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Dr. Allison Sampson Jackson Family Preservation Services Of North Carolina

What’s Trauma Got To Do With I t ? . Dr. Allison Sampson Jackson Family Preservation Services Of North Carolina . ACE SCREEN . 223,400,000 . 223,400,000. 317,572,282 . Exposure to Violence in Childhood . 46 million of 76 million children

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Dr. Allison Sampson Jackson Family Preservation Services Of North Carolina

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  1. What’s Trauma Got To Do With It ? Dr. Allison Sampson Jackson Family Preservation Services Of North Carolina

  2. ACE SCREEN

  3. 223,400,000 223,400,000 317,572,282 Information and slide part of Dr. Allison Sampson's Trauma Presentation

  4. Exposure to Violence in Childhood 46 million of 76 million children are exposed to violence, crime and abuse each year • Finkelhor, D., et al. (2010). Trends in childhood violence and abuse exposure: evidence from 2 national surveys. Archives of Pediatric and Adolescent Medicine, 164(3), 238–42. Information and slide part of Dr. Allison Sampson's Trauma Presentation

  5. Relevance of Trauma to Child Welfare “Henry” and Some Data

  6. Prevalence of Trauma—United States • Each year in the United States, more than 1,400 children—nearly 2 children per 100,000—die of abuse or neglect. • In 2005, 899,000 children were victims of child maltreatment. Of these: • 62.8% experienced neglect • 16.6% were physically abused • 9.3% were sexually abused • 7.1% endured emotional or psychological abuse • 14.3% experienced other forms of maltreatment (e.g., abandonment, threats of harm, congenital drug addiction) Source: USDHHS. (2007) Child Maltreatment 2005; Washington, DC: US Gov’t Printing Office. 26 26

  7. Prevalence of Trauma—United States • Each year in the United States, more than 1,400 children—nearly 2 children per 100,000—die of abuse or neglect. • In 2005, 899,000 children were victims of child maltreatment. Of these: • 62.8% experienced neglect • 16.6% were physically abused • 9.3% were sexually abused • 7.1% endured emotional or psychological abuse • 14.3% experienced other forms of maltreatment (e.g., abandonment, threats of harm, congenital drug addiction) Source: USDHHS. (2007) Child Maltreatment 2005; Washington, DC: US Gov’t Printing Office. 26 26

  8. U.S. Prevalence,cont'd • One in four children/adolescents experience at least one potentially traumatic event before the age of 16.1 • In a 1995 study, 41% of middle school students in urban school systems reported witnessing a stabbing or shooting in the previous year.2 • Four out of 10 U.S. children report witnessing violence;8% report a lifetime prevalence of sexual assault, and 17% report having been physically assaulted.3 • 1. Costello et al. (2002). J Traum Stress;5(2):99-112. • 2. Schwab-Stone et al. (1995). J Am Acad Child Adolesc Psychiatry;34(10):1343-1352. • 3. Kilpatrick et al. (2003). US Dept. Of Justice. http://www.ncjrs.gov/pdffiles1/nij/194972.pdf. 27 27

  9. Prevalence of Trauma in the Child Welfare Population • A national study of adult “foster care alumni” found higher rates of PTSD (21%) compared with the general population (4.5%). This was higher than rates of PTSD in American war veterans.1 • Nearly 80% of abused children face at least one mental health challenge by age 21.2 • 1. Pecora, et al. (December 10, 2003). Early Results from the Casey National Alumni Study. Available at: http://www.casey.org/NR/rdonlyres/CEFBB1B6-7ED1-440D-925A-E5BAF602294D/302/casey_alumni_studies_report.pdf. • 2. ASTHO. (April 2005). Child Maltreatment, Abuse, and Neglect. Available at: http://www.astho.org/pubs/Childmaltreatmentfactsheet4-05.pdf. 28 28

  10. Prevalence in Child Welfare Population,cont'd • A study of children in foster care revealed that PTSD was diagnosed in 60% of sexually abused children and in 42% of the physically abused children.1 • The study also found that 18% of foster children who had not experienced either type of abuse had PTSD,1 possibly as a result of exposure to domestic or community violence.2 1. Dubner et al. (1999). JCCPsych;67(3): 367-373. 2. Marsenich (March 2002). Evidence-Based Practices in Mental Health Services for Foster Youth. Available at: http://www.cimh.org/downloads/Fostercaremanual.pdf. 29

  11. Mismanagement of TraumaHendrick, H. (2012) Creating Trauma-Informed Child Welfare Systems, p. 6 • - Reduces likelihood of reunification (1) • - Increases placement instability (2) • - Increase in restrictive placements (3) • - Increases likelihood of using stronger psychotropic medications (4) • - Increases child perpetuating intergenerational cycle of abuse and neglect when they become a parent (5) • Rubin, O’Reilly, Luan, & Localio (2007) Pediatrics, 119 (2) 336-344 • Hartnett, Leathers, Falconnier & Testa (1999) Placement Stability Study. • Pecora et al. (2005) www.nxtbook.com/nxtbooks/casey/alumnistudies/ • Raghavan et al. (2005) Journal of Child and Adolescent Psychopathology, 15(1), 97-106 • Fang & Corso (2007) American Journal of Preventative Medicine, 33(4), 281-290

  12. “Our Kids” in Juvenile Justice “ I am a child” Poem

  13. Trauma and Juvenile Justice A growing body of research indicates that victims of violence are more likely than their peers to also be perpetrators of violence, and that individuals most likely to be victims of personal crime are those who report the greatest involvement in delinquent activities (ABA, 2000; Shaffer and Ruback, 2002; Wiebush et al., 2001).

  14. “Our Kids” in Juvenile Justice • Studies with antisocial youth have found self reported trauma exposure ranging from 70% to 92% (Greenwald, 2002) • Antisocial youth have high rates of Post Traumatic Stress Disorder (PTSD) ranging from 24% to 65% (Greenwald, 2002) • Research has indicated high levels of trauma in the experiences of conduct-disorder youth (Bowers, 1990; McMackin, Morissey, Newman, Erwin, & Daley, 1998; Rivera & Widom, 1990; and Steiner, Garcia, & Matthews, 1997) • Research suggests that anger and violent acting out often are symptoms of PTSD (Chemtob, Novaco, Hamada, Gross, & Smith, 1997) Information and slide part of Dr. Allison Sampson's Trauma Presentation

  15. Trauma and Juvenile Delinquency Research shows that childhood exposure to domestic and community violence, for example, can cause children to engage in aggressive behavior, suffer from problems such as depression and anxiety, have lower levels of social competence and self-esteem, experience poor academic performance, and exhibit posttraumatic stress symptoms such as emotional numbing and increased arousal (Colley-Quille et al., 1995; ABA, 2000; Osofsky, 1999).

  16. The future for “our kids” …. • Being abused or neglected as a child increased the likelihood of arrest as a juvenile by 59 percent and as an adult by 28 percent, and for a violent crime by 30 percent. The abused and neglected cases were younger at first arrest, committed nearly twice as many offenses, and were arrested more frequently (Widom, 1995; Widom and Maxfield, 2001).

  17. Data from the National Survey of Adolescents (Kilpatrick et al., 2003b) • 47.2 percent of the sexually assaulted boys reported engaging in delinquent acts, compared with only 16.6 percent of those not sexually assaulted • The rate of girls who had been sexually assaulted and then committed delinquent acts was 19.7 percent, five times higher than the rate of girls who had not been sexually assaulted (4.8 percent). • The percentage of boys who were physically assaulted and had ever committed an Index offense was 46.7 percent, compared to 9.8 percent of boys who were not assaulted. • 29.4 percent of physically assaulted girls reported having engaged in serious delinquent acts at some point in their lives, compared with 3.2 percent of nonassaulted girls. • About one third (32 percent) of boys who witnessed violence reported ever engaging in delinquent acts, compared with only 6.5 percent of boys who did not witness violence. • About 17 percent of girls who witnessed violence reported lifetime delinquent behavior, compared with 1.4 percent of girls who did not witness violence.

  18. Relevance to Education Systems

  19. Trauma impacts learning and academic outcomes • Decreased IQ and reading ability (Delaney-Black et al., 2003) • Lower grade-point average (Hurt et al., 2001) • More days of school absence (Hurt et al., 2001) • Decreased rates of high school graduation (Grogger, 1997) • Increased expulsions and suspensions (LAUSD Survey)

  20. Impact of being in Child Welfare System for Foster Care Children • 25% will be incarcerated within first 2 years of aging out of the system • More than 20% will become homeless • Only 58% will have a High School Diploma • Less than 3% will have a college education by age of 25 • Many will re-enter the system as parents • For children under age of 5, increase likelihood of developmental delays 13-62% compared to 4-10% • Conradi, L. (2012) Chadwick Trauma Informed System Project p. 54 • Leslie et. al. (2005). Developmental and Behavioral Pediatrics 26(3), 177-185

  21. 1 year of violence=124 billion dollars in recovery costs • The breakdown per child is: • •       $32,648 in childhood health care costs • •       $10,530 in adult medical costs • •       $144,360 in productivity losses • •       $7,728 in child welfare costs • •       $6,747 in criminal justice costs • •       $7,999 in special education costs

  22. Emotional Chain of Custody System Issue

  23. Alcoholism and alcohol abuse • Chronic obstructive pulmonary disease (COPD) • Depression • Fetal death • Health-related quality of life • Illicit drug use • Ischemic heart disease (IHD) • Liver disease • Risk for intimate partner violence • Multiple sexual partners • Sexually transmitted diseases (STDs) • Smoking • Suicide attempts • Unintended pregnancies • Early initiation of smoking • Early initiation of sexual activity • Adolescent pregnancy

  24. My story ….

  25. Unlocking the Brain At least for today…3 brain levels-they each speak a different language Brainstem-housekeeping of the Body, sleeping, eating, breathing Limbic-smoke alarm, implicit memories Cortex-planning, logic, reason, judgment

  26. A Person’s Response to Perceived Danger Trauma Event Danger Response Fight Flight Freeze Aggression Run Away Dissociate Verbal attack Substance Abuse Non-emotionality Slide from Ellen Williams, LCSW Center for Child & Family Services

  27. Looking Through The Eyes of a Traumatized Child-How it looks to Us…. Slide from Ellen Williams, LCSW Center for Child & Family ServicesServices

  28. How it looks to The Traumatized Child Slide from Ellen Williams, LCSW Center for Child & Family ServicesServices

  29. Fight Response Fight-discharge energy

  30. Fight, Flight, Freeze Flight Response: Movement

  31. Images of Freeze

  32. “Thousands wait” A Forced Freeze

  33. Types of Stress Information and slide part of Harris (2013) Buzz on Brain and Babies Presentation

  34. The Hand Model of the Brain http://www.youtube.com/watch?v=DD-lfP1FBFk

  35. The Handy Model

  36. Chasing Behaviors Agitation Hopelessness Intrusive Memories Nightmares Insomnia Defiance Poor Impulse Control Numbing Traumatic Event Shame & Self-Hatred Depression Dissociation PanicAttacks Somatic Symptoms Withdrawal Self-DestructiveBehavior Eating Disorders Substance Abuse T Slide by Trish Mullens, Chesterfield CSB

  37. We must …… Respond to the need …. Not react to the behavior

  38. Resilience Trumps Aces From Trish Mullen, Chesterfield Community services Board

  39. http://www.ovc.gov/pubs/ThroughOurEyes/index.html Trauma and the Brain

  40. The Influence of Developmental Stage • Child traumatic stress reactions vary by developmental stage. • Children who have been exposed to trauma expend a great deal of energy responding to, coping with, and coming to terms with the event. • This may reduce children’s capacity to explore the environment and to master age-appropriate developmental tasks. • The longer traumatic stress goes untreated, the farther children tend to stray from appropriate developmental pathways. 52 52

  41. The Influence of Developmental Stage: Young Children Young children who have experienced trauma may: • Become passive, quiet, and easily alarmed • Become fearful, especially regarding separations and new situations • Experience confusion about assessing threat and finding protection, especially in cases where a parent or caretaker is the aggressor • Regress to recent behaviors (e.g., baby talk, bed-wetting, crying) • Experience strong startle reactions, night terrors, or aggressive outbursts 53 53

  42. The Influence of Developmental Stage:School-Age Children School-age children with a history of trauma may: Experience unwanted and intrusive thoughts and images Become preoccupied with frightening moments from the traumatic experience Replay the traumatic event in their minds in order to figure out what could have been prevented or how it could have been different Develop intense, specific new fears linking back to the original danger 54 54

  43. The Influence of Developmental Stage:School-Age Children,cont’d School-age children may also: • Alternate between shy/withdrawn behavior and unusually aggressive behavior • Become so fearful of recurrence that they avoid previously enjoyable activities • Have thoughts of revenge • Experience sleep disturbances that may interfere with daytime concentration and attention 55

  44. The Influence of Developmental Stage:Adolescents • In response to trauma, adolescents may feel: • That they are weak, strange, childish, or “going crazy” • Embarrassed by their bouts of fear or exaggerated physical responses • That they are unique and alone in their pain and suffering • Anxiety and depression • Intense anger • Low self-esteem and helplessness 56 56

  45. The Influence of Developmental Stage:Adolescents,cont’d • These trauma reactions may in turn lead to: • Aggressive or disruptive behavior • Sleep disturbances masked by late-night studying, television watching, or partying • Drug and alcohol use as a coping mechanism to deal with stress • Over- or under-estimation of danger • Expectations of maltreatment or abandonment • Difficulties with trust • Increased risk of revictimization, especially if the adolescent has lived with chronic or complex trauma 57 57

  46. Adolescents who have experienced trauma may use alcohol or drugs in an attempt to avoid overwhelming emotional and physical responses. In these teens: • Reminders of past trauma may elicit cravings for drugs or alcohol. • Substance abuse further impairs their ability to cope with distressing and traumatic events. • Substance abuse increases the risk of engaging in risky activities that could lead to additional trauma. • Child welfare stakeholdersmust address the links between trauma and substance abuse and consider referrals for relevant treatment(s). 58 58

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