Laura St. John's Trauma PowerPoint

Content of the presentation:

Strategies for Building Resiliency
and Supporting Students Impacted by Trauma

Laura St. John

Project Director, SAFE-TI

School & Family Engagement- Trauma Informed

Bozeman School District

MSU Education 2/27/18

Take a moment…

Before I begin…

WHAT DID YOU WALK IN THIS ROOM WITH?

• Good night sleep?
• Visit with family?
• Fight with family?
• Money issues?
• Someone in family battling a medical issue or a break up?
• Nice meal?  Too much to drink or eat?
• Or maybe…bad meeting right before this??

School and Family Engagement – 
Trauma Informed
(SAFE-TI) 

“This project was supported by Award No. 2014-MU-MU-0017, awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this presentation are those of the author and do not necessarily reflect those of the Department of Justice.”

Developing Knowledge About What Works to Make Schools Safe 

National Institute of Justice  

Grant Award:  $3,319,810 over three years

Partners:

• University of Montana's Institute for Educational Research and Service  - Montana Safe Schools Center and the National Children’s Trauma Center
• Gallatin County Youth Court Services
• Bozeman Police Department
• School and community-based mental health providers (who will deliver the trauma-informed care)
• Thrive

Our Grant

Link:  Childhood trauma and behavioral health care problems

We believe that a multi-tiered package of trauma-informed interventions offers a promising alternative to a more traditional punitive disciplinary approach.

Notes to slide Our Grant

We know that children's exposure to violence and their unresolved trauma impacts behavior and increases

• risk-taking
• ATOD (stress relievers)
• sexual promiscuity
• depression/suicide
• juvenile justice system involvement
• adverse academic progress

Additionally unmanaged long term stress is a health concern (as shown in the ACEs study)

If effective, our project’s suite of interventions could serve as a cost-effective model for improving school climate and promoting school safety on a national level (and more effectively help our struggling students)

Impacts

The project:

• Is embracing the question “Does a trauma sensitive, multi-tiered, whole school approach enhance well-being and safety?” 
• Has potential for nationally relevant understanding on a new way of addressing school safety problems.

The ACE Study

The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted on the links between childhood maltreatment and later-life health and well-being.

• 1995-1997            17,000 individuals
• HMO in So California
• CDC followed the individuals for mortality and health

Notes to slide The ACE Study

It was a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego. Researchers asked 17,000 members undergoing a comprehensive physical examination (for a study related to obesity) to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction.

Traumatic experiences in childhood have been linked to increased medical conditions throughout the individuals’ lives. The Adverse Childhood Experiences (ACE) Study is a longitudinal study that explores the long-lasting impact of childhood trauma into adulthood. The ACE Study includes over 17,000 participants ranging in age from 19 to 90. Researchers gathered medical histories over time while also collecting data on the subjects’ childhood exposure to abuse, violence, and impaired caregivers.  Results indicated that nearly 64% of participants experienced at least one exposure, and of those, 69% reported two or more incidents of childhood trauma.       Results demonstrated the connection between childhood trauma exposure, high-risk behaviors (e.g., smoking, unprotected sex), chronic illness such as heart disease and cancer, and early death.

The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego.

More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made.

The ACE Study findings suggest that certain experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. It is critical to understand how some of the worst health and social problems in our nation can arise as a consequence of adverse childhood experiences. Realizing these connections is likely to improve efforts towards prevention and recovery.

ACE Study Questions


• Did you experience physical abuse?
• Did you experience physiological abuse?
• Did you experience contact sexual abuse?
• Did you experience emotional neglect?
• Did you experience physical neglect?
• Was there an alcoholic or drug-user in your household?
• Was there a member of your household imprisoned?
• Was there a member of your household that was mentally ill, or did you have a depressed parent or institutionalized family member?
• Did you witness your mother being treated violently?
  
              WHATSMYACESCORE.COM

Notes to slide ACE Study Questions

Give yourself one point for each “yes” answer, then add them up to get your ACE score

If ever experienced physical abuse = 1 point (whether happened once or multiple times or by different people) all = 1 point

American Academy of Psychotherapists, most hands raised

Five charts showing correlation between higher ACE scores and increased percentage of suicide attempts, chronic depression, smoking as an adult, intravenous drug use, antipsychotic prescriptions, and adult alcoholism.

ACE’S IS THE WHAT…

• • • • • SAFE-TI IS THE 
          • • WHAT’S NEXT??...

What is Trauma?

• A highly stressful experience with lasting emotional and physical effects
• Perceived threat to life, physical integrity, caregiver, environment
• Overwhelms capacity to cope

Notes to slide What is Trauma?

When a person experiences trauma – they are experiencing a highly stressful situation that overwhelms their ability to cope…usually in the face of something that is life threatening (or perceived to be), or threatening to their physical integrity, or threat of losing a caregiver or to their environment…..even with exposure to a significant experience like this, the exposure itself will not necessarily lead to a traumatic stress reaction

Chronic state can impede development of critical brain functions: eg. Memory, language, problem solving higher order thinking

Children with Traumatic stress are about “survival in the moment.”  Immediate and extreme response to reminders of the trauma.  Survival in the moment is governed by pathways in the brain that appraise threat, sacrifice context for speed of response, make decisions out of consciousness, mobilize the body for fight flight or freeze

Higher order brain functions are temporarily put on hold when survival is at stake.

Most creative ideas in a calm state

TRAUMA COMES IN MANY FORMS

Notes to slide TRAUMA COMES IN MANY FORMS

WHAT ARE YOU SEEING WITH YOUR STUDENTS??

Trauma Types

• Acute Trauma:
  • “A single traumatic event that overwhelms a child’s ability to cope.” (Fitzgerald and Groves)
• Chronic Trauma
  • Repeated, ongoing
  • Experiencing a prior traumatic event does not toughen up a child. Instead, the effects can add up
• Complex Trauma
  • Multiple and/or chronic, most often of an interpersonal nature and early life onset.
  • These exposures often occur within the child’s care giving system 

Notes to slide Trauma Types

Some traumatic experiences occur once in a lifetime, others are ongoing

Chronic - What happens if the violence, molestation, or trauma occurs repeatedly, or several different types of traumas happen over a child's years of growing up? Children and adolescents may never have the time or support to recover from one set of posttraumatic stress reactions before new ones add to them. Young children who are abused commonly also witness domestic violence. A teenager may have been the victim of a criminal assault or rape and, at another time, have witnessed a friend being shot. Experiencing a prior traumatic event does not toughen up a child. Instead, the effects can add up, with each successive experience leading to more severe and chronic posttraumatic stress reactions and other developmental consequences. In fact, a child who has suffered from prior traumatic experiences may be apt to have more intense reactions to another trauma.

The term complex trauma describes the problem of children's exposure to multiple or prolonged traumatic events and the impact of this exposure on their development. Typically, complex trauma exposure involves the simultaneous or sequential occurrence of child maltreatment—including psychological maltreatment, neglect, physical and sexual abuse, and domestic violence—that is chronic, begins in early childhood, and occurs within the primary caregiving system. Exposure to these initial traumatic experiences—and the resulting emotional dysregulation and the loss of safety, direction, and the ability to detect or respond to danger cues—often sets off a chain of events leading to subsequent or repeated trauma exposure in adolescence and adulthood.

Many children with complex trauma histories suffer a variety of traumatic events, such as physical and sexual abuse, witnessing domestic and community violence, separation from family members, and revictimization by others. Complex trauma can have devastating effects on a child’s physiology, emotions, ability to think, learn, and concentrate, impulse control, self-image, and relationships with others. Across the life span, complex trauma is linked to a wide range of problems, including addiction, chronic physical conditions, depression and anxiety, self-harming behaviors, and other psychiatric disorders.

Beyond the consequences for the child and family, these problems carry high costs for society. For example, a child who cannot learn may grow up to be an adult who cannot hold a job. A child with chronic physical problems may grow up to be a chronically ill adult. A child who grows up learning to hate herself may become an adult with an eating disorder or substance addiction.

Children whose families and homes do not provide consistent safety, comfort, and protection may develop ways of coping that allow them to survive and function day-to-day. For instance, they may be overly sensitive to the moods of others, always watching to figure out what the adults around them are feeling and how they will behave. They may withhold their own emotions from others, never letting them see when they are afraid, sad, or angry. These kinds of learned adaptations make sense when physical and/or emotional threats are ever-present. As a child grows up and encounters situations and relationships that are safe, these adaptations are no longer helpful, and may in fact be counterproductive and interfere with the capacity to live, love, and be loved.

Why Do Education Programs Need to Know About Trauma

• When children experience trauma it affects
  • Ability to learn
  • Ability to make friends/social skills
  • Behaviors in the classroom
• Teachers may be the first to notice symptoms
• Teachers can provide social/emotional curriculum and employ classroom strategies to help

Notes to slide Why Do Education Programs Need to Know About Trauma

FIGHT FLIGHT FREEZE

• 1 out of 4 children who attend school has been exposed to a traumatic event

Or…

TOXIC STRESS

Notes to slide Toxic Stress

I WANT TO TALK ABOUT THIS…POSITIVE STRESS TOLERABLE STRESS AND TOXIC STRESS

Basic Needs Must be Met

• Learning
• Esteem/Self-Love
• Relationship
• Safety
• Physiological

Notes to slide Basic Needs Must be Met

PHYSIOLOGICAL--- BREATHING– FREEDOM FROM HUNGER & THIRST – RESTED

SAFETY--- PHYSICAL SAFETY – EMOTIONAL SAFETY – FREEDOM FROM BULLYING – FREEDOM FROM HARSH PUNISHMENT

RELATIONSHIPS --- !!!

ESTEEM --- SELF RESPECT --CONFIDENCE—RESPECT FROM OTHERS --DESIRE TO SUCCEED

WHAT IF…

[photo of snarling bear]

DO YOU…

Bruce Perry – Child Trauma Academy
Adaptive Responses to Trauma

Notes to slide Bruce Perry – Child Trauma Academy
Adaptive Responses to Trauma

Brain Functioning is State Dependent

Neocortex – most calm and creative when not overstimulated or distracted – quiet rhythms of nature, stress response down; cognition is abstract; mental state is calm – our society doesn’t allow this – best learning happens in this state and the next (subcortex) – (often hit this state in the shower)

Subcortex – cognition is concrete, mental state is alert

Limbic – cognition is emotional and mental state is alarm

Midbrain – cognition is reactive, mental state is fear

Autonomic – cognition is reflexive, mental state is terror

Need sleep and non-structured reflective time

Children who grow up in chaotic environments grow up in the Emotional/Alarm/Limbic Brain State - This is their baseline – their heart rate is typically high too – 

When external world is calm, with normal stressors – not on high alert all the time, only when need to be

Living in chaos, wake up in an Alarm state – eventually functioning deteriorates

As soon as threatened, start to regress down through the brain stages…

Hyper arousal Continuum: kid defiant, teacher gets in face, escalates kid’s state and behavior, highly defensive mode – pisses off adult, child gets help

Dissociative Continuum: teacher engages with kid, kid doesn’t want to be noticed, moves up the continuum, but it looks like complete compliance, then reaches complete dissociative state (the teacher might think the child is stupid or being passive aggressive) – these kids get no help, go under the radar.  Later in life when these kids want to physiologically release, end up using drugs, cutting, promiscuity. Need caregivers who are loving and stable – takes time. When hyperarousal kids get pushed too far, you can tell, but dissociative kids, you can’t tell, they’ve checked out.

Need to take kids in hyper arousal states of arousal and bring them down.

Bruce Perry

This is an interesting slide….this was shared with us by Dr. Bruce Perry, the Director of the Child Trauma Academy….Dr. Perry talks about two of the major traumatic stress symptoms we can experience…hyper arousal and dissociation….and talks about them as falling along a spectrum based on our mental state…..if we tend to be the hyper aroused child, when we feel threatened we may become resistant, defiant, or aggressive…..if we tend to be the more disassociated child, in the face of fear we may appear compliant or checked out…..

If you look at the row that says Mental State….in which state listed do you think we do our best creative thinking? Calm, alert, alarm, fear, or terror? Dr. Perry says calm – when our stress response is down….

Of those Mental states….which do you think a child who lives in constantly chaotic environments wakes up in? what is their normal baseline mental state? Dr. Perry says Alarm…they wake up in a state of Alarm….

So, a child who is experiencing chronic trauma…..who is more hyper aroused, easily agitated….wakes up in a state of Alarm and is already feeling Resistant….if you are a classroom teacher, you know these kids walk into your classroom already resistant….and it doesn’t take much to trigger them towards the next state of fear….I might ask this student a question…what’s the answer to number four….and getting in this child’s proximity might be a trigger and they perceive what I did as a threat and become more fearful….and what it looks like is defiance…..I don’t know…..why are you asking me – you already know the answer….and how do teachers typically respond to defiance in their classrooms (often with reprimands and punishment)…so the student escalates, the teacher gets upset and reacts – the child becomes aggressive and then gets sent to the office….

But the child who tends to check out or dissociate may look very different when they perceive a threat….what do they look like when they wake up in the morning, according to Dr. Perry? If they wake up in the mental state of alarm, what does that look like to the rest of us…..compliant….I don’t want to rock the boat….I don’t want anything to happen to me….I’m just going to go under the radar….If the teacher triggers the child (unintentionally by asking a direct question) the child may respond by freezing…checking out….and the teacher sees this as either the child is dumb or being passive aggressive…..this child tends to go under the radar….

This is a very difficult situation because how do we know what’s going on? It’s easy to make assumptions…..easier to detect when hyper aroused kids get pushed too far…..not so easy with kids who check out….

Neither child is getting the support they need…..

WHAT ARE TRAUMA INFORMED SCHOOLS?

Asking…

• ….What’s happened to you?

Not…

• ....What’s wrong with you?

Threat Appraisal and Detection in Traumatized Children

[two rows of photos of faces, one male, one female, with facial expressions which start angry on the left and change to sad on the right]

Notes to slide Threat Appraisal and Detection in Traumatized Children

Threat appraisal

Repeatedly exposed to the rage of unpredictable adults, abused children appear to develop an exquisite sensitivity to the emotional signals of anger, the study finds. Shown computerized images of a face morphing gradually from sadness or fear to anger, the children who had been abused detected the angry facial expression far more quickly than did other children.

The abused children ''saw anger in faces that maybe only had 30 or 40 percent of anger mixed into them,'' said Dr. Seth Pollak, an assistant professor of psychology, psychiatry and pediatrics at the University of Wisconsin and the lead author of the study, to be published today in The Proceedings of the National Academy of Sciences.

Being attuned to the emotions of others is a way to adapt to the dangerous environment of an abused child's home, Dr. Pollak said, adding that in such a situation ''these kids' brains are doing exactly what you would want your brain to do.''

But when the children move on to other settings, where the people around them behave more rationally, their perceptual systems fail to make the shift. Instead, Dr. Pollak said, they may see anger when it is not there, or spend so much time scanning for the signs of impending rage that they miss other important social clues.

SORRY…..

• BUT IT IS NOT ABOUT US…WE JUST HAPPEN TO BE THERE.

HOT BUTTON

• ONE BEHAVIOR THAT PUSHES YOUR BUTTON
  • How do you feel?
  • HOW DID IT IMPACT YOUR RELATIONSHIP WITH STUDENT?

TEACHER AFFECT


Manage our own reactions and emotions 

Understanding… 

• What pushes our buttons
• We are not the cause…we just happen to be there
• Secondary Trauma

Perceived Triggers of Danger

• Reminders of trauma
  • Sensory: sights, smells, sounds, touch, taste
  • Emotional: anxiety, fear, vulnerability
• Sudden fear - fight/flight/freeze response
• Adults can unintentionally trigger children through harmless actions

Trauma’s Impact on Emotional Development

• Difficulty with self-regulation
• Difficulty describing feelings/internal states
• Difficulty communicating wishes and desires
• Often feel self critical, anxious, worried, ashamed, guilty - rarely experience joy

[photo of four crayons]  [arrow pointing right] [photo of many crayons in box]

Marrow & Benamati

Notes to slide Trauma’s Impact on Emotional Development

• One of the most prominent difficulties facing many youth who have experienced trauma is modulating their emotions, particularly when experiencing trauma reminders.
• These youth may also have a limited feelings vocabulary and a limited understanding of their emotional states. It is as if they have the trial-sized box of crayons (click the remote or press the space bar) version of emotion. They know happy, sad, and angry – and thus they respond based upon this limited scope of emotional understanding, instead of having a full-sized crayon box of emotions (click the remote or press the space bar). 
  Emotions alert us to early warning signs of danger

May experience intense emotions out of the blue

Do not easily understand or express their emotions

Limited emotional literacy

Difficult to understand the emotions of others

• Difficulty with self-regulation
• Often experience negative self-critical feelings: shame or guilt

Anxious, worried, fearful

New fears

Difficulty describing feelings

in traumatic situations when there is violence against family members, they can feel like failures for not having done something helpful. They may also feel very ashamed or guilty. 

School-age children get scared of the speeding up of their emotions and physical reactions, adding new fears to the danger from outside. For example, an 8 year-old child described, "My heart was beating so fast I thought it was going to break." 

Children who have experienced complex trauma often have difficulty identifying, expressing, and managing emotions, and may have limited language for feeling states.  They often internalize and/or externalize stress reactions and as a result may experience significant depression, anxiety, or anger.. Their emotional responses may be unpredictable or explosive. A child may react to a reminder of a traumatic event with trembling, anger, sadness, or avoidance. For a child with a complex trauma history, reminders of various traumatic events may be everywhere in the environment. Such a child may react often, react powerfully, and have difficulty calming down when upset. Since the traumas are often of an interpersonal nature, even mildly stressful interactions with others may serve as trauma reminders and trigger intense emotional responses.  Having learned that the world is a dangerous place where even loved ones can’t be trusted to protect you, children are often vigilant and guarded in their interactions with others and are more likely to perceive situations as stressful or dangerous.  While this defensive posture is protective when an individual is under attack, it becomes problematic in situations that do not warrant such intense reactions.  Alternately, many children also learn to “tune out” (emotional numbing) to threats in their environment, making them vulnerable to revictimization.       
 
Difficulty managing emotions is pervasive and occurs in the absence of relationships as well.  Having never learned how to calm themselves down once they are upset, many of these children become easily overwhelmed.  For example, in school they may become so frustrated that they give up on even small tasks that present a challenge.  Children who have experienced early and intense traumatic events also have an increased likelihood of being fearful all the time and in many situations. They are more likely to experience depression as well.

Adolescents:

With the help of their friends, adolescents begin a shift toward more actively judging and addressing dangers on their own. This is a developing skill, and lots of things can go wrong along the way. With independence, adolescents can be in more situations that can turn from danger to trauma. They can be drivers or passengers in horrible car accidents, be victims of rape, dating violence and criminal assault, be present during school or community violence, and experience the loss of friends under traumatic circumstances. During traumatic situations, adolescents make decisions about whether and how to intervene, and about using violence to counter violence. They can feel guilty, sometimes thinking their actions made matters worse. Adolescents are learning to handle intense physical and emotional reactions in order to take action in the face of danger. They are also learning more about human motivation and intent and struggle over issues of irresponsibility, malevolence, and human accountability.

Young Children:

Think of what it is like for young children to be in traumatic situations. They can feel totally helpless and passive. They can cry for help or desperately wish for someone to intervene. They can feel deeply threatened by separation from parents or caretakers. Young children rely on a "protective shield" provided by adults and older siblings to judge the seriousness of danger and to ensure their safety and welfare. They often don't recognize a traumatic danger until it happens, for example, in a near drowning, attack by a dog, or accidental scalding. They can be the target of physical and sexual abuse by the very people they rely on for their own protection and safety. Young children can witness violence within the family or be left helpless after a parent or caretaker is injured, as might occur in a serious automobile accident. They have the most difficulty with their intense physical and emotional reactions. They become really upset when they hear cries of distress from a parent or caretaker.

OH WAIT…

MAYBE IT IS ABOUT US??!!

Relationship is the Evidence-Based Practice

• Engage in positive, trusting relationships
• Provides new experiences with adults which includes:
  • Consistent approach to communication
  • Feelings are acknowledged and validated
  • Protective toward them
  • Unconditional regard and care even when behaviors are challenging

Notes on slide Relationship is the Evidence-Based Practice

• Trauma results primarily from disrupted relationships

Supporting children to re-experience relationships differently is the key to trauma recovery and change. 

Positive relationships: Being connected with others is more powerful than want of drugs – monkey study – when monkeys were presented with the choice between cocaine or monkey food, they became cocaine addicts; presented with cocaine versus m and m’s – they used each about equally and did not become addicts; when they could choose between cocaine or interacting with another monkey (relationship) – they always chose the relationship and did not become addicted to cocaine. (unless the monkey they could choose to interact with was their mother in law – joke).  Tammy Cole 

UNIVERSAL – TIER I

• Recognize the impact of trauma on learning and behavior
• Create safe environments (physically and emotionally)
• Manage our own reactions and emotions
• Incorporate teaching specific social skills for managing and coping with emotions
• Classroom lessons – Stress Trauma & Resiliency

AUTOMATICS

• HOMELESS
• RESIDENTIAL/TREATMENT FACILITIES
• RISK TO SELF
• RISK TO OTHERS
• YOUTH COURT SERVICES
• ADOPTED
• FOSTER CARE

Most common reasons

• Anxiety
• Depression
• Family Disruptions
• Suicidal Ideation
• Non Suicidal Self Injury

COMMUNICATION

• IDENTIFY “TRIGGERS”
• IDENTIFY COPING MECHANISMS
• PARENT/TEACHERS/COUNSELORS/ADMIN
• 504 ELIGIBLE?

WHAT CAN YOU DO??

• CONSISTENCY—ROUTINES & RITUALS
• CHECK YOUR AFFECT
• CLASS MEETINGS
• HELP WITH GROUNDING
• CONNECT (KEEP TRACK OF WHO YOU TALK WITH!!)

Summary

• Recognize the impact of trauma on learning and behavior
• Implement a multi-tiered system of support (MBI/PBIS/Foundations/MTSS)
• Create safe environments (physically and emotionally)
• Manage your own reactions and emotions
• Incorporate teaching specific social skills for managing and coping with emotions

RESILIENCE

• Research has shown that 2/3 of children who experience adverse childhood events will grow up and “beat the odds”.
• GUESS MAJOR FACTOR FOR RESILIENCY??

Notes to slide RESILIENCE

The holiest of flowers for Hindus, the beautiful lotus is symbolic of the true soul of an individual. It represents the being, which lives in turbulent waters yet rises up and blossoms to the point of enlightenment. 

Factors that contribute to resilience: 

Close relationships with family and friends

A positive view of yourself and confidence in your strengths and abilities

The ability to manage strong feelings and impulses

Good problem-solving and communication skills

Feeling in control

Seeking help and resources

Seeing yourself as resilient (rather than as a victim)

Coping with stress in healthy ways and avoiding harmful coping strategies, such as substance abuse

Helping others

Finding positive meaning in your life despite difficult or traumatic events

RELATIONSHIPS

• Connection to family/community/cultural supports
• Optimistic temperament
• Ability to seek help/resources 
• Healthy coping skills
• Helping others
• Positive view of self

Things To Remember

ARE YOU TAKING CARE???

ARE YOU USING SELF INDULGENCE…

OR

SELF CARE??

WHAT GIVES YOU JOY