Trauma-Informed Practice

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Today’s Agenda

Evaluation Pre-test Review Learning Objectives Trauma Basics Adverse Childhood Experiences Study Historical Trauma and Culture Child Welfare’s Response to Trauma Self-Care Evaluation Post-Test

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Curriculum Pre-Test3

Goals for Today

Become familiar with the terms and definitions associated with trauma-informed practice.

Understand how trauma impacts children and adults

Develop strategies for how to help children and families heal from trauma

Understand how trauma impacts professionals

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Activity – Stress and Associated Feelings

• Very Hot

– Very uncomfortable

– Extremely stressed out and anxious

– Need to get out of here now

• Hot

– Moderately uncomfortable

– Stressed and anxious

– Distracted and edgy

• Warm

– Mildly uncomfortable

– Slightly stressed and anxious

– Losing my focus

• Just Right

– Comfortable

– Not stressed or anxious

– Focused and engaged

• Cool

– A little bored

– Losing my focus

• Ice cold

– Totally bored

– Not focused or engaged

– Planning my escape

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Child Trauma is…

An event that overwhelms the child’s ability to cope and causes fear, helplessness, or horror, expressed by sadness, withdrawal, or disorganized / agitated behavior.

Witnessing or experiencing an event that poses a real or perceived threat to the life or well-being of the child or someone close to the child.

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Activity – Matching Game7

Types of Trauma – Acute

Acute trauma is a single traumatic event that is limited in time:Serious accidentsPainful medical treatmentNatural disasters Sudden or violent loss of a loved onePhysical or sexual assault TerrorismSeparation from Parent/family

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Types of Trauma - Chronic• Chronic: Repeated, prolonged trauma (domestic

violence, abuse, war)

– Ongoing domestic violence

– Repeated abuse

– Long term bullying

– Continued separation from family

– War

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Types of Trauma - Complex

Interpersonal trauma May be varied and multiple in nature Chronic Often caused by trusted caregivers

It describes both children’s exposure to multiple traumatic events, and the wide-ranging, long-term impact of this exposure.

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Child Traumatic Stress

When a child has had one or more traumatic events, and has reactions that continue and affect his or her daily life long after the events have ended, we call it Child Traumatic Stress.

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How many children experience child traumatic stress? In 2010, according to the U.S. Department of

Health and Human Services (2011), 695,000 children were victims of substantiated child maltreatment. Of these:

78.3% experienced neglect 17.6% were physically abused 9.2% were sexually abused

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National Child Traumatic Stress Network (2013)

Activity

Child Traumatic Stress in the home of origin / community

Child Traumatic Stress in the child welfare system

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Photo Credit: iStockphoto

Factors that influence how children experience trauma

The number and severity of the traumatic episodes

Proximity to the event The personal significance of the

traumatic event for the child The extent to which the child’s support

system is disrupted after the trauma

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Other Factors

Child’s age and developmental stage Child’s perception of the danger faced Child’s relationship to victim and/or

perpetrator Presence/availability of adults who can offer

help and protection Genetic predisposition Previous history of trauma experiences

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Trauma Impact on the Brain

The cerebral cortex is responsible for many complex functions. (memory, attention, thinking, language, etc).

Trauma can result in a smaller cortex, thus impeding the ability of the brain to perform these functions.

Trauma can disrupt attachment, bonding and Memory

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Types of Memory

Implicit memory: babies can perceive their environment and retain unconscious memories (e.g., recognizing mother’s voice)

Explicit memory: conscious memories are created around age two and tied to language development

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Impact on Brain in Early Childhood

Reduced size of the cortex. Affects “cross-talk” between the brain’s

hemispheres which may affect: IQ ability to regulate emotions, and lead to increased fearfulness and a reduced sense of safety and

protection.

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Impact on Brain in School Aged Children

Trauma undermines the development of brain regions that would normally help children: Manage fears, anxieties, and aggression Sustain attention for learning and problem

solving Control impulses and manage physical

responses to danger, enabling the child to consider and take protective actions

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Impact to Adolescent Brain Development

Trauma can interfere with development of the prefrontal cortex, the region responsible for consideration of the consequences of behavior, realistic appraisal of danger and safety and ability to govern behavior and meet longer-term goals

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Trauma and Development

Infants/Toddlers Preschool-Age Children School-Age Children Adolescents

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Child Traumatic Stress symptoms may include:

Intrusive Memories Nightmares or Flashbacks Avoidance of Trauma Reminders Heightened Arousal (being “on edge,” jumpy,

or hyper-alert) Intense and Overwhelming Feelings of fear,

anger, shame, and helplessness

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What are Trauma Reminders?

Anything that reminds children of past traumatic experiences (even years afterward) Places People Sights Sounds Smells Feelings

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Video - Removed24

How can Social Workers Reduce Trauma?

o Investigation

oRemoval

o Placement/placement changes

o Transition home or to permanent plan

oCase closure

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How can a Social Worker Help?

Let child know they can talk about experiences or fears if they want to

Listen carefully when they do talk Notice behaviors Give the child choices and some sense of

control If you have any questions, ask for help from

Supervisor Know where to refer

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What Can Social Workers Do?

Make referrals for services to:

•Mental Health services

•Trauma focused Therapy

•Public health nurse or physician

•Special activities

•Educational staff or programs

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Adverse Childhood Experiences (ACE) Study

Landmark study done by the CDC and Kaiser Permanente regarding relationship of ACEs to many of the leading causes of death in adults.

The more traumatic experiences, the greater the risk of poor physical and behavioral health outcomes.

More than half of all children reported for maltreatment had experienced 4 or more ACEs at the time of contact with CWS.*

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* Source: National Survey of Child and Adolescent Well-being (NSCAW), Research Brief #20, August 2013

ACE Study Video29

Activity

At your tables, list different health concerns that might be related to ACEs. You will have 5 minutes. Be prepared to report out.

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How can Birth/Resource parents support Children with ACEs?

DO’sBe nurturing/ comforting Be FlexibleBe Honest – Even if it’s DifficultBe patient – the effects of trauma can be long-lasting with a long process for recoveryProvide a consistent pattern for the child’s dayDiscuss behavioral expectations/disciplineTalk and share info with the SW and MH Clinician

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DON’Ts•Don’t be afraid to talk about the trauma if the child wants to, and listen if they do – follow the child’s cues•Don’t Over-react•Don’t underestimate how important it is for children to know their caretakers are “in control”•Don’t be afraid to ask for help

Parents’ Trauma History

Many parents of children in foster care have histories of adult and/or childhood trauma

What this means… Parents’ past or present trauma can

make it difficult for them to work effectively with case workers and resource parents towards reunification with their children

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How Trauma can Affect Birth Parents

Compromise parents’ ability to make judgments about safety

Harder for parents to form and maintain secure and trusting relationships

Impair their capacity to regulate emotions Low self-esteem and lack of coping strategies

can impair a parent’s decision-making ability Make the parent more vulnerable to other life

stressors

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Activity

Review Pages 2 & 3 of Birth Parents with Trauma Histories and the Child Welfare System: A Guide for Resource Parents

Groups will take into consideration the Parents’ own Trauma history and chart ways to engage parents in the development of their case plan and assist parents in their Trauma recovery

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How can Social Workers Help Parents Heal

Understand parents anger, fear, resentment, or avoidance as reactions to past trauma

Assess parent’s trauma history Understand that Traumatized parents are not

bad and do not judge or blame them Build on parents’ desires to care for their child Help parents understand impact of their own

past trauma Refer parents to trauma-informed services

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Cultural Trauma

Social and cultural realities strongly influence children’s risk for—and experience of—trauma.

Children and adolescents from minority backgrounds are at increased risk for trauma exposure and subsequent development of PTSD.

In addition, children’s, families’ and communities’ responses to trauma vary by group.

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The Influence of Culture

Variance of trauma responses

Strong cultural identity and community/ family connections

Shame

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Importance of Culture VideoGeorgetown University Center for Human Development

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Cultural Trauma Activity39

Discuss and chart in your table groups what factors may contribute to Cultural Trauma and what types of trauma responses you may see.

Historical TraumaHistorical Trauma

Historical Unresolved Grief Disenfranchised Grief Internalized Oppression Multigenerational Trauma

The population of Native Americans in North America decreased by 95% from the time Columbus came to America in 1492 and the establishment of the United States in 1776.

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VIDEO - Case Study: Historical Loss

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The voice of a young woman and her anger.

Activity – What can you do?

At your table group develop a role play between a Social Worker and a Family Member in which the Social Worker displays skills that exhibit sensitivity and awareness regarding cultural and historical trauma.

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Pathways to Wellbeing(Formerly known as Katie A.)

WHAT IS IT?: o Class-Action Lawsuit in CA that further spells

out and holds accountable the roles of Child Welfare Workers and Mental Health personnel in supporting mental/behavioral health needs of children & youth

WHO IS ELIGIBLE FOR SERVICES? o Children & Youth in Foster Care (or at

imminent risk of entering Foster Care)

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Pathways to Wellbeing:Implications for Child Welfare Practice

MUST SCREEN children and youth for mental health issues

REFER children/youth to trauma-informed and evidence-based practices

MONITOR children/youth’s health & well-being MUST COLLABORATE with Mental Health

providers as part of Child & Family TEAMS! Check with your supervisor for more county-

specific details!

***Concerted Efforts***

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Essential Elements of Trauma-Informed Child Welfare Practice

1. Maximize the child’s sense of safety.

2. Assist children in reducing overwhelming emotion.

3. Help children make new meaning of their trauma history and current experiences.

4. Address the impact of trauma and subsequent changes in the child’s behavior, development, and relationships.

5. Coordinate services with other agencies.

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Essential Elements of Trauma-Informed Child Welfare Practice

6. Utilize comprehensive assessment of the child’strauma experiences and their impact on the child’s development and behavior to guide services.7. Support and promote positive and stable relationships in the life of the child.8. Provide support and guidance to child’s family and caregivers. 9. Manage professional and personal stress.

Essential Elements Activity

Evenly distribute the 9 Essential Elements amongst the Table Groups

Have each table write a definition and provide one case example for each Essential Element to which they were assigned.

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Quote

“The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.”

Rachel Remen,

Kitchen Table Wisdom

Secondary Traumatic Stress

Distress that results when an individual hears about the firsthand trauma experiences of another. Symptoms mimic those of PTSD.re-experiencing personal trauma or changes in memory/perception; depletion of personal resources;disruption in perception of safety, trust, independence.

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Sources of Secondary Traumatic Stress

Child or family member death on an active or recently closed case,

Investigating abuse and neglect Working in violent communities Working with families with extensive abuse histories Removing a child under distressing circumstances System frustrations Verbal or physical assault by parents or community

members.

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Compassion Fatigue Self-Test: An Assessment

Cynicism and anger Anxiety, fearfulness Emotional detachment Hopelessness and Guilt Sleep disturbance Social withdrawal Diminished self-care Physical ailments

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Coping

Understand and accept one’s vulnerability Learn to balance the needs of the client,

the agency and oneself Utilize supervision to recognize and

address Recognize when one’s self care system is

not working Recognize negative and positive coping

behaviors. Consider offering and asking for peer

support

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Trauma Training Post-Test53

Wrap up54

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