Creating a Trauma Informed Learning Environment

1. Creating a Trauma Informed Learning Environment Presented by: Kym Asam, LICSW, QMHP March 6, 2015

2. Objectives Differentiate between PTSD and developmental trauma Understand the impact of trauma on the brain utilizing the Neuro-Sequential Model of Therapeutics (NMT) Impact on students’ capacity to learn Brain regions and a tiered (PBiS) approach to intervention Understand the students’ states of arousal and how it impacts their functioning in school Key skills in working with children who have experienced developmental trauma ARC and its intersect with a tiered approach Adults Students

3. Polling Question #1 • How many audience participants have had some training on developmental or complex trauma?

4. Grounding Principles Trauma-Sensitive Schools benefit all children – those whose trauma history is known, those whose trauma will never be clearly identified and those who may be impacted by their traumatized classmates. Schools are the Central Community for most children. Source: Helping Traumatized Children Learn

5. Definitions What is trauma? Trauma is not just the event itself, but rather a response to a stressful experience in which a person’s ability to cope is dramatically undermined.

6. What is Developmental Trauma? A psychological and neurobiological injury that results from protracted exposure to stressful events Derails typical development across all domains (attachment, affect, biology, behavior, cognitive, dissociation, self-concept) Experiences often occur in the caregiving system. Impact is immediate and long term Effects will require all tiers of intervention

7. Sources of Trauma Sexual abuse Physical abuse Emotional abuse Neglect Domestic Violence Neighborhood violence Torture Bullying Prolonged exposure to traumatic stress Intrauterine stress Epigenetics

8. Toxic Stress Pyramid ACE study, Felitti, 2014

9. Pervasiveness in children Overall substantiated child maltreatment in 2013 = approximately 678,932 (746 in Vermont) Sexual Abuse = 9% (67.8% in Vermont) Physical Abuse = 18% (42.8% in Vermont) Psychological abuse = 8.7% (0.4% in Vermont) 79.5% experienced neglect (3.5% in Vermont) 48.7% were males 50.91% were females Source: US Department of Health and Human Services 2013 Child Maltreatment Report

10. The brain develops from the bottom up Cortex Limbic Diencephalon Brainstem Prefrontal Cortex Cerebral Cortex Limbic Diencephalon and the inside out Brain Stem

11. Early childhood synaptic growth

12. Abstract thought Concrete Thought Affiliation "Attachment" Sexual Behavior Emotional Reactivity Motor Regulation "Arousal" Appetite/Satiety Sleep Blood Pressure Heart Rate Body Temperature

13. Brain Builders http://www.albertafamilywellness.org/resources/video/how-brains-are-built-core-story-brain-development

14. Developmental Agenda

15. The still face experiment http://www.youtube.com/watch?v=apzXGEbZht0

16. Neural Connections http://www.youtube.com/watch?v=8NA_o1jOjsQ

17. Impact of Neglect on the Brain

18. Bottom up, Inside out

19. Sequential Thinking A child’s successful completion of many academic tasks depends on the ability to bring a linear order to the chaos of daily experience. Traumatic experience can limit this ability to organize material sequentially, leading to difficulty in reading, writing and communicating verbally. From Helping the Traumatized Child Learn

20. Stages of Sleep

21. Polling question #2 • How many of you have students who frequently go to the nurse?

22. Negative Interactions Social experiences with caregivers become biologically embedded .

23. Effects of Trauma on Brain Functioning Thalamus Visual, auditory, olfactory, kinesthetic, gustatory Prefrontal Cortex (Integration and Planning) Amygdala (Intensity/significance) Hippocampus (cognitive map)

24. Normative Danger ResponsesAutonomic Nervous Response System • Fight • Flight • Freeze • Flock

25. Emotional Identification

26. Facial Expression Recognition

27. The Arousal Continuum Body’s hard wired physiological and emotional response to extreme danger readying us for fighting, fleeing, freezing or flocking. Chronic hyperarousal is a distressing, physically uncomfortable state and interferes with other functioning. Child can look constantly on edge, startles easily, is ever-vigilant, cannot relax, overreacts to minor provocations and likely has disrupted sleep.

28. Psychoeducation – let’s explain it to the kids

29. Typical path to reactions

30. Express Route to Reactions!

31. Arousal 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. Cognitive Ability Arousal Level A child in a hyper-aroused state can not be reasoned with, she needs you to help her reduce her arousal level.

32. How to Intervene • Somatosensory interventions • Targeting the part of the brain that was impacted by developmental insults • EVERY DAY • EVERY GRADE • EVERY BODY

33. Targeting the Tiers, PBiS approaches Brain stem/diencephalon Intensive limbic targeted universal cortex

34. Repeat, Repeat, Repeat! • Patterned • Consistent • More intensity • Curiosity

35. Building up from the base Establish State Regulation -- Intensive • School 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. Brainstem Brain stem

36. Building up from the base Introduce Somato-Sensory Integration – targeted, intensive Diencephalon • 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. Diencephalon Bruce Perry (2006)

37. Polling Question #3 • How many of you work with students who receive targeted or intensive level of supports who struggle with playing games or taking turns?

38. Building up from the base Facilitate Socio-emotional Growth – targeted Limbic • 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. Limbic Bruce Perry (2006)

39. Building up from the base Encourage Abstract Thought – Universal Cortex • 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. Cortex Bruce Perry (2006)

40. Polling Question #4 • Who in webinar land is familiar with the ARC model?

41. ARC Model - 10 Building Blocks Trauma Experience Integration Dev’tal Tasks Executive Functions Self Dev’t & Identity Affect Expression Affect Identification Modulation Routines and Rituals Caregiver Affect Mgmt. Attunement Consistent Response Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

42. 4 Key Principles of Attachment • Build school staff capacity to manage affect • Build school staff-child attunement • Build consistency in school staff response to child behavior • Build routines and rituals into classroom and school

43. Healthy Attachment Sequence Physical or psychological need Security, trust, attachment, self-regulation, object constancy Relaxation (parasympathetic ANS) State of high arousal Attunement/satisfaction of need Beverly James

44. Unhealthy Attachment Sequence Physical or psychological need Shame, mistrust, disregulation, disturbed mental blueprint Anxiety, rage, numbing State of high arousal Needs are disregarded/attunement disrupted Beverly James

45. Affect Management When caregivers modulate their own affect and emotional responses, they can create an emotionally safe environment in which children a can learn

46. Attunement Caregivers accurately read cues to respond to underlying emotion rather than overt behavior. Behavior is usually a front for feeling that a child has difficulty expressing in a more effective way.

47. Attunement • Communicating unmet needs • What is the function of and feeling behind the behavior? • Being a feelings detective!

48. attunement https://www.youtube.com/watch?v=Bpu0TIXzI1w

49. Observe, validate, and put language to youth experience • Reflect • Validate • Normalize Blaustein & Kinniburgh 2010; Kinniburgh & Blaustein 2005

50. Consistent Response Caregivers respond in a consistent way to both positive (desired) and negative/unsafe behaviors. Predictability reduces the child’s need for control.