Childhood Trauma and Strategies for Sensitive Caregivers

1. Childhood Trauma and Strategies for Sensitive Caregivers

2. The history of trauma research Trauma research is a recent frontier in mental health Returning soldiers were studied and diagnosed with Post-traumatic Stress Disorder (PTSD) diagnosis Trauma is now seen as an underlying condition of mentally ill and incarcerated persons

3. Major Events that indicate Shock Trauma for Families War/Genocide/Acts of Terrorism Natural Disasters Homicide/Suicide Debilitating Injury or Illness Rape or Personal Assault Car Accidents/Fire/ Sudden Loss

4. Developmental Trauma concerns for young children Fear Based Parenting Out of Home Systems (foster care or adoptive placement) Frequent Moves Birth Complications Humiliating or deeply disturbing experience Media and Techno Stress Divorce/Blended Families Women overwhelmed Dual Careers

5. Continued Emotional Absence Parental Depression Needs Left Unmet Separation or Caregiver Work/Leisure Accidents Childhood Illness/Surgery

6. Continued Developmental trauma • Poverty • Environmental toxins • Bullying • Birth order • School pressure/competition

7. Childhood trauma depends on… The temperament of the child Caregiver ability to provide sensitive care The amount of accumulated events that have occurred in a child’s life, particularly in the first few years of life. (John Micsak MA, LLPC, CTC)

8. Share personally in PEARS Think of a traumatic event that happened to you or someone you know that impacted them in a negative manner What do you think the person’s needs were? If these needs were met, how would it have changed or enhanced this person’s experience

9. Reflect on your exchange.. Take care of yourself when working with trauma Do a mental scan and ask: how am I feeling? What am I feeling? What do I need to tell myself to calm myself? Scan your body for tension Do yoga breaths into those places to release tension. Make statements to feel good about addressing this important area.

10. It is important to understand trauma young children experience because: The prevalence of traumatic events in children’s lives Caregiver’s perception of children’s behaviors may direct helpful responses Proactive strategies help children feel safe Proactive strategies enhance children’s social and emotional development

11. Indicators of social and emotional development are: Typical expressions for each age group are present Young children use relationships in a meaningful and effective way (identify those with whom they feel bonded or attached) Young children manage emotions and impulses in an age appropriate way (cry, seek help, tantrums, seek friend, etc.) Young children are mentally available to learn about the world

12. Healthy response to stress for young children Arrest response (attention to distressing stimuli) Or Startle response Orienting to locate what is happening Evaluating (fight or flight response) Completion of self-protection reaction (cry, run, scream, yell, etc.) Discharge of energy Relaxation response returns Sense of mastery

13. Brain changes lead to reactive behaviors in traumatized children in two ways: 1) HYPO-AROUSAL behavior in children: *depression *resistance to authority or change *defiance *withdrawal from others *numbness of emotions *isolation to protect self from danger

14. Another way brain changes may affect behaviors in traumatized children are: • HYPER-AROUSAL behaviors in children: *anger/aggression *hyperactivity *fidgety/anxious *flight-panic *fight-terror *hyper vigilance

15. Let’s review… Sam, age two, is opening the kitchen cabinet containing the pots and pans. Judy, his mother, grabs a wooden spoon and shakes it threateningly at Sam as she screams, “Get out of there! I’ve told you thirty times to not go in that cabinet. Go play with your toys.” What do you think? Does mom’s reaction mean anything to Sam’s development? Does it really matter? Won’t he just forget it? How might he react: (see lists on slides) hypo-arousal, hyper-arousal?

16. The effects of prenatal trauma can be lodged in the transmission of the baby’s DNA In the second trimester, babies can engage psycho-processing. If mothers are stressed, it may be transmitted through the placenta and through olfactory capacities in which babies sense mom’s reaction to stress

17. Regulatory capacities are the foundation of emotional resiliency A child’s stress response matures as sensitive caregivers provide what the child needs. The child’s ability to modulate internal stress develops Without the child’s needs being addressed to calm the stress reaction, the child’s ability to control impulses may be inhibited or delayed.

18. What is a healthy developmental environment for young children? Creating a “Nurturing Environment” These are factors that surround children at any time (people, places, tools, rituals) which enhance their significant caregivers ability to provide care. This means giving a child enough space but letting them know you are nearby to meet their needs.

19. Attachment is key to a sense of belonging for the child! Attachment styles that hinder or enhance a child’s ability to form meaningful relationships are: Secure Ambivalent Avoidant Disorganized

20. Primary Factors and Strategies for Healing… Brain Plasticity: Our brain has the lifelong ability to reorganize neural pathways based on new experiences Trauma is observed by the flight, fight, or freeze response Primary Factors in Healing the Brain: Positive Relationships Positive Environment Repetition of Both of the above HEALING BEGINS FROM THE INSIDE OUT AND FROM THE HEART!

21. Needs of traumatized children from caregivers… Triple A Care Attachment Attunement Affection!

22. Strategies to heal and promote a “Modeling Environment” Meeting the child’s basic needs: provide food, clothing, shelter, water, safety, etc A sense of belonging and validation “I am loved and cared for, therefore I am a child of importance” Meet the child at their developmental level and challenging them to continue to meet developmental milestones.

23. Strategies for reactive behaviors in young children Time In: Decrease stimulation and add closeness Example: Child care provider accompanies child to a less stimulating area and spends time with child alone. Containment: Reduce the threat in the immediate environment and provide a way for the child to learn boundaries and limits. (Hand holding, gentle reassuring touch if appropriately received, or chair holding.)

24. Continued Strategies>>>> Energy Release: Free movement opportunities: Classroom management can center on free movement opportunities, moving to music, coloring, during story time, brief walks during the day. Meaningful Transitions are important to consider for energy release. Calming and Self Regulation: Teach deep breathing, how to manage intense feelings and reactions: blowing out birthday candles, rub away the pain, hand manipulative, soft pillows or stuffed animals to hold and hug

25. Review the Process>>> After the event, validate that they have overcome their uncomfortable reaction. “Its ok and you are ok now, I am here to help you and be there for you. Example: Use stuffed animals, puppets to illustrate safety and validation. Suggest an activity to change the scene once a child is calm.

26. Child Care provider self assessment for behavioral crisis Important as sensitive caregiver to assess how you are feeling in a crisis. Ask yourself: How am I feeling right now about this child and the situation? Do I need assistance right now to manage this child’s reaction? How can I deepen my relationship with the child in this moment? Use soft voice and calming tone.

27. Strategies for Sensitive Caregivers to deepen your relationship with child in need PRIDE=Praise, Reflect, Imitate, Describe, Enthusiasm. (Sheila Eyeberg, Ph.D) CARE=Child, Adult, Relationship, Enhancement (Sheila Eyeberg, Ph.D) Active Listening Non-Verbal Communication Reassurance Gentle Care

28. Each child is unique and responds differently… Ask yourself? What do I know about the child? What has worked previously during a reaction like this with this child? What does the child feel, need or want? Consider the following needs or wants: Security Presence, Reassurance Negotiation

29. What is the environmental impact for the child in need? How can I find a meaningful way of assisting the child before instruction resumes? Playfulness, humor, Curious George (open face, puzzled tone of voice, shows and feels no anger, listens and values their space and is interested in their world) Empathy-Labels feelings and understands what the child is experiencing.

30. Resume instruction only after resolution. Redirect the child to avoid unintentional shaming: Stay positive, simple guidelines, supply warmth and reinforce with labeled praise. (“You are happier and calm, and I am so happy I am with you”) Ongoing: Continue to assess the child for surviving to thriving behaviors: Surviving behaviors are: withdrawn or out of bounds physical play, repetitive play, and behaviors, anxious or flat affect

31. LET’S PRACTICE SENSITIVE CAREGIVING TIMING (assess environment and ability to respond sensitively) CHOICES NEEDS OF CHILD (Ask what are the child’s immediate needs? Use ABC-Affirm, Basic Needs, Construct a positive environment.

32. Lets Practice scenarios…. Consider in PEARS a time where you can use sensitive care giving practices. Consider the age and developmental level of the child Consider your approach and how you would use your self-assessment tool with your interaction with the child.

33. References Healing the Inside Child, Brain Based and Wellness approaches John Micsak, LLPC, CTC Susan m Kleine, MAPC, LPCC Bari Kraus, MSW, LSW Sheila EyeBeRG, PH.D