WHAT WILL BE PRESENTED TODAY

How to challenge our viewpoints and perspectives to be

more trauma focused

Tools we can use to become more trauma informed and

effective

Resources we can use to help support our teens

THE ABC’S TO BEING TRAUMA INFORMED

Awareness

knowledge or perception of a situation or

fact.

Belief

an acceptance that a statement is true or

that something exists

Capacity

the ability or power to do, experience, or

understand something

MASLOW

MASLOWS HIERARCHY OF NEEDS

1) Physiological needs: the person who is starving and dehydrated wants nothing more than water and food.

2) Once this need is satisfied, s/he desires safety and security – somewhere to live without being threatened or

harassed.

3) Once safety is achieved, s/he wants to obtain a sense of belonging, of being accepted and loved, and also seeks

healthy relationships.

4) After the above goals are satisfied, the next need, according to Maslow, is to develop a sense of self – esteem.

5) The final need, Maslow informs us, is to achieve the highly elusive state of self-actualization. By self-

actualization, he meant creatively reaching one’s potential and finding meaning and purpose in life. Maslow

also states that this need is only satisfied by individuals extremely rarely.

WHAT DO PEOPLE TAKE FOR GRANTED WHEN THEIR NEEDS ARE MET?

THE EFFECTS OF CHILDHOOD TRAUMA ON OUR ABILITY TO

ASCEND MASLOW’S PYRAMID OF NEEDS:

The Effects Of Childhood Trauma On Our Ability To Ascend Maslow’s Pyramid Of Needs:

Childhood trauma can drastically impinge upon our ability to reach these goals. For example:

– a highly neglectful parent may not feed his/her child properly, meaning that that child’s physiological needs are

not met

– a child who lives with a parent who abuses him/her, or lives in a household in which domestic violence exists will

live in an atmosphere of fear and, therefore, will not have his/her needs for safety and security met

– the child who is rejected by his/her patents will not have his/her need to belong satisfied nor is s/he likely to

develop a solid sense of self-esteem

FAULTY TRAUMA ASSUMPTIONS

-Teens are grateful for help

-You are the reason for their actions or lack of

-Your approach to them is non threatening

-They have the ability at this time to process or take in information given

-Tools given are able to be useful outside of your safe environment

EVERYONE HAS EM……

What are some experiences that have formed your beliefs?

What are some ways these beliefs affect how we see others?

How are these ideas changed if we see things from a survival perspective?

THE EFFECTS OF TOXIC STRESS AND TRAUMA ON

DEVELOPMENT AND WELL‐BEING It may be harder to forge a trusting relationship, because the young person has not experienced adults as

consistently safe.

Parents and teachers may describe the youth as easily upset, easily provoked, or highly reactive.

The youth may display what others consider inappropriate emotions and behavior.

The young person may be triggered by traumatic reminders.

The youth may be diagnosed as hyperactive, or oppositional, or conduct disordered.

The teen may appear inattentive, but he is actually hyper- attentive to “danger signals” of which adults are not

aware.

common post-traumatic presentation is dissociation. This may be reported as “lying” – which actually represents a

confabulated reality produced to replace actual events difficult to recall - or “zoning out” – which has proven

adaptive during traumatic moments.

ACTING OUT

What if we see behaviors as the sign that a person might be dealing with trauma?

OUR INTERACTIONS CAN BE HEALING . . . OR CAN

RE‐TRAUMATIZE Many who have experienced trauma have a harder time distinguishing between healthy and unhealthy

relationships. Therefore, the issue of trust and betrayed trust will be a major, on-going issue.

Relationships worthy of trust are the foundation of progress.

We have been taught healthy things whether we knew it or not. We often can expect healthy behaviors without

realizing these are not things they have ever seen or understand

Appropriate boundaries are key underpinnings of relationships. Because traumatized youth have so little

experience with trust, breaking their trust or not following through on a perceived commitment can cause great

harm.

Think about the possibility of past adversity as an underlying problem when you are up against something you don’t

understand. If you cannot understand why someone does or doesn’t do something that seems to be common

sense, be curious and ask “What happened?”

USEFUL TOOLS TO INCREASE OUR KNOWLEDGE

NATIONAL CHILD TRAUMATIC STRESS NETWORK

http://www.nctsn.org/sites/default/files/assets/pdfs/tips_for_finding_help.pdf

ITS OK TO SAY WE ARE

NOT EQUIPPED AND

REACH FOR HELP.

Why is it important for us to know our limitations when it

comes to trauma ?

So we can have the

capacity

to do something about it!

TF CBT

NATIONAL CERTIFICATION

Tfcbt.org

Master’s degree & licensure

Completion of TF-CBT Web Training (http://tfcbt.musc.edu/)

Minimum 2 days live training with approved trainer or developer

Follow up consultation/supervision for 6-12 months

3 completed cases

Use of standardized instrument to assess progress

Passing TF-CBT knowledge test.

WHAT IS TF-CBT?

A structured individual and parent trauma-focused model for children and adolescents (3-18 years old) who have

experienced one or more traumatic events and are experiencing symptoms as a result.

Includes initial skills-based components followed by more trauma-specific components with gradual exposure

integrated into each component.

CORE VALUES -CRAFTS

Components Based

Respectful of cultural values

Adaptable and Flexible

Family Focused

Therapeutic relationship is central

Self-efficacy is central

EVIDENCE BASE

TF-CBT is the most researched and most supported of all current treatments for childhood Posttraumatic Stress

Disorder (PTSD) and child trauma, with seven completed randomized controlled trials (RCT), three open (non-

controlled) studies, and four ongoing RCTs. (www.nctsn.org)

Evidence base is strong when done in sequence.

A TF-CBT THERAPIST…

Has knowledge about child/adolescent trauma & development.

Has trauma-specific assessment skills

Is able to be directive as well as to inhabit a teacher role in session

Has child and adult therapy skills

Has resolved personal trauma issues

Guards against colluding with avoidance

Seeks consultation with others experienced in using the model

Is able to resist chasing of COWs

PRACTICE COMPONENTS

Assessment

Conceptualization

Psychoeducation & Parent Education

Relaxation

Affect Regulation

Cognitive Coping

Trauma Narrative

In vivo exposure

Conjoint Sessions

Enhancing Future Safety

CAREGIVER INVOLVEMENT

Caregiver engagement is essential

1:1 – Parallel child’s progress through components.

Green light parent:

Believes child

Stays child-focused

Is positive and supportive of child

Protects child

GRADUAL EXPOSURE

The process through which children and parents undergo incremental desensitization to trauma reminders → relief

from emotional/physiological distress upon re-exposure.

This is what makes it Trauma-Focused

This does NOT refer to the gradual telling of a child’s trauma story.

As the child progresses through the model, therapist encourages parent and child to implement skills with

increasing specificity of reminders of the abuse until the details are recounted in narrative compenent.

PSYCHOEDUCATION

Handouts providing trauma specific info (i.e. sexual abuse, witness to DV)

Common reactions to stress and trauma

Common parent reactions to child trauma

Neurobiology of trauma

Fight, flight, freeze

Triggers

A Terrible Thing Happened Holmes et al (2000)

PARENTING

Generic Parenting skills and trauma-specific skills.

Validate parents’ concerns and take them seriously.

Functional Analysis of behaviors: what is the goal of the behaviors? (escape, attention, control?)

GE: Help parents understand the impact of the traumatic experience on themselves and the child – frame child’s

behavior as due to trauma, rather than being “bad.”

RELAXATION

Goal: Decrease physiological reactivity and/or learn mindfulness.

Peaceful Piggy Meditation or Moody Cow Meditates (McLean)

Breathing

Progressive Muscle Relaxation

Guided Imagery

https://www.youtube.com/watch?v=_mZbzDOpylA (Sesame Street: Belly Breathe)

http://amysmartgirls.com/short-film-just-breathe-helps-kids-deal-with-emotions/

AFFECT REGULATION

Goal: To improve identification and expression of feelings

“How might a child feel when they experience abuse?”

Focus on recognizing emotional triggers and regulating emotion, not on the description of the experiences

themselves

If trauma reminders are a main cause of dysregulation, they may not improve significantly till after the narrative.

COGNITIVE COPING

Goal: To change inaccurate and unhelpful thoughts to accurate and helpful thoughts; and to link thoughts and

feelings to behaviors.

MINIMAL MASTERY

When to move on to next component?

1 skill used 1 time, away from therapist

TRAUMA NARRATIVE

Goals:

To expose the child to distress of trauma memories in measurable doses – desensitization

To integrate and make meaning out of the trauma.

Not: a forensic interview, or a tell all

Is: a therapist guided process

HOW DO WE KNOW WHEN WE’RE “DONE”?

Measuring Desensitization

Decreased refusal/avoidance

Affective changes

0-10 rating drop by ½

Increase in trauma details

Willingness to write about other traumas

Willingness to share with witness

“This is boring…”

COGNITIVE PROCESSING

Guide child to add thoughts and feelings at key points

Guide child to change euphemistic language

Guide child to correct distortions about fault, blame and responsibility

Identify themes and make meaning of them

CONJOINT SESSIONS

Goal:

Have the child share the full trauma narrative with caregiver

Have the caregiver witness the telling, give praise, believe and cheerlead.

Always prepare the caregiver.

Witness must be an adult

ENHANCING FUTURE SAFETY

Goals:

Increase child’s safety skills

Address safety with caregiver

Should occur after narrative component so child will not blame self for not preventing the trauma, but we can move

this up if there are urgent safety concerns not being addressed by skill building in PRAC components.

Assertiveness skills

Ask parent/child to bring in topics (i.e. internet, dating)

Protective skills

ENDING TF-CBT

Post test of PTSD assessment & share results

“Graduation” party

Maintenance sessions if needed

WHAT ARE TRAUMA FOCUSED ASPECTS THAT YOU CAN SEE IN

THIS CASE DESCIPTION

GENERAL RESOURCES

http://depts.washington.edu/hcsats/PDF/TF-%20CBT/pages/psychoeducation.html (many good handouts

applicable to all components)

http://learn.nctsn.org/mod/pcast/view.php?id=9497&mode=4&hook=I (ADHD vs. Trauma Symptoms podcast)

www.nctsn.org

https://www.pinterest.com/cami0416/

Treating Trauma and Traumatic Grief in Children and Adolescents & Trauma Focused CBT for Children and

Adolescents: Treatment Applications, both by Judith A. Cohen , Anthony P. Mannarino , Esther Deblinger

OTHER GREAT COMMUNITY RESOURCES

NAMI: YOUTH AND FAMILY PROGRAM

COORDINATOR Megan Mc Lachlin

REMEMBER

• When we are trauma informed, we shift from a stance of “What’s wrong with you?” to “What happened to

you?”

• When we are trauma informed we are respectful and minimize the possibility of triggering their reactivity.

• When we are trauma informed we understand what is about us and what is not about us. When we do not

interpret mistrust, reactivity, or anger as personally directed, we can respond with empathy rather than

defensiveness.

• When we are trauma informed we learn to “hold” others’ pain in a supportive way rather than to “own” it.

• When we work with youth who have endured unbearable lives, we often find that in sharp contrast to them

being “damaged” or “broken,” they are sensitized and fully committed to making others’ lives better.