creating a trauma informed learning environment presented by: kym asam, licsw, qmhp
TRANSCRIPT
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Creating a Trauma Creating a Trauma Informed Learning Informed Learning
EnvironmentEnvironment
Presented by: Presented by:
Kym Asam, LICSW, QMHPKym Asam, LICSW, QMHP
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ObjectivesObjectives
• Differentiate between PTSD and developmental traumaDifferentiate between PTSD and developmental trauma• Understand the impact of trauma on the brain utilizing Understand the impact of trauma on the brain utilizing
the Neuro-Sequential Model of Therapeutics (NMT)the Neuro-Sequential Model of Therapeutics (NMT)• Impact on students’ capacity to learnImpact on students’ capacity to learn• Brain regions and a tiered (PBiS) approach to interventionBrain regions and a tiered (PBiS) approach to intervention
• Understand the students’ states of arousal and how it Understand the students’ states of arousal and how it impacts their functioning in schoolimpacts their functioning in school
• Key skills in working with children who have experienced Key skills in working with children who have experienced developmental traumadevelopmental trauma• ARC and its intersect with a tiered approachARC and its intersect with a tiered approach
• AdultsAdults• StudentsStudents
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Polling Question #1Polling Question #1
How many audience participants How many audience participants have had some training on have had some training on developmental or complex trauma?developmental or complex trauma?
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Grounding PrinciplesGrounding Principles
Trauma-Sensitive Schools benefit all Trauma-Sensitive Schools benefit all children – those whose trauma children – those whose trauma
history is known, those whose trauma history is known, those whose trauma will never be clearly identified and will never be clearly identified and
those who may be impacted by their those who may be impacted by their traumatized classmates.traumatized classmates.
Schools are the Central Community for Schools are the Central Community for most children.most children.
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DefinitionsDefinitions
What is trauma?What is trauma?
Trauma is not an event itself, but Trauma is not an event itself, but rather a response to a stressful rather a response to a stressful
experience in which a person’s ability experience in which a person’s ability to cope is dramatically undermined.to cope is dramatically undermined.
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What is Developmental What is Developmental Trauma?Trauma?
• A psychological and neurobiological injury that A psychological and neurobiological injury that results from results from protractedprotracted exposure to stressful exposure to stressful eventsevents
• Derails typical development across all Derails typical development across all domains (neurological, psychological, domains (neurological, psychological, cognitive, social, self/identity)cognitive, social, self/identity)
• Experiences often occur in the caregiving Experiences often occur in the caregiving system. system.
• Impact is immediate and long termImpact is immediate and long term• Effects will require all tiers of interventionEffects will require all tiers of intervention
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Sources of TraumaSources of Trauma
Sexual abuse Sexual abuse Physical abusePhysical abuse Emotional abuseEmotional abuse NeglectNeglect Domestic ViolenceDomestic Violence
Neighborhood violenceNeighborhood violence TortureTorture BullyingBullying Prolonged exposure to traumatic stressProlonged exposure to traumatic stress Intrauterine stressIntrauterine stress EpigeneticsEpigenetics
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Toxic Stress PyramidToxic Stress Pyramid
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Pervasiveness in childrenPervasiveness in children
Overall substantiated child maltreatment in 2011 = Overall substantiated child maltreatment in 2011 = approximately 681,000 (705 in Vermont)approximately 681,000 (705 in Vermont)
9.1% experienced sexual abuse (67% in Vermont)9.1% experienced sexual abuse (67% in Vermont) 17.6% experienced physical abuse (37.1% in Vermont)17.6% experienced physical abuse (37.1% in Vermont) 78.5% experienced neglect (2.6% in Vermont)78.5% experienced neglect (2.6% in Vermont) 48.6% were males48.6% were males 51.1% were females51.1% were females
Source = National Children’s Alliance and US Department of Health and Human Services, 2011 reportSource = National Children’s Alliance and US Department of Health and Human Services, 2011 report
Child Welfare League of AmericaChild Welfare League of America
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The brain The brain develops from develops from
the the bottom upbottom up
Cortex
Limbic
Diencephalon
Brainstem
and the inside out
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Early childhood synaptic Early childhood synaptic growthgrowth
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Brain FunctionBrain Function
Cortex
Limbic
Diencephalon
Brainstem
Abstract ThoughtConcrete ThoughtAffiliation/RewardAttachmentSexual BehaviorEmotional ReactivityMotor RegulationArousalAppetite /SatietySleepBlood PressureHeart RateBody Temperature
Perry, B. 2006
Encourage Abstract Thought
Facilitate Socio-emotional Growth
Introduce Somato-Sensory Integration
Establish State Regulation
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The still face experimentThe still face experiment
http://www.youtube.com/watch?http://www.youtube.com/watch?v=apzXGEbZht0v=apzXGEbZht0
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Neuronal ConnectionsNeuronal Connections
http://www.youtube.com/watch?http://www.youtube.com/watch?v=8NA_o1jOjsQv=8NA_o1jOjsQ
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Impact of Neglect on the Impact of Neglect on the BrainBrain
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Stages of SleepStages of Sleep
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Polling question #2Polling question #2
How many of you have students who How many of you have students who frequently go to the nurse?frequently go to the nurse?
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Negative InteractionsNegative Interactions
Social experiences with caregivers become Social experiences with caregivers become biologically embeddedbiologically embedded
..
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Effects of Trauma on Brain Effects of Trauma on Brain FunctioningFunctioning
Prefrontal Cortex(Integration and Planning)
Amygdala(Intensity/significance)
ThalamusVisual, auditory, olfactory,
kinesthetic, gustatory
Hippocampus(cognitive map)
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Normative Danger ResponsesNormative Danger ResponsesAutonomic Nervous Response Autonomic Nervous Response
SystemSystem FightFight FlightFlight FreezeFreeze FlockFlock
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Emotional IdentificationEmotional Identification
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Facial Expression Facial Expression RecognitionRecognition
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Arousal ContinuumArousal Continuum
State Calm Arousal, Attention
Alarm Fear Terror
Adaptive Response Rest Vigilance Freeze Fight Flight
RegulationBrain Region
NeocortexCortex
CortexLimbic
LimbicMidbrain
MidbrainBrainstem
BrainstemAutonomic
Deesecalating Adult Responses
Talking, adult presence, rocking
Eye contact, simple directives, quiet voice
Quiet words, invited physical touch
Disengagement, quiet adult presence
Wait, leave group, allow child to calm, no words
Escalating Adult Responses
Noise, confrontation
Complex directives, anger, ultimatums
Raised voice, shaking finger
Chaos, frustration, yelling
grabbing, shaking screaming
Cognition Abstract Concrete Emotional Reactive Reflexive.
Perry, B. (2006). Applying principles of neurodevelopment to clinical work with maltreated and traumatized children. New York, NY: Guilford Press
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Typical path to reactionsTypical path to reactions
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Express Route to Reactions!Express Route to Reactions!
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Arousal and CognitionsArousal and Cognitions
As arousal increases cognitive ability decreases. Hyper-aroused children may be defiant, resistant and/or aggressive. They are stuck in survival mode and may freeze, fight, or flee.
A child in a hyper-aroused state can not be reasoned with, she needs you to help her reduce her arousal level.
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How to InterveneHow to Intervene
Somatosensory interventionsSomatosensory interventions Targeting the part of the brain that Targeting the part of the brain that
was impacted by developmental was impacted by developmental insultsinsults EVERY DAYEVERY DAY EVERY GRADEEVERY GRADE EVERY BODYEVERY BODY
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Targeting the Tiers, PBiS Targeting the Tiers, PBiS approachesapproaches
Intensive
targeted
universal
Brain stem/diencephalon
limbic
cortex
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Building up from the baseBuilding up from the base
Brainstem
Establish State Regulation -- IntensiveSchool staff can be thinking about short, predictable, repetitive, patterned interactions throughout the day which would include:
Touch Rhythmic activities (rocking) Eye contact drumming
Respond to physiological cues. A child’s heart rate is a great indicator of levels of arousal (low end 80, high end 120). When interacting become an affective co-regulator for the child.
Bruce Perry (2006)
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Building up from the baseBuilding up from the base
Diencephalon
Introduce Somato-Sensory Integration – targeted, intensive Large motor and fine motor
Music and movement Sensory stimulation Predictable routines (eating, transitions, sleeping)
Consider beginning the day with predictable, structured, patterned, rhythmic music and movement activities. Studies have indicated that children have increased self-regulation throughout the day when sensory integration occurs early.
Remember that the brain fatigues after 7 minutes.
Bruce Perry (2006)
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Polling Question #3Polling Question #3
How many of you work with students How many of you work with students who receive targeted or intensive who receive targeted or intensive level of supports who struggle with level of supports who struggle with playing games or taking turns?playing games or taking turns?
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Building up from the baseBuilding up from the base
Limbic
Facilitate Socio-emotional Growth – targeted
Turn-taking Team play Win & lose Sharing
Consider that social development is a progression and the ability to form satisfying reciprocal interactions may depend on backing up and purposefully creating opportunities for parallel play or learning opportunities in a dyad with an adult and then a dyad with a peer before group play or group learning will be successful.
Bruce Perry (2006)
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Building up from the baseBuilding up from the base
CortexEncourage Abstract Thought – Universal
Humor Language Art Games Conflict resolution, problem solving Self-development and identity Self-esteem
Children who have foundational skills will be able to utilize their prefrontal cortex successfully. However, for children with disrupted or traumatic early experiences, adults will need to emphasize the earlier skills. Remember, stage not age.
Bruce Perry (2006)
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Polling Question #4Polling Question #4
Who in webinar land is familiar with Who in webinar land is familiar with the the ARC model?ARC model?
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Blaustein & Kinniburgh, 2010; Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005Kinniburgh & Blaustein, 2005
ARC Model - 10 Building ARC Model - 10 Building BlocksBlocks
Caregiver Affect Mgmt.
Attunement Consistent Response
Routines and
Rituals
Affect Identification
Modulation Affect Expression
Dev’tal Tasks
Executive Functions
Self Dev’t & Identity
Trauma Experience Integration
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Modulation
Executive Functioning
Self Dev’t & Identity
Affect Identification
Trauma Experience Integration
Affect Expression
Caregiver Affect Mgmt
Attunement Consistent Response
Routines and Rituals
Dev’tal Tasks
universal
targeted
intensive attachment
Self-regulation
competency
Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005
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4 Key Principles of 4 Key Principles of AttachmentAttachment
Build school staff Build school staff capacity to capacity to manage manage affectaffect
Build school staff-child Build school staff-child attunementattunement
Build Build consistencyconsistency in in school staff school staff responseresponse to child behaviorto child behavior
Build Build routinesroutines and and ritualsrituals into classroom into classroom and schooland school
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Healthy Attachment Healthy Attachment SequenceSequence
Physical or psychological needPhysical or psychological need
Security, trust, attachment, self-
regulation, object constancy
State of high arousal
Attunement/satisfaction of need
Relaxation (parasympathetic ANS)
Beverly James
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Unhealthy Attachment Unhealthy Attachment SequenceSequence
Physical or psychological needPhysical or psychological need
Shame, mistrust, disregulation,
disturbed mental blueprint
State of high arousal
Needs are disregarded/attunement
disrupted
Anxiety, rage, numbing
Beverly James
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Affect ManagementAffect Management
When caregivers modulate their own When caregivers modulate their own affect and emotional responses, they affect and emotional responses, they
can create an emotionally safe can create an emotionally safe environment in which children a can environment in which children a can
learnlearn
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AttunementAttunement
Caregivers accurately read cues to Caregivers accurately read cues to respond to underlying emotion rather respond to underlying emotion rather
than overt behavior. Behavior is than overt behavior. Behavior is usually a front for feeling that a child usually a front for feeling that a child
has difficulty expressing in a more has difficulty expressing in a more effective way.effective way.
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AttunementAttunement
Communicating unmet needsCommunicating unmet needs
What is the function of the behavior?What is the function of the behavior?
Being a feelings detective!Being a feelings detective!
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Consistent ResponseConsistent Response
Caregivers respond in a consistent way Caregivers respond in a consistent way to both positive (desired) and to both positive (desired) and negative/unsafe behaviors. negative/unsafe behaviors.
Predictability reduces the child’s need Predictability reduces the child’s need for control.for control.
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Routines and RitualsRoutines and Rituals
Routines increases predictability and Routines increases predictability and the child’s ability to anticipate next the child’s ability to anticipate next steps. Establishing classroom and steps. Establishing classroom and school-wide routines helps reduce school-wide routines helps reduce
trouble spots (transitions, substitute trouble spots (transitions, substitute teachers, unstructured activities/days).teachers, unstructured activities/days).
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SELF REGULATIONSELF REGULATION
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Self-RegulationSelf-Regulation A Stepped Approach A Stepped Approach
Affect IdentificationAffect Identification
Affect ModulationAffect Modulation
Affect ExpressionAffect Expression
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Islands of CompetenceIslands of Competence
““When the student is allowed to be successful in his When the student is allowed to be successful in his or her area of competence, the learning process can or her area of competence, the learning process can
begin to take hold and develop. Focusing on an begin to take hold and develop. Focusing on an island of competence should not be misunderstood island of competence should not be misunderstood as “dumbing-down” an activity or lesson; rather, it as “dumbing-down” an activity or lesson; rather, it is tailoring learning to a child’s interests in order to is tailoring learning to a child’s interests in order to achieve academic success. Not only does success achieve academic success. Not only does success bolster learning, but it is also central to developing bolster learning, but it is also central to developing a positive, trusting relationship with the student.”a positive, trusting relationship with the student.”
(From, “Helping the Traumatized Child Learn”)(From, “Helping the Traumatized Child Learn”)
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CompetencyCompetency3 Key Principles3 Key Principles
Build student executive functioning Build student executive functioning skillsskills
Target self-development and identityTarget self-development and identity Target additional key developmental Target additional key developmental
taskstasks
The child develops an ability to evaluate situations, inhibit The child develops an ability to evaluate situations, inhibit impulsive responses and actively make choices. impulsive responses and actively make choices.
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Jessica
http://www.youtube.com/watch?v=qR3rK0kZFkg
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Possible Collision Points at School
Schools focus on preparing children for and information related to the external world Students with DT focus on the present and internally to stay
safe. Much of school is motivated by connection and
participation with others Schools often use delayed gratification
Students with DT are focused on the present to stay safe. Delaying gratification is dangerous and unpredictable.
Teachers often set limits/goals for the common good Youth with DT don’t operate with a template that
understands the common good.
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Competing Demands Survival vs. learning
It is nearly impossible to dedicate your full attention and energy to survival and learning at the same time.
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The Healthy Mind PlatterThe Healthy Mind Platter
Physical timePhysical time Sleep timeSleep time Focus timeFocus time Time in (flossing your brain)Time in (flossing your brain) Down timeDown time Plan timePlan time Connecting timeConnecting time
The Whole Brain Child, Dan Siegal
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Keys to Successful InterventionKeys to Successful Intervention
The 6 R’sThe 6 R’s Relevant (developmentally matched)Relevant (developmentally matched) Repetitive (patterned)Repetitive (patterned) Rewarding (pleasurable)Rewarding (pleasurable) Relational (safe)Relational (safe) Rhythmic (resonant with neural Rhythmic (resonant with neural
patterns)patterns) Respectful (child, family, culture)Respectful (child, family, culture)
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Relevent LinksRelevent Links
http:/studentsfirst.orghttp:/studentsfirst.org http:/howardcenter.orghttp:/howardcenter.org http://www.nctsn.org/http://www.nctsn.org/ http://mentalhealth.vermont.gov/http://mentalhealth.vermont.gov/ http://healthvermont.gov/http://healthvermont.gov/ http://www.ptophelp.org/http://www.ptophelp.org/
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Questions?????Questions?????