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Trauma Informed Services and PBiS at LSSU


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Trauma Informed Services and PBiS at LSSU

  1. 1. Nicole Mondejar, MHAEarly Childhood Programs Administrator/WCMHS PBiS Implementation Coach /Lamoille Region May 24th, 2012
  2. 2.  Brain Development & Trauma/Stress Scope of the problem How PBiS can help
  3. 3. Trauma & Toxic StressPositive Stress All managed by brain circuits and hormones in the body .Tolerable Stress Prolonged exposure to stress hormones = impaired brainToxic Stress development and functioning.
  4. 4. Trauma & Toxic StressTrauma is defined as a physical or psychological threat or assault to a child’s physical integrity, sense of self, safety or survival or to the physical safety of another person significant to the child. (VT CUPS Handbook)
  5. 5. Children may experience trauma as aresult of a number of differentcircumstances, such as: Abuse including sexual, physical and/or emotional Abandonment or neglect Witness to domestic violence Death or loss of a loved one Severe natural disasters War, terrorism, military or police actions (including media images) Witness to community violence Personal attack by another person or an animal Kidnapping Severe bullying Medical procedure, surgery, accident or serious illness Living in chronically chaotic environments
  6. 6. Brain Development
  7. 7. Brain Development
  8. 8. Brain Development
  9. 9. Brain Development
  10. 10. Brain Development
  11. 11. Adversity in Early Childhood
  12. 12. Adversity in Early Childhood
  13. 13. Adversity in Early Childhood
  14. 14. 7 Domains of Impairment in Children Exposed to Complex Trauma1. ATTACHMENT: Uncertainty about the reliability and predictability of the world Problems with boundaries Distrust and suspiciousness Social isolation Interpersonal difficulties Difficulty attuning to other people’s emotional states Difficulty with perspective taking Difficulty enlisting other people as allies
  15. 15. 7 Domains of Impairment in Children Exposed to Complex Trauma2. BIOLOGY: Sensorimotor developmental problems Hypersensitivity to physical contact Analgesia Problems with coordination, balance, body tone Difficulties localizing skin contact Somatization Increased medical problems across a wide span, e.g., pelvic pain, asthma, skin problems, autoimmune disorders, pseudo seizures
  16. 16. 7 Domains of Impairment in Children Exposed to Complex Trauma3. AFFECT REGULATION: Difficulty with emotional self-regulation Difficulty describing feelings and internal experience Problems knowing and describing internal states Difficulty communicating wishes and desires4. DISSOCIATION: Distinct alterations in states of consciousness Amnesia Depersonalization and derealization Two or more distinct states of consciousness, with impaired memory for state-based events
  17. 17. 7 Domains of Impairment in Children Exposed to Complex Trauma5. BEHAVIORAL CONTROL: Poor modulation of impulses Self-destructive behavior Aggression against others Pathological self-soothing behaviors Sleep disturbances Eating disorders Substance abuse Excessive compliance Oppositional behavior Difficulty understanding and complying with rules Communication of traumatic past by reenactment in day-to-day behavior or play (sexual, aggressive, etc.)
  18. 18. 7 Domains of Impairment in Children Exposed to Complex Trauma6. COGNITION: Difficulties in attention, regulation and executive functioning Lack of sustained curiosity Problems with processing novel information Problems focusing on and completing tasks Problems with object constancy Difficulty planning and anticipating Problems understanding own contribution to what happens to them Learning difficulties Problems with language development Problems with orientation in time and space Acoustic and visual perceptual problems Impaired comprehension of complex visual-spatial patterns
  19. 19. 7 Domains of Impairment in Children Exposed to Complex Trauma7. SELF-CONCEPT: Lack of a continuous, predictable sense of self Poor sense of separateness Disturbances of body image Low self-esteem Shame and guilt
  20. 20. Scope of the Problem Between 2004 and 2010, the National Child Traumatic Stress Network (NCTSN) collecteddata on 14,088 children and adolescents served by 56 service centers across the country. This study examined the prevalence of trauma exposure and service use among these care recipients…
  21. 21. Percent of Children & Adolescents Scope of the Problem Figure 1. Percent of children who experienced single versus multiple trauma exposures (n = 11,104)
  22. 22. The Good News! Contrary to popular belief children living in highlydisadvantaged environmentscan be protected from serious emotional or behavioral consequences.
  23. 23. The Good News!Studies of evidence-based interventions and recent findings show that trauma-related, mental health conditions are highly treatable.
  24. 24. What We Can Do:1. Healthy Adult Relationships2. Promote Protective Factors  Nurturing and attachment  Knowledge of parenting and of child and youth development  Parental resilience  Social connections  Concrete supports for parents3. Early Identification & Access to Supports4. Increase Awareness
  25. 25. Best PracticesSystems Approach to Intervention  Child Protective Services  Court System  Schools  Social Service AgenciesInterventions should:  Build Strengths  Reduce Symptoms
  26. 26. Best PracticesWhile residential treatment remains an important component of a system of care, for most youth, community-based interventions represent a more appropriate, less costly alternative. Perspectives on Residential and Community-Based Treatment for Youth and Families, Magellan Health Services Children’s Services Task Force (2008)
  27. 27. Supporting Social Competence & Academic Achievement OUTCOMES DA MS Supporting Supporting TA E STStaff Behavior Decision SY Making PRACTICES Supporting Student Behavior
  28. 28. Continuum of School-wide Instructional & Positive Behavioral SupportTertiary Prevention: Specialized IntensiveIndividualized Systems for Students For a Fewwith High-Risk BehaviorSecondary Prevention: SpecializedGroup Systems for Students with TertiaryAt-Risk Behavior For SomePrimary Prevention:School-Classroom-WideSystems for All Students,Staff, & Settings Universal For ALL
  29. 29. Establishing Continuum Intensive PREVENTIONfor VTPBiS • Function-based support • Wraparound ~5% • Person-centered planning • • ~15% Targeted PREVENTION • Check in/out • Targeted social skills instruction • Peer-based supports • Social skills club • Universal PREVENTION • Teach SW expectations • Proactive SW discipline • Positive reinforcement • Effective instruction • Parent engagement • ~80% of Students
  30. 30. When a student… Doesn’t know how to read – WE TEACH! Doesn’t know how to add – WE TEACH! Doesn’t know how to drive – WE TEACH! Doesn’t know how to behave – ?
  31. 31. Thank You!