משפחה: ג:<br />הודעה:שלום רב!שמי ר אני בת 34 נשואה ואמא ל-4 ילדים,הבעיה שלי היא עם בני בן ה-4 שנים. הוא לא מפסיק לדבר על נסראלה. במלחמה הוא היה רק בן שנתיים, אבל הוא זוכר את הכול. מאז המלחמה אני לא יכולה לצאת לעבוד ולא לעזוב אותו בכלל. הילד רואה את נסראלה בחדשות הוא מתעצבן ומרביץ לטלויזיה. אם אנחנו קונים לו משחקים שמתאימים לילד בן 4 הוא לא נוגע בהם, הוא רוצה רק חרבות ונשקים. כשהוא יושב לצייר הוא מצייר קטיושות או פצצות ארוכות שיגיעו לנסראלה. אני לא יודעת למי ליפנות אני מבקשת את עזרתכם אני לא רוצה שהילד יגדל עם כל כך הרבה שנאה ויהפוך להיות אלים.בברכה ותודה ר <br />I am 34, married, and a mother of 4 children. My problem relates to my 4 year old son. He does not stop talking about Nasrallah. During the war he was only two years old but he remembers everything. Since the war, I can not go to work nor leave him alone. When he sees Nasrallah on TV he becomes angry and hits the TV. When we buy him age appropriate toys he refuses to play with them and is interested only in weapons and swords. When he draws, he draws only Katyushas or bombs and says he wants them to reach Nasrallah. I do not know who to contact and I am asking for your help. I am afraid he will grow up with so much hatred and may become a violent person. <br />Thank you in advance, R.<br />
  7. 7. 7<br />
  8. 8. 8<br />What is resilience?<br />Individual Resilience is the ability of the organism to adapt positively in the context of past or present adversity. <br />Questions:<br />What is positive adaptation?<br />Are we talking about “ability”?<br />What kind of adversity..?<br />
  9. 9. 9<br />What is societal Resilience<br />Societal resilience is the ability of society to adapt positively to adversity and keep society functional, supportive and open.<br />
  10. 10. 10<br />What are the challenges for society after massive trauma?<br />Survival mode (focus on short term immediate solutions)<br />Patterns of Traumatic Bonding <br />Coping with feelings of helplessness<br />Isolation of victim groups <br />Sensation seeking<br />disregulation <br />
  11. 11. 11<br />1. Survival mode<br />Focus on Preparedness <br /> (preparing for the past)<br />Focus on prevention, often to the exclusion of the curative approach<br />Neglect of long-term planning<br />
  12. 12. 12<br />2. Patterns of Traumatic Bonding<br />Strong bonding in peak periods (in-group)<br />Wild growth of volunteer organizations, often competing fiercely.<br />Neglect (and often isolation) of groups that are seen as “guilty”, or as “not coping”. <br />Strong rejection of out-group<br />
  13. 13. 13<br />Traumatic bonding long-term: an example from Israel<br /> Life in Israel has grown cheap. In place of asociety of mutual cohesiveness and genuinesolidarity, we have alienation, and peoplemerely pay lip service to the grief of others.This is an inevitable development: the worsethe armed struggle ... , themore Israel&apos;s citizens are concerned with theirown well-being and repress the significance ofthe ever-increasing bereavement.<br /> U. Benziman, Haaretz 26/10/03<br />
  14. 14. 14<br />A New Orleans example<br />01/08/2009 Katrina&apos;s Hidden Race War<br />Repost from The Nation; an investigative report supported by the Nation Institute. In Algiers Point, white vigilantes shot African Americans with impunity in the days following Hurricane Katrina. <br />
  15. 15. 15<br />3. Feelings of helplessness<br />Strong emphasis on doing and helping<br />Emphasis on heroism<br />Depression and fatalism<br />Continuous search for protection/new solutions<br />Ongoing grief and Death Imprint<br />
  16. 16. 16<br />3. Feelings of helplessness<br />Multi-layered traumatic memories are based in personal, familial, cultural experiences<br />
  17. 17. 17<br />4. Isolation of victim groups<br />Estrangement between victims and non-victims is a two-way process<br />Victims feels alone:<br />“No one under-stands me”<br />2. Need for recognition (narcissistic phase)<br />Society creates special status for victims<br />
  18. 18. 18<br />5. Isolation of victim groups(cont..)<br />Care of victims may perpetuate their special (i.e. isolated) status<br />Professionals sometimes are unable to hear their traumatized clients (Danieli) (Counter transference in the best case)<br />“Blaming the victim” serves to reduce anxiety<br />Children<br />Grief<br />
  19. 19. 19<br />5. Sensation seeking<br />Keeping up alertness<br />Addiction to alertness (adrenaline)<br />Risk-taking behavior<br />
  20. 20. 20<br />6. Disregulation<br />Exhaustion<br />Disregulation of anger<br />Perception of time<br />Memory for immediate past<br />
  21. 21. 21<br />So, what can we do when massive trauma hits?<br /><ul><li>Prevention/building resilience ?
  22. 22. Early detection ?
  23. 23. Therapy ?</li></ul>How do we build all of this into one integrated system?<br />
  24. 24. 22<br />Third Generation Trauma Services<br />First Generation = Trauma – Pathology - Treatment<br />Second Generation = Prevention Programs<br />
  25. 25. 23<br />Five Main Fields of Services<br /><ul><li>Building Resilience
  26. 26. Immediate Intervention
  27. 27. Detection of disorders
  28. 28. Treatment
  29. 29. Training</li></li></ul><li>24<br />Integrative intervention for protecting children:Community and Clinical Intervention Model<br />Ecological – systemic intervention<br />Community<br /> intervention<br />Screening<br /> process<br />Therapeutic <br />intervention<br />Parent <br />Groups<br />Care <br />givers<br />Groups<br />Therapists <br />training<br />First<br />Phase<br />Interviewers <br />training<br />4 treatment <br />modules<br />Group<br />facilitator<br />training<br />Second <br />Phase<br />“How do we cope?<br />Community Resilience”<br />Treatment<br />Identifying toddlers and parents in distress <br />Empowerment and assistance on the individual and community level <br />
  30. 30. 25<br />Direct care for children:Community and Clinical Intervention Model<br />Ecological – systemic intervention<br />Community<br /> intervention<br />Screening<br /> process<br />Therapeutic <br />intervention<br />Parent <br />Groups<br />Care <br />givers<br />Groups<br />First<br />Phase<br />4 treatment <br />modules<br />Second <br />Phase<br />Assistance on the individual and community level <br />
  31. 31. 26<br />Capacity building for trauma care:Community and Clinical Intervention Model<br />Ecological – systemic intervention<br />Community<br /> intervention<br />Screening<br /> process<br />Therapeutic <br />intervention<br />Therapists <br />training<br />Interviewers <br />training<br />Group<br />facilitator<br />training<br />“How do we cope?<br />Community Resilience”<br />Increasing <br />capacity<br />Identifying toddlers and parents in distress <br />Empowerment and assistance on the individual and community level <br />
  32. 32. 27<br />Integrative intervention for protecting children:Community and Clinical Intervention Model<br />Ecological – systemic intervention<br />Screening<br /> process<br />Therapeutic <br />intervention<br />Community<br /> intervention<br />Parent <br />Groups<br />Care <br />givers<br />Groups<br />Therapists <br />training<br />First<br />Phase<br />Interviewers <br />training<br />4 treatment <br />modules<br />Group<br />facilitator<br />training<br />Second <br />Phase<br />“How do we cope?<br />Community Resilience”<br />Treatment<br />Identifying toddlers and parents in distress <br />Empowerment and assistance on the individual and community level <br />
  33. 33. 28<br />Continuum of Services<br />Pre-event<br />Long- term<br />Immediate Care<br />Community<br />Event<br />Target group Content <br />Agency <br />
  34. 34. 29<br />Example of school intervention<br /><ul><li>Discussion with principal and leading team
  35. 35. Workshop for school staff
  36. 36. Parent meeting
  37. 37. Information and consent regarding screening
  38. 38. Screening - administration of self report questionnaires by teachers and research assistants in the classroom
  39. 39. Classroom debriefing with teacher and research assistant
  40. 40. Feedback of results to school counselors
  41. 41. Counselor interview to validate screening results
  42. 42. Meeting with parents and identified child for decision making and referral to school or community based services
  43. 43. Start a whole school resiliency program
  44. 44. More specialized school based programs after follow- up</li></li></ul><li>30<br />An example: Living Under Threat of Missiles: Toddler-Parents Resilience Project in Sderot – Israel<br />Research Team<br />Community Team<br />Treatment Team<br />New- York Team<br />Israel Center for the Treatment of Psychotrauma, Herzog Hospital, Jerusalem, Israel<br />Mashabim, Kiryat Shmona, Israel<br />Psychological Services, Shaar Hanegev, Israel<br />Mount Sinai School of Medicine, New York, NY <br />Dr. Ruth Pat-Horenczyk<br />Osnat Peled<br />Michal Achituv<br />Alon Weltman<br />Dr. Daniel Brom<br />Nira Kaplansky<br />Dalia Yosef<br />Prof. Mooli Lahad<br />Ornit Rosenblat<br />Zvi Fajerman<br />Dr. Claude Chemtob<br />Shelley Horwitz, UJA Federation of NY<br />The study has been supported by UJA-Federation of New York through a grant from The Picower Foundation<br />
  45. 45. 31<br />Community Intervention<br /><ul><li>Enhancing Parental Resiliency
  46. 46. Psycho education
  47. 47. Learning to Play Again
  48. 48. Identify Coping Resources
  49. 49. Enhancing community support</li></li></ul><li>32<br />Organizational demands<br />Sound organizational thinking<br />Learn from mistakes<br />Multi-level involvement<br />Buy-in from highest level<br />Psycho-education and training as organizational tools<br />
  50. 50. 33<br />Conclusions<br />When trauma is a massive presence in society, we need to think systemically and get away from our “one-on-one” orientation to therapy.<br />Active screening and outreach to children at risk are highly effective for all ages<br />The big challenge for the science of traumatology is to see if “resilience” can be built or strengthened. <br />
  51. 51. 34<br />Conclusions (cont…)<br />4. Understanding and utilizing human need to help and to bond in ongoing trauma can enhance social resilience<br />5. Long-term planning and inter-agency collaboration are indicated<br />
  52. 52. 35<br />So what am I saying?<br />We need to open our minds to broader concepts than PTSD.<br />There are natural tendencies of society that counteract the planning of services in the midst of ongoing trauma<br />Mental health workers can be most effective in a post-disaster or post-war environment if they transcend their clinical role.<br />
  53. 53. 36<br />
  54. 54. 37<br />For more information:<br />www.traumaweb.org<br />Thank you !!<br />

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