Orientation To Child Trauma


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This is a quick review of the presentation by the CTAC team in February at Hillsdale College

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  • Orientation To Child Trauma

    1. 1. Module I Orientation to Child Trauma Assessment
    2. 2. Part I <ul><li>A Review of the Community Session with CTAC </li></ul>
    3. 3. Project Goal <ul><li>Introduce and embed trauma informed knowledge and practices </li></ul><ul><li>culturally competent </li></ul><ul><li>evidence supported/based </li></ul><ul><li>responsive to the needs of traumatized children and their families </li></ul>
    4. 4. Changes Desired: <ul><li>System change </li></ul><ul><li>Service delivery </li></ul><ul><li>Child & Family outcomes </li></ul>
    5. 5. DHS CMH SCHOOLS COURTS Resource Parents
    6. 6. The Team
    7. 9. Cultural & Linguistic Competence Yvette D. Hyter, Ph.D., CCC-SLP Speech-Language Pathologist Western Michigan University Children's Trauma Assessment Center
    8. 10. Why this information is important <ul><li>World is becoming more global. </li></ul>U. S. is becoming more diverse U. S. counties are following the same trend Image from Office of Languages, Canada
    9. 11. Culture is like an Iceberg <ul><li>What is visible? </li></ul><ul><li>What is underneath the surface? </li></ul>Photo courtesy of L. Hyter (1997) Ting-Toomey, 1999
    10. 12. Every Living Being has Culture Degazon, C. E. (2008) <ul><li>Organizing structures include </li></ul><ul><ul><ul><ul><ul><li>Child rearing practices </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Religion </li></ul></ul></ul></ul></ul><ul><li>Family structure </li></ul><ul><ul><li>Physical space </li></ul></ul><ul><ul><ul><li>Communication </li></ul></ul></ul>
    11. 13. Diversity within Cultures <ul><li>Diversity includes </li></ul><ul><ul><li>Immigrant status </li></ul></ul><ul><ul><li>Race </li></ul></ul><ul><ul><li>Ethnicity </li></ul></ul><ul><ul><li>Socioeconomic status </li></ul></ul><ul><li>and it includes </li></ul><ul><ul><li>Social class </li></ul></ul><ul><ul><li>Sexual orientation </li></ul></ul><ul><ul><li>Gender identity </li></ul></ul><ul><ul><li>Disability </li></ul></ul>
    12. 14. Pathway to Cultural & Linguistic Competence Awareness Sensitivity Reciprocity Competence Open to others; learning about cultural histories, values, beliefs (Adams, 1995) Aware of differences & similarities that have an effect on values and behavior; no value judgments (Stafford et al., 1997) Coordinated behaviors, attitudes, and policies that allow effect service across multiple cultural & linguistic groups (Cross et al., 1989 Recognition underlying taken-for-granted assumptions, how they guide behaviors and affect those that do not hold them (Kalyanpur & Harry, 1999)
    13. 15. Reflect, Revise, Retry Know Your Self and your group Understand History Learn from others Ten Principle Practices Eliminate ethnocentrism Cultural Competence Learn from mistakes made Tear down barriers Be accountable Honor Uniqueness Center other experiences Hyter, 2009
    14. 17. The Brain-Behavior Connection Neurobiological & Neurodevelopmental Impact of Traumatic Stress & Prenatal Alcohol Exposure in Children & Adolescents: Understanding Difficult Behaviors Mark A. Sloane, DO, FACOP, FAAP Kalamazoo, MI 18 February 2009
    15. 18. Mind (Brain)-Boggling Numbers <ul><li>100 BILLION </li></ul><ul><li>1000 </li></ul><ul><li>100 TRILLION </li></ul><ul><li>Neurons in the human brain </li></ul><ul><li>Potential connections for single neuron </li></ul><ul><li>Total possible neuron connections </li></ul>
    16. 19. Building the brain From simple to complex: Hierarchy of brain function Brain- stem Diencephalon Limbic Neocortex Abstract Thought Concrete Thought Executive Function Attachment Sexual Behavior Emotional Regulation Motor Regulation Motivation Arousal Sleep BP / Heart Rate Respiratory Drive Body Temperature Perry 2006 All sensory input enters here
    17. 20. The Delicate Balance: Brain control of emotion / behavior Top-Down “ Brakes ” (Prefrontal Cortex) Bottom-Up “Accelerator” (Brainstem/Limbic System)
    18. 21. So… now let’s talk about the accelerator
    19. 22. Wake up!!! Let’s talk about arousal …
    20. 23. No energy / tired & sleepy (Eeyore) Optimal “Goldilocks” Arousal Way too wound-up / “wild” (“Tigger - on crack”) Arousal Genesis / Regulation Too wound-up (Tigger)
    21. 24. Role of Anxiety & Panic in Mood / Emotion Generation <ul><li>Fight-Flight-Freeze concepts </li></ul><ul><li>Anxious boys and girls can look different </li></ul><ul><li>Anxiety / Panic  Anger/explosiveness </li></ul><ul><li>Multiple causes for this in kids </li></ul><ul><ul><li>Genetic </li></ul></ul><ul><ul><li>Environmental (traumatic stress) </li></ul></ul>
    22. 25. Next, let’s talk about the… BRAKES
    23. 26. The Prefrontal Cortex: The home of Executive Function <ul><li>Executive Function: </li></ul><ul><li>The “brakes” of the brain </li></ul><ul><li>Working memory </li></ul><ul><li>Attention regulation </li></ul><ul><li>Planning / organizing </li></ul><ul><li>Impulse control </li></ul><ul><li>Mental flexibility </li></ul><ul><li>Self-monitoring </li></ul>
    24. 27. Experience alters brain structure <ul><li>These sculpted changes are structural changes seen in response to the specific environment </li></ul><ul><li>Allow the child’s brain to become the best brain for the given surroundings </li></ul><ul><ul><li>Implications for traumatic stress </li></ul></ul><ul><ul><li>Implications for foster care placements </li></ul></ul>
    25. 28. Building (& Rebuilding) the Brain Neural systems can be changed / treated but some systems are easier to change Brain- stem Diencephalon Limbic Neocortex Complexity Plasticity & Ease of change
    26. 29. Child Traumatic Stress & the Developing Brain
    27. 30. Traumatic Stress & the Child’s Developing Brain <ul><li>Research reveals a strong link between all types of child abuse /neglect and the subsequent development of psychiatric illness in adulthood </li></ul><ul><li>New findings link child traumatic stress with variety of adult medical illness </li></ul><ul><li>VJ Felitti, MD </li></ul>
    28. 31. Traumatic Stress & the Child’s Developing Brain <ul><li>Early childhood traumatic stress to the developing brain results in: </li></ul><ul><ul><li>Physical “hard wired” brain changes that : </li></ul></ul><ul><ul><ul><li>Cause abnormal functioning (including memory) </li></ul></ul></ul><ul><ul><ul><li>Contribute to problematic behaviors </li></ul></ul></ul><ul><ul><ul><li>Contribute to developmental delays </li></ul></ul></ul><ul><ul><ul><li>Result in child being unable to realize potential </li></ul></ul></ul>
    29. 32. So…what about neglect???
    30. 33. But…this case only involves neglect !
    31. 34. Impact of Severe Neglect
    32. 35. Complex Trauma: Summary <ul><li>Affects the structure & function of the brain in ways that negatively affect all stages of development: </li></ul><ul><ul><li>Social </li></ul></ul><ul><ul><li>Emotional </li></ul></ul><ul><ul><li>Cognitive </li></ul></ul>
    33. 36. Complex Trauma And Developmental Trauma Disorder Connie Black-Pond MA, LMSW, LPC
    34. 37. <ul><ul><li>Children who experienced complex trauma have endured multiple interpersonal traumatic events from a very young age </li></ul></ul><ul><ul><li>The trauma was usually caused by adults who should have been caring for and protecting the child </li></ul></ul>What is Complex Trauma? Sources: Cook et al. (2005). Psychiatry Ann ,35 (5):390-398; van Der Kolk & Courtois. (2005) J Trauma Stress , 18 :385-388 . The term Complex trauma (or Developmental Trauma Disorder ) describes exposure to chronic (repeated) trauma and the impact of such exposure (traumatic stress) on the child.
    35. 38. Domains Impacted by Complex Trauma Behavioral Control Cognition Attachment Dissociation Affect Regulation Biology Self Concept
    36. 39. Functional Impairment <ul><ul><li>Scholastic </li></ul></ul><ul><ul><li>Familial </li></ul></ul><ul><ul><li>Peer </li></ul></ul><ul><ul><li>Legal </li></ul></ul><ul><ul><li>Vocational </li></ul></ul>
    37. 40. Generalized Expectancies of the Traumatized Child <ul><ul><li>Negative self-attribute </li></ul></ul><ul><ul><li>Loss of caregiver </li></ul></ul><ul><ul><li>Loss of protection </li></ul></ul><ul><ul><li>Loss of trust in social system </li></ul></ul><ul><ul><li>Lack of recourse </li></ul></ul><ul><ul><li>Inevitability of future victimization </li></ul></ul>
    38. 41. What do we see? <ul><li>Disruptions of affect regulation </li></ul><ul><li>Disturbed attachment patterns </li></ul><ul><li>Rapid behavioral regressions and shifts in emotional states </li></ul><ul><li>Loss of autonomous strivings </li></ul><ul><li>Aggression towards self and/or others </li></ul><ul><li>Failure to achieve developmental strides </li></ul>
    39. 42. <ul><li>Loss of bodily regulation: sleep, food and self care </li></ul><ul><li>Negative working models of their world </li></ul><ul><li>Somatic problems </li></ul><ul><li>Anticipatory and traumatic reactions </li></ul><ul><li>Self hatred and self blame </li></ul><ul><li>Chronic sense of ineffectiveness/helplessness </li></ul>
    40. 43. <ul><li>May suffer from distinct alterations of states of consciousness: </li></ul><ul><ul><li>Amnesia </li></ul></ul><ul><ul><li>Difficulties with attention </li></ul></ul><ul><ul><li>Disorientation in time and space </li></ul></ul><ul><ul><li>Unable to identify internal states - alexythimia </li></ul></ul>
    41. 44. <ul><li>The child’s age and developmental stage </li></ul><ul><li>The child’s perception of the danger faced </li></ul><ul><li>Whether the child was the victim or a witness </li></ul><ul><li>The child’s relationship to the victim or perpetrator </li></ul><ul><li>The child’s past experience with trauma </li></ul><ul><li>The challenges the child faces following the trauma </li></ul><ul><li>The presence/availability of adults who can offer help, reassurance, and protection </li></ul>Other factors that affect a child’s experience of a potentially traumatic event include:
    42. 45. <ul><li>If we don’t look for or acknowledge trauma in the lives of children and adolescents, we end up chasing behaviors and limiting the possibilities for change. </li></ul>
    43. 46. <ul><li>The behavioral and emotional adaptations that maltreated children make in order to survive are brilliant, creative solutions, and are personally costly. </li></ul>
    44. 47. <ul><li>If you don’t ask, they won’t tell. </li></ul>
    45. 48. Traumatic Expectations of the World
    46. 49. How Children Respond to Trauma <ul><li>A strong relationship with a competent, caring adult </li></ul><ul><li>Feeling connected with positive role models/mentors </li></ul><ul><li>Being able to reach out to others for help </li></ul><ul><li>Having his or her talents/abilities recognized and appreciated </li></ul><ul><li>Having empathy and caring for other people </li></ul><ul><li>Good communication and social skills </li></ul><ul><li>A sense of humor </li></ul>Factors that may help a child “bounce back” from traumatic events include:
    47. 50. <ul><li>Trauma = chaos, </li></ul><ul><li>Structure = healing </li></ul>
    48. 51. Sensory Processing Disorder Ben J. Atchison, PhD, OTR, FAOTA Department of Occupational Therapy Western Michigan University
    49. 52. Sensory Processing is.. <ul><li>Detection </li></ul><ul><li>Registration </li></ul><ul><li>Modulation </li></ul><ul><li>Response </li></ul>
    50. 53. Key Idea is: <ul><li>ADAPTIVE RESPONSE </li></ul><ul><li>Meaningful </li></ul><ul><li>Purposeful </li></ul><ul><li>Organized </li></ul>
    51. 54. Sensory Processing Disorder (SPD) Sensory Modulation Disorder Sensory-Based Motor Disorder Sensory Discrimination Disorder SOR SUR SS SOR=Sensory Over-reactivity-Low threshold SUR=Sensory Under-reactivity-High Threshold SS=Sensory Seeking/Craving-High Threshold Miller, et al, (2007) , Mar.April AJOT Dsypraxia Postural Disorders Visual Auditory Tactile Position/Mvt Taste Smell
    52. 55. <ul><li>Children with a trauma history demonstrate significant prevalence of sensory modulation disorders </li></ul><ul><li>Atchison (2008) </li></ul>
    53. 56. <ul><li>This atypical responsiveness has a significant impact on the quality of life </li></ul><ul><li>for these children and their families by limiting their participation in home, school, </li></ul><ul><li>and community activities </li></ul><ul><li>Cohn, Miller, & Tickle-Degnen, 2000; Dunn, 2001;Dunn & Westman, 1997; </li></ul><ul><li>Miller, Reismann McIntosh, & Simon, 2001; Parham & </li></ul><ul><li>Mailloux, 1995) and countless parent testimony… </li></ul>
    54. 57. <ul><li>There are five key limitations or disabilities commonly demonstrated by </li></ul><ul><li>children with disturbances in sensory modulation </li></ul><ul><li>Parham and Mailloux (1995) </li></ul>
    55. 58. Including… <ul><li>(1)Decreased social skills and participation in play </li></ul><ul><li>(2) Disturbances in self-confidence–self-esteem </li></ul><ul><li>(3) Difficulties with daily life skills and at school </li></ul><ul><li>(4) Anxiety, disturbances in attention, and </li></ul><ul><li>disturbances in the ability to regulate reactions to others </li></ul><ul><li>(5) Disturbances in skill development </li></ul>
    56. 59. Social Communication Yvette D. Hyter, Ph.D., CCC-SLP Speech-Language Pathologist Western Michigan University Children’s Trauma Assessment Center [email_address] , 269-387-8025
    57. 60. <ul><li>“ A new world of complex relationships and feelings opens up when the peer group takes its place along side the family as the emotional focus of the child’s life. </li></ul>Greenspan, S. (1993) cited in Nelson, N. W.
    58. 61. Early Peer Relationships Contribute To: <ul><li>Work in groups </li></ul><ul><li>Deal with disappointment </li></ul><ul><li>Enjoy friendships </li></ul><ul><li>Understand social relations </li></ul>Greenspan, S. (1993) cited in Nelson, N. W.
    59. 62. Social Communication <ul><li>The ability to </li></ul><ul><li>and </li></ul>Coggins, Timler, & Olswang, 2007 influence others understand and interpret social situations
    60. 63. Social Communication Framework Higher Order Executive Functions Decision making and strategic planning processes Social Communicative Behaviors Social Communicative Competence Using language in interpersonally appropriate ways to successfully influence people and interpret events Coggins, T. E., Timler,G. R. & Olswang, L.. B. (2007). Social Cognition Understanding why people act in certain ways and what they are likely to do next. Language Sentence Structure Word meanings/relationships Language use
    61. 64. Benefits of Social Communication: <ul><li>Development of positive peer interactions </li></ul><ul><li>Higher levels of prosocial behaviors </li></ul><ul><li>Less aggression </li></ul><ul><li>Boosts self esteem </li></ul><ul><li>Supports positive mental health </li></ul><ul><li>Supports interactions throughout the life span </li></ul>
    62. 65. Hey!.....Here’s a good idea!... Let’s finish with a group… stress test!!!
    63. 66. Stress Test <ul><li>The next picture contains 2 identical dolphins. It has been recently used in national stress research. </li></ul><ul><li>Notice the two dolphins jumping out of the water. The dolphins are identical. A closely monitored, scientific study revealed that, in spite of the fact that the dolphins are identical, a person under stress would find differences in the two dolphins. The more differences found between the dolphins, the more stress that person is experiencing. </li></ul><ul><li>Look closely at the photo and if you find more than one or two differences, you need to go on vacation. </li></ul>
    64. 68. Are You Ready…For the Next Step? Are You Ready for the Next Step?
    65. 69. You Are Ready….IF… <ul><li>Commitment </li></ul><ul><li>Energy </li></ul><ul><li>Passion </li></ul><ul><li>Teaming </li></ul>
    66. 70. This presentation is part of a comprehensive professional education and training project created by the SW Michigan Children’s Trauma Assessment Center funded by a grant from the Substance Abuse and Mental Health Services, Department of Health and Human Services which funds the National Children’s Trauma Stress Network