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Trauma Informed Services and PBiS at LSSU
- 1. Nicole Mondejar, MHA EarlyChildhood Programs Administrator/WCMHS PBiS Implementation Coach /Lamoille Region May 24th, 2012
- 2. Brain Development & Trauma/Stress Scope of the problem How PBiS can help
- 3. Trauma & ToxicStress 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. Trauma & ToxicStress Trauma 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. Children may experiencetrauma as a result of a number of different circumstances, 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
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- 11. Adversity in EarlyChildhood
- 12. Adversity in EarlyChildhood
- 13. Adversity in EarlyChildhood
- 14. 7 Domains ofImpairment in Children Exposed to Complex Trauma 1. 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. 7 Domains ofImpairment in Children Exposed to Complex Trauma 2. 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. 7 Domains ofImpairment in Children Exposed to Complex Trauma 3. AFFECT REGULATION: Difficulty with emotional self-regulation Difficulty describing feelings and internal experience Problems knowing and describing internal states Difficulty communicating wishes and desires 4. 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. 7 Domains ofImpairment in Children Exposed to Complex Trauma 5. 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. 7 Domains ofImpairment in Children Exposed to Complex Trauma 6. 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. 7 Domains ofImpairment in Children Exposed to Complex Trauma 7. 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. Scope of theProblem Between 2004 and 2010, the National Child Traumatic Stress Network (NCTSN) collected data 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. Percent of Children& Adolescents Scope of the Problem Figure 1. Percent of children who experienced single versus multiple trauma exposures (n = 11,104)
- 22. The Good News! Contrary to popular belief children living in highly disadvantaged environments can be protected from serious emotional or behavioral consequences.
- 23. The Good News! Studiesof evidence-based interventions and recent findings show that trauma-related, mental health conditions are highly treatable.
- 26. What We CanDo: 1. Healthy Adult Relationships 2. Promote Protective Factors Nurturing and attachment Knowledge of parenting and of child and youth development Parental resilience Social connections Concrete supports for parents 3. Early Identification & Access to Supports 4. Increase Awareness
- 27. Best Practices Systems Approachto Intervention Child Protective Services Court System Schools Social Service Agencies Interventions should: Build Strengths Reduce Symptoms
- 28. Best Practices While residentialtreatment 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)
- 30. Supporting Social Competence& Academic Achievement OUTCOMES DA MS Supporting Supporting TA E ST Staff Behavior Decision SY Making PRACTICES Supporting Student Behavior
- 31. Continuum of School-wideInstructional & Positive Behavioral Support Tertiary Prevention: Specialized Intensive Individualized Systems for Students For a Few with High-Risk Behavior Secondary Prevention: Specialized Group Systems for Students with Tertiary At-Risk Behavior For Some Primary Prevention: School-Classroom-Wide Systems for All Students, Staff, & Settings Universal For ALL
- 32. Establishing Continuum Intensive PREVENTION for 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
- 33. 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 – ?
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Editor's Notes
- #4 Discuss types of stress. When strong, frequent, or prolonged adverse experiences (extreme poverty or repeated abuse) are experienced without nurturing adult support , stress becomes TOXIC and disrupts developing brain circuits as excessive cortisol begins to interfere with functioning.
- #6 No evidence of physical harm DOES NOT = no harm done. Children growing up in domestic violence actually end up with mental health problems at a rate higher than children who are the direct victims of physical abuse. Childhood exposure to violence is about living in a threatening, scary environment that does not have to escalate to physical violence to be traumatic. The chaos, the roller coaster, the unpredictability and fear is traumatic enough to do long-term harm.
- #8 Brain develops from the bottom up and from the inside out. Normal development of the top, depends upon healthy development of the bottom. The top, where we do all of our thinking, is the most changeable, but if a child has developmental experiences of threat or exposure to domestic violence, the lower parts of the brain will be impacted and are harder to change as they grow older. Young children who experience trauma are at particular risk because their rapidly developing brains are so vulnerable. Early childhood trauma has been associated with reduced size of the brain cortex which is responsible for many complex functions including memory, attention, perceptual awareness, thinking, language, and consciousness. These changes can affect IQ and the ability to regulate emotions, so the child may become stuck in a fearful state of fight or flight.
- #9 Another way to look at the brain… Sensory pathways like those for basic vision and hearing are the first to develop, followed by early language skills and then higher cognitive functions. Connections are formed in a prescribed order, with later, more complex brain circuits built upon earlier, simpler circuits. The timing is genetic, but experiences early on determine whether the circuits are strong or weak.
- #10 In the first few years of life, 700 new neural connections are formed every second. A baby's brain has the greatest density of brain cells connectors (synapses) by age 3 but this density does not remain throughout life. After these connections are formed, there is a "plateau period" and then a period of pruning, or elimination, where the densities decrease. This period of elimination begins around early adolescence and continues until at least age 16. Different parts of the brain undergo synapse formation, plateau, and elimination at different points in development, depending upon when they mature. Early experiences affect the nature and quality of the brain’s developing architecture by determining which circuits are reinforced and which are pruned through lack of use. Some people refer to this as “use it or lose it”.
- #11 These images illustrate the negative impact of neglect on the developing brain. CT scan on the left is an image from a healthy 3-year-old with an average head size. The image on the right is from a 3-year-old suffering from severe sensory-deprivation neglect. This child's brain is significantly smaller than average and has abnormal development of the cortex. These images are from studies conducted by a team of researchers from the Child Trauma Academy led by Bruce D. Perry, M.D., Ph.D.
- #12 Double click to play video. Mention handout.
- #13 As the number of adverse early childhood experiences mounts, so does the risk of developmental delays. These risk factors include Poverty, Single Parent Households, Parental Mental Illness, Parental Substance Abuse, History of Trauma, Domestic Violence, DCF Involvement, Homelessness, etc. Our data from ECFMH reveals that out of 51 families referred through CIS between 2010-2011, 63% presented with 5 or more risk factors.
- #14 As the number of adverse early childhood experiences mounts, so does the risk of…
- #22 Nearly 80% of children referred for screening and evaluation reported experiencing at least one type of traumatic event. Of the 11,104 children and adolescents who reported trauma exposure, 77% had experienced more than one type of trauma, 27% had experienced 3 to 4 types of trauma, and 31% had experienced five or more types. Although this high prevalence of lifetime trauma might be expected in a clinic-referred population, the density (number of types of trauma) and diversity in types of trauma exposures is striking.
- #23 Although such conditions increase their risk for serious mental health problems, learning impairments, and long-term physical illnesses, children who experience serious threats to their psychological health, such as those who are physically abused, chronically neglected, or emotionally traumatized, do not inevitably develop significant mental illnesses. These children can be protected through the early identification of their emotional needs and the provision of appropriate assistance in the context of stable, nurturing relationships with supportive and skilled caregivers as well as through preventative mental health services
- #24 school-based interventions can provide critical access for students in need of mental health services, and can address multiple financial, psychological and logistical barriers to treatment.
- #27 Mention Guide/Handout re: Protective Factors
- #28 In this way, treatment for children and adolescents also serves to protect against poor outcomes in adulthood.
- #29 Youth in residential treatment often make gains between admission and discharge, but many do not maintain improvement post-discharge The milieu in residential treatment may have serious adverse effects on many adolescents. Youth may learn antisocial or inappropriate behavior from intensive exposure to other disturbed youth Youth who engage in seriously violent and aggressive behavior have not shown statistically significant improvement from residential care; similarly, those youth diagnosed with oppositional, defiant, or conduct disorder do poorly in these settings (Joshi & Rosenberg, 1997). No change was found for aggression toward objects, disobedience, impulsivity and inappropriate sexual behavior, and anxiety and hyperactivity often worsen (Lyons et al., 2001).
- #31 NOT ANOTHER INITIATIVE…PBiS is FRAMEWORK found to actually complement and support other initiatives including RC, RtI, etc.