Treating Complex Childhood Trauma in Schools: Targeting the Building Blocks of Resilience

1. Treating Complex Childhood Trauma in Schools: Targeting the Building Blocks of Resilience Presentation by Kati Taunt For Islington Education Service September 2017 Day 1 ARC Developed By: Margaret E. Blaustein, Ph.D. Kristine M. Kinniburgh, LICSW The Trauma Center at JRI

2. Introductions Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

3. Ground rules: Kindness Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

4. The Plan for today • 1. What is trauma? • 2. How does early trauma impact brain development? • 3. Why trauma informed schools? • 4. Introduction to the ARC model. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

5. Check Yourself

6. +10 +5 0 -5 Let’s talk about energy How high (or low) is your energy right now?

7. Totally comfortable Really uncomfortable Let’s talk about energy How comfortable does that energy feel in your body?

8. Great match (Very effective) Terrible match (Not at all effective) Let’s talk about energy How good a match is your energy level for what you are doing?

9. Great match (Very effective) Totally comfortable +10 +5 Terrible match (Not at all effective) 0 Really uncomfortable -5

10. What kind of interventions might people try? • Treatment guided purely by diagnosis or behavior might include: • Medications • Behavioral intervention and limit setting • Consequences for task and homework completion • Caregiver consequences related to attendance / truancy Curriculum - Blaustein

11. Sophie • Sophie is 14 years old • Living with Maternal Aunt Angela last 2 years • Self harms • 2 serious overdoses in last 12 mths • Has been out of school for 18 mths • Sexually active (at risk of CSE) • Poor peer relationships • Aggressive outbursts (violent to Aunt)

12. Sophie • When asked to try new tasks can become aggressive and leave class • Often distracted or inattentive • Hypervigilant, interferes with others work (needs to always know what is going on) • Misreads other peers intentions • Diagnosis over the years: ADHD, Conduct Disorder, Oppositional Defiance • Currently considered diagnosis: (Depression, Emerging severe personality disorder) • Dysregulates quickly with no apparent trigger

13. What is ‘trauma’?

14. Definition of Trauma: DSM-V The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Curriculum - Blaustein

15. “Events are never ‘traumatic’ just because they meet a threshold criterion.” • AriehShalev, M.D. Curriculum - Blaustein

16. Trauma is not the event itself: rather trauma reside in the nervous system… • Levine and Kline

17. Distinction from Post Traumatic Stress Disorder • “Traumatic events are extraordinary, not because they occur rarely but rather because they overwhelm the ordinary human adaptations of life, the common denominator is a feeling of: • Intense fear • Helplessness • Loss of control • Involves some degree of experienced or witnessed threat to self) • A proposed new diagnosis of Developmental Trauma Disorder (Attempt to capture impact of long term trauma from within the care giving system) Islington CAMHS 2017

18. Human Stress Response • Perception is more important than reality • Human beings are biologically primed for survival • When threat is perceived: Activation of ‘survival centres’ • Recognition of fear/danger • Activation of fight/flight/freeze response Shutting down of non-essential tasks

19. What sorts of events or experiences may your students have experienced that could be seen as “trauma”? Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

20. Situations that can be traumatic: • Physical or sexual abuse • Abandonment • Neglect • The death or loss of a loved one • Life-threatening violence in a caregiver • Witnessing domestic violence • Automobile accidents or other serious accidents • Bullying • Life-threatening health situations and/or painful medical procedures • Witnessing or experiencing community violence (e.g., shootings, stabbings, robbery, or fighting at home, in the neighbourhood, or at school) • Witnessing police activity or having a close relative incarcerated • Life-threatening natural disasters • Acts or threats of terrorism (viewed in person or on television) • Living in chronically chaotic environments in which housing and financial resources are not consistently available • —NCTSN Child Trauma Toolkit for Educator Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

21. Situations that can be traumatic: Physical or sexual abuse Abandonment Neglect The death or loss of a loved one Life-threatening violence in a caregiver Witnessing domestic violence Automobile accidents or other serious accidents Bullying Life-threatening health situations and/or painful medical procedures Witnessing or experiencing community violence (e.g., shootings, stabbings, robbery, or fighting at home, in the neighbourhood, or at school) Witnessing police activity or having a close relative incarcerated Life-threatening natural disasters Acts or threats of terrorism (viewed in person or on television) Living in chronically chaotic environments in which housing and financial resources are not consistently available —NCTSN Child Trauma Toolkit for Educator Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

22. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

23. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

24. ACES and School Readiness Indices (N=265) Blodgett, C. (2013). The association of ACEs in Head Start Children with social emotional development and school readiness. Research Brief: Washington State University. Curriculum - Blaustein

25. The “path” of ACES

26. ACEs Studies in the UK2012: 1st UK study using ACE found increasing ACE associated with behavioural, social and Health outcomes (bellis et al 2014)2014: national study 8% of population reported 4 or more ACEs2016: Centre for Public Health study of ACE in Luton, Hertfordshire and Northants. 17% of population have 2-3 ACEs and 9% have 4+ Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

27. One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior. • Trauma can impact school performance. • Lower academic attainment • Higher rate of school absences • Increased drop-out • More suspensions and expulsions • Decreased reading ability Islington CAMHS 2017

28. Traumatized children may present with physical and emotional distress. • Physical symptoms like headaches and stomach aches • Poor control of emotions • Inconsistent academic performance • Unpredictable and/or impulsive behavior • Over or under-reacting to bells, physical contact, doors slamming, sirens, lighting, sudden movements • Intense reactions to reminders of their traumatic event: • Thinking others are violating their personal space, i.e., “What are you looking at?” • Blowing up when being corrected or told what to do by an authority figure • Fighting when criticized or teased by others • Resisting transition and/or change Islington CAMHS 2017

29. Some of the Key components of a trauma informed school • Establishing a shared definition of a ‘Trauma informed school’ • Enhancing trauma- awareness throughout the school community • Conducting a thorough assessment of the school climate • Inclusiveness • Specific risk and protective factors for each individual school community • Senior leadership ‘buy in’ • Knowing there will be skeptics • Developing trauma informed discipline policies • Awareness of the prevalence and impact of secondary traumatic stress of teachers and staff Islington CAMHS 2017

30. The impact of trauma and neglect on the developing brain • Video of the developing brain. Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

31. Brain stuff: The Triune Brain

32. What helps the child survive? Assumption of danger Rapid mobilisation in the face of perceived threat Self-protective stance Development of alternative strategies to meet developmental needs

33. How does understanding early trauma help us to make sense of the dysregulated and challenging behavior we actually seein 7 Sentences

34. Sentence #1 Our Brain is Highly Motivated For Us To Survive • Survival (of ourselves, of the species via the attachment drive) is perhaps the most indelibly stamped task of the animal brain

35. Sentence #2:One Way We Survive Is By Learning To Read Signs of Danger

36. Sentence #3: We all Define Danger Differently • Our individual filters – based on experience - guide our interpretation of the world.

37. Sentence #4: There are Only a Few Possible Responses to Danger* *and ALL of them REQUIRE a surge of arousal.

38. What are our safety options? FIGHT FLEE

39. Sentence #5: Repetition is a strong teacher of current behavior “Experience is not always the kindest of teachers, but it is surely the best.” – Spanish proverb • Think of one thing you feel like you could “do in your sleep”: why does it feel so easy? • All of us develop a repertoire of strategies for managing the world (i.e., behavioral patterns) guided in part by our previous experience: what we’ve used in the past, and how successful those strategies have been in the past

40. Sentence #6: Behavior is Generally Functional • Most of our behaviors serve some purpose: we do what we do for a reason • This holds true for unhealthy behaviors (drinking, using drugs, unhealthy eating, self-injury, high-risk behaviors, etc.) • The same behavior may serve a different functionfor different people (one person may use drugs to feel alive; another person may use them to turn off / shut down) or at different times.

41. Sentence #7: Our Ability to Shift From “Survival Mode” (survival-based behaviors) To Active Engagement Is Impacted By Our Internal and External Resources Trust Affect management Frustration tolerance Problem-solving ability Ability to read others Social connection and support Biological vulnerabilities

42. Translation: • The youth (and adults) you work with are frequently in cycling states of hyperarousal (and/or hypo aroused adaptation) which in the face of (often) perceived danger leads to potentially extreme self-protective behaviors and – in the absence of effective and age-appropriate strategies or protective resources –desperate attempts to tolerate and manage distress.

43. While kids are getting really good at survival, what are they not getting? Curriculum - Blaustein

45. Multi-layered nature of trauma • Discrete experiences of danger (i.e., physical/sexual abuse) • Failures of need fulfillment (i.e., neglect) • Interpersonal context (i.e., betrayal of caregiving expectations; loss, abandonment; working models) • Interference with developmental tasks Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

46. Multiple Layers Lead to Complex Outcomes • Expectations of harm (from the world and from others) • Difficulty forming relationships • Difficulty managing, understanding, and regulating feelings and behaviour • Developmental challenges (problem-solving, agency, imagination, academic performance, etc.) Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

47. Young Children (0–5)

48. School-Aged Children (6–12)

49. Trauma’s Dual Influence on Development • Prioritization of those domains of skill / competency / adaptation which help the child survive their environment and meet physical, emotional, and relational needs • De-emphasis of domains of development which are less immediately relevant to survival Blaustein & Kinniburgh, 2010; Kinniburgh & Blaustein, 2005

50. “In addition to the conditioned physiological and emotional responses to reminders characteristic of PTSD, complexly traumatised children develop a view of the world that incorporates their betrayal and hurt, They anticipate and expect the trauma to recur and respond with hyperactivity, aggression, defeat or freeze responses to minor stresses.” • Bessel A. van der Kolk, MD